Hostname: page-component-7c8c6479df-24hb2 Total loading time: 0 Render date: 2024-03-28T19:10:26.048Z Has data issue: false hasContentIssue false

Respirator-Fit Testing: Does It Ensure the Protection of Healthcare Workers Against Respirable Particles Carrying Pathogens?

Published online by Cambridge University Press:  02 January 2015

M. C. Lee*
Affiliation:
Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, Alberta
S. Takaya
Affiliation:
Division of Infectious Diseases, Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
R. Long
Affiliation:
Division of Pulmonary Medicine, University of Alberta, Edmonton, Alberta
A. M. Joffe
Affiliation:
Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, Alberta
*
University of Alberta Hospital, 2E4.16, Walter C. McKenzie Centre, 8440, 112 Street, Edmonton, AB T6G 2B7, Canada (maocheng@ualberta.ca)

Abstract

Objective.

Respiratory protection programs, including fit testing of respirators, have been inconsistently implemented; evidence of their long-term efficacy is lacking. We undertook a study to determine the short- and long-term efficacy of training for fit testing of N95 respirators in both untrained and trained healthcare workers (HCWs).

Design.

Prospective observational cohort study.

Methods.

A group of at-risk, consenting HCWs not previously fit-tested for a respirator were provided with a standard fit-test protocol. Participants were evaluated after each of 3 phases, and 3 and 14 months afterward. A second group of previously fit-tested nurses was studied to assess the impact of regular respirator use on performance.

Results.

Of 43 untrained fit-tested HCWs followed for 14 months, 19 (44.2%) passed the initial fit test without having any specific instruction on respirator donning technique. After the initial test, subsequent instruction led to a pass for another 13 (30.2%) of the 43 HCWs, using their original respirators. The remainder required trying other types of respirators to acheive a proper fit. At 3 and 14 months' follow-up, failure rates of 53.5% (23 of 43 HCWs) and 34.9% (15 of 43 HCWs), respectively, were observed. Pass rates of 87.5%-100.0% were observed among regular users.

Conclusions.

Without any instruction, nearly 50% of the HCWs achieved an adequate facial seal with the most commonly used N95 respirator. Formal fit testing does not predict future adequacy of fit, unless frequent, routine use is made of the respirator. The utility of fit testing among infrequent users of N95 respirators is questionable.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Hannum, D, Cycan, K, Jones, L, et al. The effect of respirator training on the ability of healthcare workers to pass a qualitative fit test. Infect Control Hosp Epidemiol 1996;17:636640.CrossRefGoogle Scholar
2. Coffey, CC, Campbell, DL, Zhuang, Z. Simulated workplace performance of N95 respirators. Am Ind Hyg Assoc J 1999;60:618624.CrossRefGoogle ScholarPubMed
3. Coffey, CC, Lawrence, RB, Campbell, DL, Zhuang, Z, Calvert, CA, Jensen, PA. Fitting characteristics of eighteen N95 filtering-facepiece respirators. J Occup Environ Hyg 2004;1:262271.CrossRefGoogle ScholarPubMed
4. Kellerman, SE, Tokars, JI, Jarvis, WR. The costs of healthcare worker respiratory protection and fit-testing programs. Infect Control Hosp Epidemiol 1998;19:629634.CrossRefGoogle ScholarPubMed
5. American National Standards Institute (ANSI). Respirator fit test methods. Document number ANSI/AIHA Z88.10-2001. New York: ANSI; 2001. Available at: http://www.nssn.org/search/DetailResults.aspx?docid=3390418cselnode=. Accessed September 23, 2008.Google Scholar
6. US Department of Health and Human Services (HHS). Interim Guidance on Planning for the Use of Surgical Masks and Respirators in Health Care Settings During an Influenza Pandemic. Washington, DC: HHS; October 2006. Available at: http://www.pandemicflu.gov/plan/healthcare/maskguidancehc.html. Accessed September 23, 2008.Google Scholar
7. Tellier, R. Review of aerosol transmission of influenza A virus. Emerg Infect Dis 2006;12:16571662.CrossRefGoogle ScholarPubMed
8. Brankston, G, Gitterman, L, Hirji, Z, Lemieux, C, Gardam, M. Transmission of influenza A in human beings. Lancet Infect Dis 2007;7:257265.Google Scholar
9. Lemieux, C, Brankston, G, Gitterman, L, Hirji, Z, Gardam, M. Questioning aerosol transmission of influenza. Emerg Infect Dis 2007;13:173174; author reply 174-175.CrossRefGoogle ScholarPubMed
10. Sutton, PM, Nicas, M, Harrison, RJ. Tuberculosis isolation: comparison of written procedures and actual practices in three California hospitals. Infect Control Hosp Epidemiol 2000;21:2832.Google Scholar
11. Cummings, KJ, Cox-Ganser, J, Riggs, MA, Edwards, N, Kreiss, K. Respirator donning in post-hurricane New Orleans. Emerg Infect Dis 2007;13:700707.Google Scholar
12. Coffey, CC, Lawrence, RB, Zhuang, Z, Campbell, DL, Jensen, PA, Myers, WR. Comparison of five methods for fit-testing N95 filtering-facepiece respirators. Appl Occup Environ Hyg 2002;17:723730.Google Scholar
13. Coffey, CC, Lawrence, RB, Zhuang, Z, Duling, MG, Campbell, DL. Errors associated with three methods of assessing respirator fit. J Occup Environ Hyg 2006;3:4452.Google Scholar
14. Coffey, CC, Zhuang, Z, Campbell, DL. Evaluation of the Bitrex qualitative fit test method using N95 filtering-facepiece respirators, J Inter Soc Respir Protect 1998;16:4753.Google Scholar