Last updated on June 21st, 2023 at 02:39 pm

Aerosol-generating procedures (AGPs)

The NHS England National Infection Prevention and Control Manual for England defines the following as AGPs:

  • Awake* bronchoscopy 
  • Awake* ear, nose, and throat (ENT) airway procedures that involve respiratory suctioning
  • Awake* upper gastro-intestinal endoscopy
  • Dental procedures (using high speed or high frequency devices, for example ultrasonic scalers/high speed drills)
  • Induction of sputum
  • Open respiratory tract suctioning
  • Surgery or post-mortem procedures (like high speed cutting / drilling) likely to produce aerosol from the respiratory tract (upper or lower) or sinuses.
  • Tracheostomy procedures (insertion or removal)

*Awake includes ‘conscious’ sedation (excluding anaesthetised patients with secured airway).

In addition, for practical purposes, the following are also considered AGPs:

  • Cardiopulmonary resuscitation (CPR) –  UK Health Security Agency (UKHSA)/NHS England (NHSE) guidance do not regard chest compressions as an AGP based on currently available evidence, however the Resuscitation Council UK (RCUK) states otherwise. The PPE guidance for CPR stated in the Trust guidance reflects this and this guidance has been reviewed and agreed by both NHSE and RCUK.
  • Tracheal extubation and intubation – UKHSA/NHSE guidance do not regard tracheal extubation and intubation in anaesthetised patient as AGPs however, given the potential for the requirement for respiratory suctioning as well as most patients being extubated not being under anaesthesia, both tracheal intubation and extubation should be regarded as AGPs from a PPE point of view.

The following are NOT considered to be AGPs:

  • Manual facemask ventilation
  • Administration of pressurised humidified oxygen
  • Non-invasive ventilation (NIV) including CPAP
  • High flow nasal oxygen (HFNO)
  • Insertion or removal of supraglottic airways
  • Administration of Entonox
  • Administration of medication via nebulization
  • Taking a nasopharyngeal swab

Please seek advice from the Infection Prevention Team regarding any procedures listed above if you are unclear whether they are AGP or not.

Full details of the Trust PPE guidance for AGP is at What to wear and when – STHK COVID-19 Guidance.

All clinical staff likely to carry out aerosol generating procedures, who have not already completed face fit testing for FFP3 masks, must do so as a matter of urgency. Details of how to access fit testing is at Fit Testing – STHK COVID-19 Guidance.