Classification of aerosol-generating procedures: a rapid systematic review

Area of Science:

• Infectious Diseases
• Public Health
• Respiratory Medicine

Background:

• Aerosol-generating procedures (AGPs) pose infection risks, particularly during pandemics like COVID-19.
• Consistent classification of AGPs is crucial for appropriate personal protective equipment (PPE) use.
• Variability in guidance necessitates a review of existing classifications.

Purpose of the Study:

• To systematically review and assess the agreement on AGP classifications in official guidance and academic literature.
• To identify procedures with consensus and those with disagreement regarding their aerosol-generating potential.

Main Methods:

• Rapid systematic review adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards.
• Inclusion of guidelines, policy documents, and academic papers in English or French.
• Systematic searches of medical databases (Medline, Cochrane Central) and Google, conducted in March-April 2020.

Main Results:

• 128 documents were reviewed, categorizing 1248 procedure mentions into 39 groups.
• High agreement (≥90%) on AGP classification was found for procedures including autopsy, intubation, bronchoscopy, and high-flow oxygen therapy.
• Disagreements were noted for oral/dental procedures, upper gastrointestinal endoscopy, thoracic surgery, and swabbing.

Conclusions:

• Sufficient consensus exists to classify several procedures as AGPs, informing PPE recommendations.
• Lack of clarity and mention for some clinically relevant procedures requires attention.
• Recommendations include clearer procedural definitions, further research on aerosolization, and broader guideline development.