Coronavirus Disease (COVID-19)
COVID-19 AGMP in Healthcare Settings

COVID-19 AGMP in Healthcare Settings

General Information

To prevent transmission of infection associated with aerosols produced by aerosol generating medical procedures (AGMPs) performed on patients who are suspected or confirmed COVID-19 cases

The Public Health Agency of Canada (PHAC) has recommended that, in addition to routine practices, when caring for patients with suspected/confirmed COVID-19 Droplet/Contact precautions. Airborne precautions must be used when AGMPs performed.

AGMPs are medical procedures that can generate aerosols that consist of small droplet nuclei in high concentration and present a risk for airborne transmission of pathogens that would not otherwise be spread by the airborne route.

Aerosol-generating medical procedures includes:

  • Intubation and extubation procedures

  • High frequency oscillatory ventilation

  • Manual ventilation

  • Open endotracheal suctioning (intentional and unintentional)

  • Break in closed ventilation system

  • Cardiopulmonary resuscitation with bag mask ventilation

  • Sputum induction (i.e. inhalation of nebulized hypertonic saline solution to liquefy and produce secretions, NOT natural coughing to bring up sputum)

  • Administration of nebulized medication (NOTE: Avoid if possible; use of alternatives such as meter-dosed inhaler with spacer are preferred)

  • Positive pressure ventilation (CPAP, BiPAP)

  • High-flow heated humidity oxygen therapy (e.g. Optiflow and AIRVO) (NOTE: Non-humidified oxygen delivered through nasal prongs and/or non-rebreather masks are NOT an AGMP, regardless of flow rate)

  • Bronchoscopy and bronchoalveolar lavage

  • Laryngoscopy

  • Nasopharyngeal washing, aspirate, and scoping

  • Autopsy

  • Tracheostomy insertion/care/tube change/decannulation

    • Tracheostomy care does not include dressing changes or tie changes
  • Tracheotomy

  • Open airway suctioning (e.g. deep insertion for nasopharyngeal or tracheal suctioning, NOT inclusive of oral suctioning)

A nasopharyngeal swab or nares/throat swab are not considered AGMPs

Precautions

Airborne + Droplet & Contact Precautions

In addition to Droplet/Contact precautions, AGMPs must be performed using Airborne precautions. The PPE will include gown, gloves, N95 mask and facial protection (goggles or face shield).

Recommendations for AGMPs

  • Health care workers are to wear a fit tested N95 mask.
  • Only health care workers required for the procedure should be present.
  • Health care workers in the room should wear appropriate personal protective equipment (PPE), which includes gown, gloves, fit tested N95 mask and eye protection.
  • Hand hygiene should be performed before donning, during and after doffing PPE and after exiting the patient’s environment.
  • AGMPs should only be performed if deemed medically necessary
  • Place the patient in a negative air pressure room (if available)

  • If a negative air pressure room is unavailable, AGMPs should be done in a private (single) room and the door must remain shut

  • If no further AGMPs are anticipated for the patient, they may be transferred to regular single patient room with Droplet/Contact precautions

  • In the event a patient remains in the room where the AGMP was performed and it not transferred to another room, N95 masks must be worn until sufficient time after the AGMP procedure was completed to allow for the air to be cleared of aerosolized droplets

  • The length of time is dependent on the level of ventilation in the room (i.e. the number of air exchanges per hour in the space) (see "Air Exchanged per Hour" below)

  • Facility maintenance departments should be able to obtain how many air exchanges per hour occur within your facility

  • After sufficient time has passed, with no further AGMPs performed, Droplet/Contact precautions can be resumed

  • If the patient is transferred after the AGMP back to a regular single patient room, the negative air pressure room where the AGMP was performed must remain vacant until the appropriate air exchange time has lapsed before cleaning and disinfection, and then placing another patient in the room

  • Environmental services staff performing cleaning /disinfection duties of a space in which an AGMP has been performed must wait until the appropriate air clearance time has lapsed before beginning cleaning/ disinfection procedures. Provided that the appropriate air exchange time has lapsed, environmental services staff do not require a N95 mask to enter the room

Air exchanged per hour: 2

  • Minutes needed to reduce contaminants by 99%: 138 mins

  • Minutes needed to reduce contaminants by 99.9%: 207 mins

Air exchanged per hour: 4

  • Minutes needed to reduce contaminants by 99%: 69 mins

  • Minutes needed to reduce contaminants by 99.9%: 104 mins

Air exchanged per hour: 6

  • Minutes needed to reduce contaminants by 99%: 46 mins

  • Minutes needed to reduce contaminants by 99.9%: 69 mins

Air exchanged per hour: 12

  • Minutes needed to reduce contaminants by 99%: 23 mins

  • Minutes needed to reduce contaminants by 99.9%: 35 mins

Air exchanged per hour: 15

  • Minutes needed to reduce contaminants by 99%: 18 mins

  • Minutes needed to reduce contaminants by 99.9%: 28 mins

Air exchanged per hour: 20

  • Minutes needed to reduce contaminants by 99%: 14 mins

  • Minutes needed to reduce contaminants by 99.9%: 21 mins

More Information