Page 25 - COVID-19 Inpatient Training Resources

Therefore, if sufficient private rooms are available, it is preferred to perform AGMPs in a private room
with the door closed. However, given the large number of patients that require AGMPs at Unity Health,
this will not be possible for many patients.

If a private room is not available, it is acceptable to perform the AGMP at the bedside but with curtains
drawn around the patient. Staff within the curtained area should wear an N95 respirator. The curtains
are not a complete barrier to aerosol transmission but contain airflow within the area to some extent
and also provide a visual reminder to staff that N95 respirators are required when in close proximity to a
patient during an AGMP.

How long are N95 respirators required after an AGMP? Can the door be opened over this time?
N95 respirators should be worn during the AGMP by all in the room or at the bedside. After the AGMP is
completed, any aerosols produced are rapidly removed from the room. Out of an abundance of caution,
it is recommended that N95 continue to be worn by those in the room or at the bedside for 45 minutes
after the procedure is completed (for most rooms – only 25 minutes is required for airborne infection
isolation rooms and just 15 minutes in the OR). While the door should remain closed over this time, it
can be opened when staff need to enter or exit the room.

Won’t using N95 during AGMP use up too much of our N95 supply? What can we do to prevent the
use of too many N95?
Currently, Unity Health has sufficient N95 respirators for use based on our current recommendations.
However, it remains important the preserve N95 respirators and all of the following strategies are
appropriate:
 Do not use N95 respirators when not indicated – N95 respirators are not required for routine
care of patients with or without COVID-19 unless an AGMP will be performed, or the patient is
in airborne precautions for other reasons
 Minimize the number of staff entering the room for patients requiring AGMP
 Consider avoiding non-essential AGMPs
 Follow our ‘extended use’ protocols for N95 respirators in the same way you do for procedure
masks. If you put on an N95 respirator because you will be performing an AGMP, you can
continue to wear that respirator until you leave the clinical area as long as it is not damaged or
grossly soiled.

Why doesn’t this protocol apply to AGMP in neonates or in the neonatal ICU?
This protocol was developed for adult patients (or older children) but does not apply to neonates. There
are a number of differences in neonates in terms of exposure risk, risk of asymptomatic COVID-19, and
aerosol generation related to AGMP. These areas will continue to follow their current protocols.