Aerosol Generating Procedures

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. 

AGPs in SLP Scope of Practice

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): 

Dysphagia care: 
- Non-instrumental swallowing assessment, which includes structural and functional assessment of oral mechanism, testing oral reflexes (e.g., gag and cough reflexes), and clinical (bedside) administration of different diet and liquid consistencies 
- Instrumental assessment of swallowing, which includes fiberoptic endoscopic evaluation of swallowing (FEES)—with or without sensory testing, and videofluoroscopic swallowing study (VFSS), among others
- Dysphagia treatment, which includes rehabilitative and compensatory approaches
Instrumental assessment of voice via endoscopy, with or without stroboscopy 
Assessment and management of  laryngectomy, including voice restoration using voice prosthesis and stoma care
Assessment and treatment of  tracheostomies, with or without mechanical ventilation, including suctioning 
Non-invasive ventilation such as high-flow nasal oxygen and nasal cannulae

These procedures may raise the risk for aerosolization when triggering patients’ reflexive coughs and sneezes.

PPE for AGPs

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. 