Aerosol-Generating Respiratory Procedures
For any procedure with the potential to generate respiratory droplets or aerosolization (including but not limited to the procedures listed on the next page), on patients with signs and symptoms of suspected or confirmed tuberculosis (TB), SARS or respiratory infection with an emerging respiratory pathogen, routine practices require the addition of Droplet Precautions. Proper PPE must be used by staff when within two metres of procedures generating droplets/aerosols on any client/patient/resident, with or without symptoms of an acute respiratory infection, to prevent deposition of droplets/aerosols on staff mucous membranes. Public Health lists those procedures that have an increased risk of aerosol generation and transmission, however recognizes that the degree of risk can be impacted by the patient, the operator and the setting. AGMP’s should be For any procedure with the potential to generate respiratory droplets or aerosolization (including but not limited to the procedures listed on the next page), on patients with signs and symptoms of suspected or confirmed tuberculosis (TB), SARS or respiratory infection with an emerging respiratory pathogen, routine practices require the addition of Droplet Precautions. Proper PPE must be used by staff when within two metres of procedures generating droplets/aerosols on any client/patient/resident, with or without symptoms of an acute respiratory infection, to prevent deposition of droplets/aerosols on staff mucous membranes. Public Health lists those procedures that have an increased risk of aerosol generation and transmission, however recognizes that the degree of risk can be impacted by the patient, the operator and the setting. AGMP’s should be limited to those medically necessary and planned, if possible, and occur in private rooms, with the most experienced person performing the procedure.
Professional Accountabilities:
These precautions may be a departure for many CRTO Members, however, lessons learned during the COVID-19 pandemic remind us that strict vigilance to appropriate infection control prevention activities are vital to ensuring a safe environment for both our patients and us. With the threat of ARIs and other emerging pathogens, it is crucial that RRTs follow the MOHLTC’s recommended infection control guidelines.
| Aerosol-Generating Respiratory Procedures with conclusive evidence of transmission | Aerosol-Generating Respiratory Procedures without conclusive evidence of transmission |
|---|---|
| Endotracheal (ETT) intubation | Nebulized therapies |
| Cardio-pulmonary resuscitation (CPR) | High-Frequency Oscillatory Ventilation (HFOV) |
| Bronchoscopy* | Tracheostomy insertion, changing and/or care |
| Sputum induction* | Chest physiotherapy |
| Non-invasive positive pressure ventilation for acute respiratory failure (i.e., CPAP, BiPAP) | Nasopharyngeal swabs and/or aspirates |
| High flow oxygen therapy | Chest tube or chest needle insertion |
| Open artificial airway suctioning (i.e., ETT, tracheostomy) Use closed suction if available. | Open suctioning (i.e., mouth or nose) |
| PFT’s and Spirometry* | |
| Other breaches to the integrity of a mechanical ventilation system (e.g., filter changes) | |
 | |
| * For diagnostic (but not therapeutic) bronchoscopy or sputum induction, must wear an N95 respirator, due to risk from undiagnosed TB. | PPE should be determined by risk assessment All units and crash carts should be equipped with: • a manual resuscitation bag with hydrophobic submicron filter • in-line suction catheters • non-rebreather mask that allows filtration of exhaled gases • PPE (gloves, gowns, masks, eye protection). |
References
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