The MoH IPC subgroup recommended the removal of nebulised medications from the aerosol generating procedures (AGP) list based on a rapid review undertaken by the National Services Scotland/Health Protection Scotland team for the UK Emerging Respiratory Virus Threats Advisory Group (NERVTAG) and Public Health England (published on 12 May).
After consideration and feedback from other clinical groups the MoH COVID-19 Technical Advisory Group (TAG) supports the removal of nebulised medications from the list of AGP. This was approved at the 10 July 2020 MoH COVID TAG meeting.
The decision to remove nebulisers is based on the rationale that it is the biological fluid aerosols that are the concern rather than all aerosols, and there is evidence that nebulisation does not result in an increased risk of patient generated aerosols. Nebulisers do produce profuse aerosols of sterile fluid and medication. Nebulisers can incite coughing and infectious droplets, which is not of itself regarded as aerosol generating.
Please read the Ministry of Health's decision document (PDF) for full details on this. The supporting documents from the National Services Scotland on assessing risk (PDF) and the World Health Organization on infection prevention (PDF) are also very insightful.