Last updated: August 17, 2022 On this page AGMPs performed on patients with confirmed or suspected COVID-19 may generate aerosols at high concentrations, which could contain infectious SARS-CoV-2 particles. This presents a risk of possible inhalation of the virus by people in the room where AGMP is performed. The BC AGMP Expert Panel evaluates medical procedures to determine which are considered AGMP based on reviews of current information and evidence. Medical procedures are assessed using the AGMP COVID-19 Decision Framework. AGMP COVID-19 Decision Framework The AGMP Decision Framework for COVID-19 provides a transparent and consistent framework to guide the BC AGMP Expert Panel in making decisions about whether medical procedures are considered AGMP in the context of the COVID-19 pandemic. Procedures are evaluated as follows:
Possible AGMP Possible AGMP Non-AGMP
These three categories were developed to describe the varying amount and quality of evidence currently available for each process. New items may continue to appear and the list will be updated accordingly. AGMPs may be referred to as “aerosol manufacturing processes” by some organizations. For consistency, the BC provincial guidelines use the term AGMPs. Healthcare workers are encouraged to review the AGMP status of the above medical procedures below and accompanying documents. In addition, health workers should:
Conduct a point-of-care risk assessment prior to conducting any AGMPs to determine the appropriate personal protective equipment (PPE) required. and Implementation of additional measures described in local health authorities or organizational AGMP guidelines; and Consult your provincial, health authority or organizational guidance on the use of PPE and other measures to minimize risk.
Learn about using PPE Supplementary material is available for procedures reviewed by the BC AGMP Expert Group. Procedures without supplemental material were previously considered AGMPs and remain on the provincial list as potential AGMPs – they will be reevaluated as needed. The dates below indicate when the AGMP status of the process was last revised. Information is provided in alphabetical order Airway suction (deep suction and open tracheal suction)
O. The BC AGMP Panel concludes that there is no evidence that airway aspiration is, by itself, AGMP, but is often associated with procedures that are more likely to be AGMP. It is these other processes that would justify the use of high levels of PPE (28 January 2022)
Arterial blood gas: Non-AGMP Autopsy: Possible Bronchoscopy and bronchoalveolar lavage: Possible
Possible AGMP (January 17, 2022)
Cardiopulmonary exercise test: Non-AGMP Chest compressions alone: Non-AGMP Clinical (slanted) ingestion assessment: Non-AGMP CPR with bag valve mask ventilation: Capability
Possible AGMP (June 18, 2021)
Continuous positive airway pressure (CPAP) or bi-level positive airway pressure (BiPAP): Possible
Possible AGMP (January 17, 2022)
Cough reflex test
Possible AGMP (June 2, 2021)
Direct laryngoscopy: Possible Flexible/fiberoptic endoscopic evaluation of voice and swallowing: Possible
Possible AGMP (June 2, 2021)
High Flow Heated Nasal Oxygen (eg AIRVO, Optiflow, Vapotherm: Non-AGMP
Non-AGMP (September 10, 2021)
Intranasal naloxone: Non-AGMP Intubation and intubation procedures: Possible Examples include: Hyperoxygenation using nasal prongs prior to intubation, manual ventilation prior to intubation, disconnecting the patient from the ventilator, breaking closed ventilation systems (intentionally or unintentionally) “Physical proning of patient” was removed based on the discussion of the AGMP expert group. Mastectomy: Possible
Possible AGMP (July 9, 2021)
Methacholine challenge (ie, bronchochallenge test): Possible
Possible AGMP (May 21, 2021)
Nasopharyngeal aspiration: Possible
Possible AGMP (September 10, 2021)
Nasopharyngeal washes: Possible
Possible AGMP (September 10, 2021)
Nasopharyngeal delineation: Non-AGMP Nebulized treatment : Possible AGMP
Possible AGMP (January 17, 2022)
High Flow Non-Heated Oxygen Nebulizer Style (Single or Dual Flow): Possible
Possible AGMP (September 10, 2021)
Overnight oximetry: Non-AGMP Spirometry: Non-AGMP
Non-AGMP (September 10, 2021)
Sputum induction: Possible Tracheotomy: Possible
Possible AGMP (March 4, 2022)
Tracheostomy Care: Possible Transesophageal echocardiogram (TEE): Non-AGMP Upper gastrointestinal endoscopy: Possible Videofluoroscopic swallowing study: Non-AGMP If you have a request for specific procedures to be reviewed by the BC AGMP Expert Panel, please contact [email protected] In BC, the AGMP expert group reports to the Provincial Infection Control Network of BC (PICNet). Its purpose is to: BC AGMP expert panel members have diverse expertise, including but not limited to medical microbiology, IPC, infectious diseases, aerosol engineering research, occupational health and safety, respiratory therapy, critical care, emergency medicine, pediatrics, obstetrics, gynecology and BC Emergency Health Services. The BC AGMP Expert Group developed and uses a decision framework to guide their decisions. The group does not provide guidance on the use of PPE. Visit the PPE website for more information.
