An Aerosol Generating Procedure (AGP) refers to any medical activity that can release tiny airborne particles, known as aerosols, from a person’s respiratory tract into the surrounding environment. This term holds considerable significance in healthcare settings and public health, especially when considering the potential spread of respiratory infections. Understanding these procedures is important for preventing disease transmission and protecting individuals in clinical environments.
Understanding Aerosols
Aerosols are extremely small particles, typically measuring less than 5 to 10 micrometers, which can remain suspended in the air for extended periods. This allows them to travel over greater distances from their source compared to larger respiratory droplets. In contrast, larger respiratory droplets, generally exceeding 5 to 10 micrometers, quickly fall out of the air due to gravity, usually settling within a few meters of their origin.
Respiratory emissions exist on a continuum of particle sizes. However, the ability of smaller aerosol particles to stay airborne longer makes them a distinct concern for airborne disease transmission.
Common Aerosol-Generating Procedures
Many medical interventions can produce aerosols from a patient’s respiratory system. Procedures consistently identified as aerosol-generating include tracheal intubation and extubation, and bronchoscopy. These actions can generate aerosols through mechanical forces, such as forcing air or suctioning secretions from the lungs.
Other common AGPs include open suctioning of airways, which removes mucus and other fluids, and the induction of sputum for diagnostic purposes. Cardiopulmonary resuscitation (CPR) also leads to aerosol generation. Non-invasive ventilation methods like Bi-level Positive Airway Pressure (BiPAP) and Continuous Positive Airway Pressure (CPAP), along with high-flow nasal oxygen (HFNO), can also produce aerosols. Dental procedures using high-speed devices are also recognized for their aerosol-generating potential.
Why AGPs are a Public Health Concern
Aerosol-generating procedures are a significant public health concern because they can facilitate the spread of infectious respiratory pathogens. When an AGP is performed on a patient with a respiratory infection, the aerosols generated may contain viruses or bacteria. The small size and prolonged airborne suspension of these particles allow pathogens to disperse over wider areas and remain infectious for longer periods than larger droplets.
This airborne transmission poses an increased risk to healthcare workers and other individuals in the vicinity during these procedures. Outbreaks, such as SARS, MERS, and COVID-19, have demonstrated a link between certain AGPs and higher infection rates among healthcare personnel. The increased exposure during these procedures underscores the importance of specific precautions to mitigate transmission risks.
Patient and Healthcare Worker Safety
Understanding aerosol-generating procedures is central to ensuring the safety of both patients and healthcare workers in clinical environments. Due to the potential for airborne pathogen spread, AGPs necessitate heightened awareness and specific safety considerations. This awareness guides the implementation of appropriate environmental controls, such as performing these procedures in airborne infection isolation rooms, which are designed to contain aerosols.
Knowledge of AGPs informs the selection and consistent use of personal protective equipment (PPE), including N95 respirators. The distinct nature of aerosols, particularly their ability to remain suspended and travel further, means that standard precautions for larger droplets may be insufficient. Recognizing AGPs is crucial for identifying high-risk situations and applying targeted mitigation strategies to protect everyone involved in patient care.