Outpatient clinic
The use of PPE for COVID-positive or suspected patients in the
outpatient setting may be dictated by the nature of the patient
interaction. As previously noted, the CDC advises airborne-level
precautions (i.e. N95 or higher-level respirator, eye protection,
gloves, and gown), and consideration of negative-pressure room, when
performing aerosol-generating procedures.7 Some in
vitro evidence has been interpreted to suggest that flexible nasal
endoscopy, for example, while not intrinsically an AGP, may lead to
aerosol generation via coughing or sneezing.31 As
previously mentioned, however, the WHO classifies coughing and sneezing
as droplet-generating, not aerosolizing, events. However, nasal
endoscopy with suctioning would be classified as an AGP by the CDC,
warranting airborne-level precautions.22 Standard head
and neck physical examinations of putative or positive COVID-19 patients
require droplet-level precautions, ensuring appropriate eye protection,
given the need for close inspection of the nasal and/or oral cavities
and potential proximity to droplet transmission with expectoration.
(Table 1)