The last breath of the aerosol-generating procedure? Implications for anaesthesia of Scotland’s new infection control guidance

In August 2026, Scotland fundamentally changed its infection control guidance regarding how respiratory disease transmission risk is managed - replacing the droplet–airborne dichotomy with the simpler concept of air transmission, and entirely removing the aerosol-generating procedure (AGP) list. This evidence-informed approach is based largely on the findings of clinical aerosol studies undertaken during COVID-19 which demonstrated that many procedures on the existing AGP lists, such as tracheal intubation, generate little or no respiratory aerosol (substantially less than talking or coughing). Removing the AGP list does not mean less protection; it means precautions are based on the likely pathogen, patient's respiratory activity, practitioner exposure and environment. Scotland’s revised guidance offers a timely opportunity to replace the inherited dogmas in international guidelines with rational and evidence-informed respiratory protection before the next respiratory disease pandemic.