Updated 4/15/2020

To ensure the health and safety of Valley’s caregivers and assure adequate personal protective equipment, we have developed and continue to evolve a defined list of procedures which may be aerosolizing. These recommendations relate to caring for patients who are COVID-19 positive or a person under investigation (PUI) for COVID-19. Procedures are evaluated on current available scientific evidence in addition to local, state and national recommendations as appropriate, and may change over time as new information becomes available.

The latest list of procedures considered aerosol generating at Valley, include:

• High flow oxygen (high flow nasal cannula /HFNC) - adult* (regardless of flow rate)
• Endotracheal intubation and extubation
• Mechanical ventilation
• Non-invasive positive pressure ventilation (CPAP and BiPap)
• High-frequency oscillating ventilation (HFOV) - NICU
• Bronchoscopy
• Cardiopulmonary resuscitation (manual ventilation)
• Nasal tracheal, endotracheal, and/or oropharyngeal suctioning performed by medical personnel
• Nebulizer therapy
• Tracheotomy or tracheostomy (insertion, maintenance, suctioning, removal)
• Surgery and post-mortem procedures involving high-speed devices (e.g. surgical saws/drills)
• Induced sputum
• Cesarean section delivery
• All endoscopy procedures
• Second stage labor
• Dysphagia evaluation and care
• ENT procedures including direct/flexible laryngoscopy

NOTE: The following are non-aerosolizing procedures

• Low Flow Oxygen < 15Lpm (Low Flow Nasal Cannula including humidified Low Flow Nasal Cannula)
• Venti mask
• Nonrebreather mask
• Collection of NP or OP swabs

Please contact the Command Center for further clarifications or questions.