What is an aerosolizing procedure?

Imagine a balloon – a potentially deadly virus balloon filled with glitter. That’s coronavirus (SARS-Cov-2). What if you subjected these virus particles to a stress, a shear force, and the virus popped. Glitter would get everywhere. When this viral glitter gets everywhere it has become “aerosolized.” The balloon itself is large enough to be blocked by standard surgical masks. The glitter is small enough that it isn’t blocked, and that’s why N95 level masks are needed. COVID-19 virus is thought to be spread mainly via droplet (balloon) rather than aerosol (glitter).

These procedures are definitely aerosolizing

You should use N95 precautions along with content and droplet precautions – mask, gown, gloves. Only people essential to the procedure should be in the room.

  • Endotracheal intubation and extubation
  • Tracheostomy suctioning and changing a trach
  • Bag mask ventilation (manual ventilation)
  • Non-invasive positive pressure ventilation (BiPAP, CPAP)
  • Bronchoscopy/bedside NP scope
  • CPR unless the patient is invasively ventilated and connected to a ventilator

These procedures are lower risk for aerosolizing

A surgical mask, gown, goggles and, gloves should suffice for the following:

  • Nasal and oral suctioning
  • Nasopharyngeal and oral specimen collection – rapid streps, COVID-19, flu and other viral swabs

Think long and hard about whether or not you need to do the following because they may be aerosolizing

  • High Flow Nasal Cannula (which doesn’t work all that great for bronchiolitis)
  • Nebulized medications (use a metered dose inhaler if possible) – Note that the aerosolized fluid in news comes from the chamber, not the patient, but you could theoretically see aerosolized particles if the patient is coughing a lot


COVID-19 UK Government Guidance for infection prevention and control in healthcare settings

Leung CCH, Joynt GM, Gomersall CD, et al. Comparison of high-flow nasal canula versus oxygen face mask for environmental bacterial pneumonia patients, a randomized controlled crossover trial. J Hosp Infect 2019: 101:84-87

Roberts S, Kabaliuka N,Spencea Cjt, et Al. Nasal high-flow therapy and dispersion of nasal aerosols in an experimental setting. J Crit Care. 2015: 30(4): 742

Tran K, Cimon K, Severn M, Pessoa-Silva CL, Conly J (2012) Aerosol Generating Procedures and Risk of Transmission of Acute Respiratory Infections to Healthcare Workers: A Systematic Review. PLoS ONE 7(4): e35797. doi:10.1371/journal.pone.0035797

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