Aerosol-Generating Procedures (AGP) Guide

-Guidelines for Proper Personal Protective Equipment (PPE) during OT Interventions

The Centers for Disease Control (CDC) and WHO standard precautions, recommended to be used with all patients, include:
• Hand hygiene
• Masks for both the patient and therapist
• Additional PPE such as gloves when appropriate

Three-Tiered Risk Classification scheme where occupations are classified as high, moderate, or low risk for AGPs.

1. High-Risk Occupations
Suggested level of PPE (WHO, 2020):
❏ N95 (or higher) respirator
❏ Gown
❏ Eye Protection (goggles/face shield)
❏ Gloves

Feeding & Swallowing, including dysphagia care, swallowing assessments, and related preparatory activities (i.e., sensory & oral motor) result in the generation of aerosols with close proximity to a patient and high risk of coughing.

Hygiene & Grooming is performed in close proximity to an unmasked patient, which increases instances of saliva splatter and patient coughing, which results in particle transfer. Spread through aerosols can happen with low-speed hand-held dental brushes, water picks, and manual tooth brushing.

Sleep Preparation using a CPAP or BiPAP machine will generate aerosols. Situations where practitioners are in the same room as a patient who is using a CPAP or BiPAP or are working with patients to clean these machines should be considered high risk.
** Practice donning/doffing CPAP or BiPAP with the machine off. This activity would still constitute a moderate risk to the practitioner as the patient is not able to wear a mask.

2. Moderate-Risk Occupations

These occupations are not necessarily aerosol generating; however, control parameters relevant to context could affect the risk of performing these occupations.

Suggested level of PPE:
❏ Practice hand hygiene
❏ Masks should be worn by both the patient and practitioner

Bathing/Showering are high-contact care activities where splashes and sprays are anticipated, and high contact patient/patient care activities provide opportunities for transfer of pathogens to the hands and clothing of the practitioner.
❏ Wear a gown to reduce risk from splashes and sprays

Toileting is considered a high-contact care activity where splashes and sprays are anticipated and provide opportunities for transfer of pathogens to the hands and clothing of the practitioner. Bio-aerosol transmission via toilet plumes is associated with flushing toilets and is a potential concern to health care practitioners.
❏ Wear a gown to reduce risk from splashes and sprays
❏ If toilet has a lid, it should be lowered during flush to minimize toilet plumes

Functional & Community Mobility should be considered moderate risk activities, as long as standard precautions are utilized.
** Consider factors such as proximity, duration, and potential for mobilizing secretions during mobility activities.
** Complete these activities in well-ventilated areas, including outdoors, when appropriate.

Exercise should be considered a moderate-risk activity, as long as standard precautions are utilized. There are no available studies that indicate that exercise promotes generation of aerosols.
** Consider factors such as proximity, duration, and potential for mobilizing secretions during exercise
** Complete these activities in well-ventilated areas, including outdoors, when appropriate.

Low-Risk Occupations
Suggested level of PPE: CDC and WHO standard precautions
❏ Practice hand hygiene
❏ Masks should be worn by both the patient and practitioner
❏ Gloves should be worn when appropriate
All occupations in the Occupational Therapy Practice Framework: Domain and Process, 4th edition (AOTA, 2020), other than those listed in the tables above, are classified as low risk for generating aerosols.