Updated June 9, 2023
The following guidance is provided to help speech-language pathologists (SLPs) and related personnel make informed decisions about personal protective equipment (PPE) needed while engaging in procedures within the SLP scope of practice that may produce aerosols. The Centers for Disease Control (CDC) states that aerosol generating procedures (AGPs) are medical procedures that are “more likely to generate higher concentrations of infectious respiratory aerosols than coughing, sneezing, talking, or breathing.” AGPs produce infectious particles (aerosols/droplets) that can lead to the spread of respiratory infections. As the CDC notes, “There is neither expert consensus, nor sufficient supporting data, to create a definitive and comprehensive list of AGPs for healthcare settings.” When performing AGPs in patients with and without a diagnosis of COVID-19 or other droplet-based respiratory illnesses such as RSV, SLPs are encouraged to follow the highest level of safeguards available at the facility in accordance with CDC’s guidance, local/state/federal guidelines, and facility policy.
SLPs may perform several procedures within the SLP scope of practice that can result in generation of aerosols, specifically by the trigger of the cough reflex, that can result in production of uncontrolled respiratory secretions. These include (but are not limited to):
These procedures may raise the risk for aerosolization when triggering patients’ reflexive coughs and sneezes.
Health care workers, such as SLPs, who work in close patient proximity while performing AGPs, can be at increased risk for transmission of respiratory infections, including COVID-19 and RSV. ASHA’s guidance is to use CDC-recommended PPE for all AGPs when dealing with individuals who have tested positive for or suspected to have COVID-19 or other droplet-based respiratory illnesses. Current guidance from CDC for COVID-19 related infection control, states “NIOSH Approved particulate respirators with N95 filters or higher [are] used for all aerosol-generating procedures.” CDC continues to recommend this guidance even after the expiration of the COVID-19 public health emergency on May 11, 2023. Additional CDC guidelines for infection control, strategies for optimizing PPE, and criteria for return to work for health care personnel with confirmed or suspected COVID-19 are also available.
For those individuals without a diagnosis of a respiratory infection, ASHA recommends following general CDC guidance for infection control, local/state/federal guidelines, and facility policy.