The Society for Interventional Radiology has released a clinical notification to provide medical decision-making guidance on how to perform aerosol generating procedures (AGP) safely in the IR suite. Emerging data indicates that SARS-CoV-2 (COVID-19) is primarily spread via respiratory droplets produced when an infected person coughs or sneezes and has a “significant association with AGPs.”1,2 Healthcare workers may be exposed to these particles through the inhalation of droplets, conjunctival/mucosal contact, and touch contamination when:
The CDC and WHO first defined AGPs during its response to the EBOLA crisis,4 taking into consideration the high mortality and morbidity of EBOLA, the high risk of human to human transmission, and the lack of an FDA-approved therapeutic or vaccine as reasoning to justify the expansion of respiratory protection recommendations. The CDC and WHO have acknowledged that the AGP procedure list may not be complete. Therefore, there is a need to expand the AGP procedure list beyond what is currently listed by the CDC and WHO to ensure that respiratory protection and other required PPE are available for and allocated to healthcare workers performing AGPs or any procedure in a patient receiving ventilatory support associated with the possible mechanical dispersal of aerosols. In consideration of the current COVID-19 pandemic, any procedure that is “likely to induce coughing should be performed cautiously and avoided if possible”. 3
Table 1 represents a list of AGPs commonly performed in the IR suite. Following CDC guidance3,4, the Society of Interventional Radiology strongly advocates for and recommends the use of appropriate PPE for IRs when:
Appropriate PPE in these situations is defined as: N95 or higher-level respirator, eye protection (face shield with appropriate coverage and/or goggles), gloves, and a disposable, waterproof, surgical gown. In addition, it is recommended that N95 or higher level respirators be routinely stocked in IR suite crash carts for code situations
While in an ideal situation appropriate PPE would be readily available, we recognize the ongoing nationwide shortages and propose a triage mechanism for resource allocation for AGPs (see Figure 1). In such a triage situation, availability of proper PPE to interventional radiologists should be commensurate with availability to other providers of care to patients at high risk for dispersal of respiratory aerosols.
Table 1. Aerosol Generating Procedures Commonly Performed in IR Suites
Any procedure involving a patient who: |
Any procedure that may induce coughing: |
*Note: Any patient undergoing sedation may require airway rescue, which would require utilization of aerosol precautions. |
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Figure 1. Proposed triage mechanism for resource allocation for AGPs
SIR Provides Aerosol Generating Procedures for Interventional Radiologists. Appl Radiol.