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New research priorities identified for Aerosol Generating Procedures related to COVID-19

The NIHR has identified a new set of research priorities for Aerosol Generating Procedures (AGPs) in relation to the COVID-19 pandemic, following a review of the existing evidence by experts from science, engineering, infection prevention sectors and the healthcare system.

AGPs are any medical or patient care procedure that results in the production of airborne particles (aerosols). The World Health Organisation recommends enhanced precautions for ‘high risk AGPs’ defined as medical procedures that ‘have been reported to be aerosol-generating and consistently associated with an increased risk of pathogen transmission’.

Five new research priorities have been identified through the NIHR expert review process, with the purpose of providing evidence to understand and assess aerosol generation and the infective risk associated with individual AGPs as well as broader questions about airborne transmission of COVID-19 in healthcare settings.

The five research priorities areas are:

  • Understanding the fundamental aerobiology
    Including virus distribution and viability in airborne particles.
  • Risk factors for transmissibility
    Understanding and quantifying the risk of transmissibility across multiple domains (including patient, procedure, environment, pathogen and healthcare professional factors) in order to generate a clinically applicable risk model.
  • Mitigating precautions and their components
    Identifying which mitigating precautions are important and how they work: to include clinical efficacy testing of PPE, environmental measures (e.g. ventilation, filtration), and other barrier devices.
  • Transmission of COVID-19 and other pathogens
    Investigating the contribution of inhalation versus inoculation for infection risk from AGPs and other healthcare interventions.
  • Understanding infective risk perception, behaviours and acceptability of mitigation strategies
    This will include diverse groups of healthcare workers, patients and the public.

Professor Mark Hull, Chair of NIHR AGP Research Group and Professor of Gastroenterology at University of Leeds said: 

“Categorisation of procedures as a high-risk AGP has impacted on NHS delivery and costs during the COVID-19 pandemic with the requirement of additional ‘airborne’ Personal Protective Equipment (PPE) and increased time between procedures to allow for aerosols to settle and be removed from the air.

“Lack of clarity about infection risk associated with AGPs and the best way to mitigate the  risks, continues to impact negatively on waiting lists and clinical outcomes.These five research priorities will provide an essential evidence base to enable better safety measures for healthcare professionals and patients in environments where AGPs are performed.”  

The NIHR AGP Research Group was convened under the umbrella of the NIHR Urgent Public Health Group and follows on from an initial review produced by the Independent High Risk AGP Panel - an expert advisory panel that provides practical and scientific advice to the Chief Medical Officers for England, Scotland, Wales and Northern Ireland on specific high risk AGPs in the context of the COVID-19 pandemic. 

Their review suggested that further research was required to provide more evidence in this area and for future preparedness.The NIHR AGP Research Group links to the Independent AGP panel so that emerging evidence can have a pathway to impact in national guidance.

The NIHR Aerosol Generating Procedures Research Prioritisation report will support discussions with the Department of Health and Social Care and the Life Sciences industry in conducting more research in this critical area.

For a PDF copy of the full report which includes more details on the prioritisation workshop exercise, please email: