The Royal College of Physicians of Edinburgh ("the College") has backed a call for swallow assessment, nasogastric tube insertion, and dysphagia assessment to be added to the official list of aerosol-generating procedures (AGPs) in the UK.

Each procedure presents its own risks to healthcare workers during the COVID-19 pandemic and these potentially infectious procedures require adequate personal protective equipment (PPE) for those carrying out the procedures.

The Royal College of Speech and Language Therapists (RCSLT) and the British Association of Stroke Physicians (BASP) are among a number of prominent organisations that believe classifying these procedures as AGPs will help ensure that adequate personal protective equipment (PPE) is provided during the pandemic.

The Royal College of Physicians of Edinburgh supports the calls for these procedures to be included as AGPS in the joint guidance from the Department of Health and Social Care (DHSC), Public Health Wales (PHW), Public Health Agency (PHA) Northern Ireland, Health Protection Scotland (HPS), Public Health England and NHS England.

Professor Angela Thomas, interim president of the Royal College of Physicians of Edinburgh, said:

The Royal College of Physicians of Edinburgh supports the calls for the official list of AGPS to be expanded to cover swallow assessment, nasogastric tube insertion, and dysphagia assessment to ensure that those healthcare workers carrying out these procedures have adequate PPE. The safety of all healthcare workers should be a priority and the evidence presented demonstrates the risks that exist to those carrying out these procedures. These healthcare professionals should be afforded the same level of protections as their colleagues carrying out other APGs.

Professor Rustam Al-Shahi Salman, president of the British Association of Stroke Physicians (BASP), commented:

Anyone involved in the care of patients with stroke knows that swallow assessments, nasal bridle placement, and feeding tube insertions can generate droplet aerosols, which could transmit infections that are spread in droplets from the upper airways, like COVID-19. However, Public Health bodies in the UK will not recognise this risk. That’s because of the shortage of adequate, high-quality research to prove this. However, absence of evidence is not evidence of absence.

Notes: 

1. BASP letter to Matt Hancock MP on COVID-19, swallow assessment and nasogastric tube insertion: https://basp.ac.uk/wp-content/uploads/2020/05/The-Rt-Hon-Matt-Hancock-MP.pdf

2. RCSLT report on COVID-19 and dysphagia assessment: https://www.rcslt.org/-/media/RCSLT-Dysphagia-and-AGP220420FINAL-1-(1).PDF?la=en&hash=2E918D05AD4E63B0AFAE99F0DEA9ECBCFA64C9D3