Page 24 - COVID-19 Inpatient Training Resources

Aerosol-generating medical procedures (AGMPs)

Frequently asked questions
May 6, 2020

We recently updated our protocol for the management of aerosol-generating medical procedures
(AGMPs) in patients without suspect or confirmed COVID-19. The protocol now requires the use of N95
respirators for all staff performing or present during any AGMP, regardless of COVID-19 status.

Why was this protocol developed?
This protocol was developed to protect staff from COVID-19 and to ensure practices are consistent
across Unity Health. While we have protocols in place for the management of AGMPs in patients with
suspect or confirmed COVID-19, our protocols for patients without COVID-19 previously only addressed
a small number of specific AGMPs such as intubation.

As some patients with COVID-19 may not have symptoms, we felt it necessary to update our protocol to
ensure we have a safe approach to the care of all patients. Keeping yourself safe includes excellent hand
hygiene, universal masking and now a universal approach to safe management of AGMPs for any
patient. This new protocol helps us take a consistent and precautionary approach to AGMPs in all
patients, not just those with COVID-19 and not just for intubation, even though the chance that a
patient has COVID-19 may be very low. This protocol applies at all Unity Health sites, for all AGMPs and
for all units except our neonatal intensive care units.

Does this mean we need to wear PPE for all patients?
No – absolutely not! This protocol ONLY applies while an AGMP is in progress, and for a short period of
time afterwards. For patients without suspect or confirmed COVID-19 (and not in isolation for any other
reason) no PPE is required for most routine care, although you should be wearing your mask at all times
in clinical areas.

It is only during the AGMP (and briefly afterwards – see below) that we require the use of an N95
respirator.

What PPE is required during an AGMP in a patient not suspected to have COVID-19?
Staff performing or present in the room or at the bedside when an AGMP occurs must wear an N95
respirator, face shield, gown and gloves.

Is a negative pressure room required for all AGMP?
A negative pressure room is not required. Even for AGMPs in COVID-19 positive patients, a negative
pressure room, while preferred, is not required. The risk of long distance transmission of COVID-19 in
well-ventilated rooms is very low as any aerosols released during an AGMP are rapidly diluted and
cleared from the room.

Where should an AGMP be performed in a patient without suspected or confirmed COVID-19?
The risk of transmission from AGMPs in patients without suspected or confirmed COVID-19 is low, as the
vast majority of these patients do not have COVID-19. The key goal of this policy was to ensure that staff
wear an N95 respirator when close to patients during an AGMP to provide an extra level of protection
against any aerosols that are produced. For consistency with our protocols for AGMP in patients with
COVID-19, we do prefer a private room but this is less critical.