All Summaries of Evidence: 26 March 2020 Is respiratory/chest physiotherapy treatment an aerosol generating (agp) procedure?

Is respiratory/chest physiotherapy treatment an aerosol generating (agp) procedure?

What is the best evidence currently?

Previously, chest physiotherapy had not been considered an aerosol generating procedure by the World Health Organisation. This position was outlined in a number of official WHO documents. The Health Protection Surveillance Centre has followed WHO guidance in also maintaining this position.

A number of physiotherapists globally have advocated for an inclusion of chest physiotherapy as an agp. Rachel Moses has been particularly active in writing position papers. Canadian and Australian physiotherapy organisations have lobbied for a change in official guidance. The World Federation of Anaesthesiologists also explicitly include chest physiotherapy as an agp in their guidelines.

These campaigns have led to partial changes in classification.

The HPSC groups chest physiotherapy among procedures where agp-related increased risk is not supported by evidence or plausible hypothesis and not recognised by most national agencies.

The WHO in a document from the February 18th entitled “Surface Sampling of Coronavirus Disease” includes chest physiotherapy as an agp. Other bodies such as Public Health England and the European Centre for Disease Prevention and Control still do not classify chest physiotherapy as a agp currently. All of the evidence agrees that regardless of classification chest physiotherapy represents a low risk procedure as a means of transmission of COVID-19.

Produced by the members of the National Health Library and Knowledge Service Evidence Team. † Current as at 26 March 2020. .This rapid evidence review collates the best available evidence at the time of writing. Emerging literature or subsequent developments in respect of COVID-19 may require amendment to the information or sources listed in the document. Although all reasonable care has been taken in the compilation of content, the National Health Library and Knowledge Service Evidence Team makes no representations or warranties expressed or implied as to the accuracy or suitability of the information or sources listed in the document. This evidence summary is the property of the National Health Library and Knowledge Service and subsequent re-use or distribution in whole or in part should include acknowledgement of the service.

PICOT

Authors

Gethin White, Librarian, Dr Steevens Hospital [Author]; Thomas Veale, Systems Librarian, Our Lady of Lourdes Hospital, Drogheda [Author]; Brendan Leen, Regional Librarian, HSE South, St. Luke’s General Hospital, Kilkenny [Editor]

References

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2. Tran et al. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3338532/. [Accessed 30 March 2020].
3. World Health Organization. https://apps.who.int/iris/bitstream/handle/10665/112656/9789241507134_eng.pdf?sequence=1 [Accessed 30 March 2020].
4. World Health Organization. https://apps.who.int/iris/bitstream/handle/10665/331058/WHO-2019-nCoVEnvironment_protocol-2020.1-eng.pdf?sequence=1&isAllowed=y. [Accessed 30 March 2020].
5. Health Protection Surveillance Centre. https://www.hpsc.ie/a-z/respiratory/coronavirus/novelcoronavirus/ guidance/infectionpreventionandcontrolguidance/aerosolgeneratingprocedures/ AGPs%20for%20confirmed%20or%20possible%20COVID19_v2.0_23032020.pdf. [Accessed 30 March 2020].
6. European Centre for Infection Prevention and Control. https://www.ecdc.europa.eu/sites/default/files/documents/ nove-coronavirus-infection-prevention-control-patients-healthcare-settings.pdf. [Accessed 30 March 2020].
7. Simonds. https://www.ncbi.nlm.nih.gov/pubmed/20923611. [Accessed 30 March 2020].
8. Zhu et al. https://www.sciencedirect.com/science/article/abs/pii/S0360132305002726. [Accessed 30 March 2020].
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12. APTA. http://www.apta.org/uploadedFiles/APTAorg/News_and_Publications/Latest_News/News_Items/2020/ Physiotherapy_Guideline_COVID-19.pdf. [Accessed 30 March 2020].