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Jun 9 • 6 tweets • 5 min read
A short thread on the revised list of AGPs

The AGP list has changed in England

The following are no longer considered to be AGPs

@TonyPi314 @_andyshrimp @drjulesbrown @NWilson247 @EuanTovey

1/6
These changes are laid out in the new NHS National IPC manual (14 April 2022)

england.nhs.uk/wp-content/upl…

2/6
The @RCoANews has a statement that summarises the situation

rcoa.ac.uk/news/introduct…

3/6
The evidence review that underpins this change in AGPs is now published here (9 June 2022).

Clinical guidance on this review was provided by the #AERATOR anaesthesia group amongst others

england.nhs.uk/wp-content/upl…

4/6
Of note the remit of this review was only to explore removal of procedures from the AGP list.

The same studies that show procedures not producing aerosols show aerosol generation by exertional respiratory activity

Eg …-publications.onlinelibrary.wiley.com/doi/10.1111/an…

…-publications.onlinelibrary.wiley.com/doi/10.1111/an…

5/6
So… the AGP list is now appropriately reduced

RISK assessment is still required & should be based around patient, context, mitigation & consequences of infection

thelancet.com/journals/lanre…

6/6

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More from @doctimcook

Tim Cook Profile picture
Dec 29, 2021
A thread on the (topical) high rate of COVID identified or acquired in hospital

The fact that this is up to 30% is being highlighted by some as indicating that hospitalisation numbers are inaccurate

1/
First I agree that it leads to confusion & it would be much better to report -those admitted due to COVID
- those admitted ‘while infected’ (likely same as community rate ≈2-3% cases)
-those who acquire it in hospital

2/
Hospital patients are swabbed regularly after admissions & classified by when +ve

<2 days: community acquired
3-7d: intermediate
8-14d: suspected
>15d: hospital acquired

A significant % of suspected will be hospital acquired:some use 7d cut off

assets.publishing.service.gov.uk/government/upl…

3/
Read 14 tweets
Tim Cook Profile picture
Nov 21, 2021
OXIMETRY and SKIN COLOUR
Is it a major factor?

Lots of interest today
bbc.co.uk/news/uk-593635…
@bbchealth
@guardiannews
@HSJnews
@Telegraph
All covering it

I've had a look & this thread explores

1/
The technology is not ancient - I recall first oximeter arriving coming Gateshead 1988 in my first year of anaesthetic practice

Oximetry calculates differences in light absorption between oxygenated (light) & deoxygenated (dark) blood

No surprise that pigments affect readings.
1987: Cecil reported lower accuracy of oximeters in patients with pigmented skin

This inaccuracy seems to have been greater variability rather than systematic under-reading

Studied numbers were small

link.springer.com/content/pdf/10…

2/
Read 20 tweets
Tim Cook Profile picture
Nov 21, 2021
@ICNARC report 19 Nov

shows us a system
-under sustained pressure
-dramatically impacted by the unvaccinated
-with pressures preventing care of many vaccinated patients

For staff and patients alike seemingly unending & miserable.

icnarc.org/our-audit/audi…

1/
ICU UNDER SUTAINED PRESSURE

About 1000 patients in ICU with COVID through last several months

Equivalent to 1/3 of all UK ICU beds
So the rest of UK health is running on 2/3 of required ICU capacity
ICUs have expanded, taking staff from other locations

It's unsustainable

2/
ICU UNDER SUSTAINED PRESSURE

The numbers admitted to ICU with pneumonia (almost all COVID) dwarfs previous years

Viral pneumonia on ICU is normally a rarity.
Now it is our most common diagnosis

3/
Read 12 tweets
Tim Cook Profile picture
Nov 3, 2021
PREVENTING UNDETECTED OESOPHAGEAL INTUBATION. A thread @RCoANews @dasairway @ICS_updates @FICMNews @CollegeODP @SaferSurgeryUK @BACCNUK @MartinBromiley

It is rare
It is fatal
It is avoidable
Sadly it still happens

1/16

rcoa.ac.uk/news/rcoa-das-…
Glenda's was not a difficult airway case.

Please DO READ this judiciary.uk/publications/g…

2/16
Ten years ago in NAP4 there were 9 cases of undetected oesophageal intubation with harm reported.

No location was exempt.

3/16
Read 21 tweets
Tim Cook Profile picture
Jun 29, 2021
Important paper illustrating how changing to FFP3 masks on wards reduces risk of healthcare worker infection

Hugely important for policy
Massive for counties with low vaccination rates
Important still in those with high vaccination rates

authorea.com/users/421653/a…

1/9
I don't follow all the inferences (especially that all staff cases on 'green wards' (ie those without known COVID patients) were community acquired) but I do agree with their finding that a change to FFPs dramatically reduced staff infections on 'red wards' (COVID wards)

2/9
I've argued for a long time for more FFP use on wards based on
- epidemiological evidence of xs infection on the wards vs ICU
- aerosol data showing patient status more important that procedures
- known better performance of FFPs vs surgical masks

rcpjournals.org/content/clinme…

3/9
Read 10 tweets
Tim Cook Profile picture
May 3, 2021
A thread on what studying "AGPs" tells us about 'aerosols and droplets'

Focus on this paper
…-publications.onlinelibrary.wiley.com/doi/10.1111/an…

Done in Sydney
Hats off to @NWilson247 @EuanTovey
My role was microscopic

First: discussion should be 'what is the proportion of each in disease risk: not A vs B
The study builds on work by others esp Bristol AERATOR study which has examined designated 'aerosol generating procedures' in a laminar flow theatre

-intubation/extubation
-NIV/HFNO
-tracheostomy

& largely identified a LACK of aerosol

More to come on other designated AGPs
AERATOR papers
…-publications.onlinelibrary.wiley.com/doi/epdf/10.11…

journals.sagepub.com/doi/full/10.11…

medrxiv.org/content/10.110…
Read 17 tweets

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