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A Medical Nebulizer as a Substitute for the OSHA-Approved Nebulizer for Qualitative Fit Testing of Respirators During the Respiratory Infectious Pandemics: An Experimental Feasibility Study

Published online by Cambridge University Press:  24 August 2022

Anahita Fakherpour Open the ORCID record for Anahita Fakherpour [Opens in a new window] ,
Mehdi Jahangiri Open the ORCID record for Mehdi Jahangiri [Opens in a new window]  and
Mozhgan Seif Open the ORCID record for Mozhgan Seif [Opens in a new window]
Anahita Fakherpour
Affiliation:
Student Research Committee, Department of Occupational Health Engineering, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
Mehdi Jahangiri*
Affiliation:
Department of Occupational Health Engineering, Research Center for Health Sciences, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
Mozhgan Seif
Affiliation:
Non-Communicable Diseases Research Center, Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
*
Corresponding author: Mehdi Jahangiri, Emails: jahangiri_m@sums.ac.ir, ja_me59@yahoo.com
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Abstract

Objective:

The qualitative fit testing procedure would be challenging due to severe shortages, high cost, and unavailability of commercial fit test kits in the marketplaces during pandemics of respiratory infectious diseases. Assessment of alternatives for commercial fit test kits to be prepared for emergencies is critically required. This study aimed to investigate the feasibility of an alternative of the Accumed NF60 nebulizer for the Occupational Safety and Health Administration (OSHA)-approved Allegro nebulizer.

Methods:

Thirty-two participants were randomly allocated to 6 filtering facepiece respirators (FFRs). They were qualitatively fit tested by both manual Allegro and automated Accumed NF60 nebulizers.

Results:

There was no statistically significant difference between the Allegro and Accumed NF60 nebulizers by passing rates. The odds for passing fit testing using the Accumed NF60 nebulizer was similar to that of the Allegro one (odds ratio=1.0, 95% confidence interval [0.58-1.74]).

Conclusions:

The Accumed NF60 nebulizer could be used as a cost-benefit substitute for the standard fit test nebulizers in the pandemic situation where there is a shortage and difficulty of access. It is more convenient, decreases the time investment, and reduces the contact stress in the operators’ hands as it does not require squeezing the nebulizer bulb frequently. The test solutions’ preparation and fit testing procedures on many personnel are more straightforward, efficient, and hygienic than the Allegro one.

Keywords

qualitative fit testhealth-care workersmedical nebulizerfiltering facepiece respiratoroccupational health and safety
Type
Original Research
Information
Disaster Medicine and Public Health Preparedness , Volume 17 , 2023 , e259
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of Society for Disaster Medicine and Public Health, Inc.

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References

Jahangiri, M, Neghab, M, Nasiri, G, et al. Respiratory disorders associated with occupational inhalational exposure to bioaerosols among wastewater treatment workers of petrochemical complexes. Int J Occup Environ Med. 2015;6(1):41-49. doi: 10.15171/ijoem.2015.458 CrossRefGoogle ScholarPubMed
Racz, L, Yamamoto, DP, Eninger, RM. Handbook of respiratory protection: Safeguarding against current and emerging hazards. CRC Press; 2017.Google Scholar
ANSI-Z88.10. American National Standards Institute - Respirator Fit testing Methods. New York: American Industrial Hygiene Association. 2010.Google Scholar
EN529. British Standard- Respiratory protective devices – Recommendations for selection, use, care and maintenance – Guidance document European Committee for Standardization, British Standards Institution (BSI). [Standard]; 2005.Google Scholar
OSHA. The Occupational Safety and Health Administration (OSHA) Title 29 CFR.1910.134- Respiratory protection program Standards- Fit Testing Procedures (Mandatory), Washington, Government Publishing Office. 2016.Google Scholar
ISO16975-3. International Organization for Standardization (ISO), Respiratory protective devices-Selection, use and maintenance- Part 3: Fit Testing Procedures. 2017.Google Scholar
Rajhans, G, Pathak, B. Practical guide to respirator usage in industry. Elsevier; 2002.Google Scholar
CDC. The Need for Fit Testing During Emerging Infectious Disease Outbreaks. https://blogs.cdc.gov/niosh-science-blog/2020/04/01/fit-testing-during-outbreaks/. Accessed 6 December, 2021Google Scholar
Lam, SC, Lee, JK, Yau, SY, et al. Sensitivity and specificity of the user-seal-check in determining the fit of N95 respirators. J Hosp Infect. 2011;77(3):252-256. doi:https://doi.org/10.1016/j.jhin.2010.09.034 Google ScholarPubMed
Coffey, CC, Lawrence, RB, Campbell, DL, et al. Fitting characteristics of eighteen N95 filtering-facepiece respirators. J Occup Environ Hyg. 2004;1(4):262-271. doi: 10.1080/15459620490433799 Google ScholarPubMed
Mullins, HE, Danisch, SG, Johnston, AR. Development of a New Qualitative Test for Fit Testing Respirators. Am Ind Hyg Assoc J. 1995;56(11):1068-1073. doi: 10.1080/15428119591016278 Google ScholarPubMed
TSI. Introduction to Respirator Fit Testing. 2015.Google Scholar
Mitchell, BG, Wells, A, McGregor, A, et al. Can homemade fit testing solutions be as effective as commercial products? Heal Infect. 2012;17(4):111-114. doi: https://doi.org/10.1071/HI12019 Google ScholarPubMed
OSHA. Clarification on equivalent test nebulizer for qualitative fit tests, Standard Number: 1910.134. Available: https://www.osha.gov/laws-regs/standardinterpretations/2009-11-13. Accessed December 6, 2021.Google Scholar
Healthcare, D. Model 45 Lexan® Plastic Nebulizer. April 20, 2022. Available: http://www.devilbisshealthcare.com/products/ent-therapy/nebulizers/model-45-lexanr-plastic-nebulizer. Accessed April 20, 2022.Google Scholar
Honarbakhsh, M, Jahangiri, M, Ghaem, H, et al. Qualitative Fit Testing of Medium-Size N95/FFP2 Respirators on Iranian Health Care Workers. Heal Sco 2018;7(4) doi: 10.5812/jhealthscope.62884 Google Scholar
Lin, YC, Chen, CP. Characterization of small-to-medium head-and-face dimensions for developing respirator fit test panels and evaluating fit of filtering facepiece respirators with different faceseal design. PloS one. 2017;12(11):e0188638. doi: 10.1371/journal.pone.0188638 CrossRefGoogle ScholarPubMed
Coffey, CC, Zhuang, Z, Campbell, DL. Evaluation of the Bitrix™ Qualitative Fit Test Method Using N95 Filtering-Facepiece Respirators. Int Soc Resp Prot. 1998;16(1/4):48-55.Google Scholar
Cramer, A, Tian, E, Galanek, M, et al. Assessment of the Qualitative Fit Test and Quantitative Single-Pass Filtration Efficiency of Disposable N95 Masks Following Gamma Irradiation. JAMA network open. May 1 2020;3(5):e209961. doi: 10.1001/jamanetworkopen.2020.9961 CrossRefGoogle ScholarPubMed
Hardis, KE, Cadena, CA, Carlson, GJ, et al. Correlation of qualitative and quantitative results from testing respirator fit. Am Ind Hyg Assoc J. 1983;44(2):78-87. doi: 10.1080/15298668391404419 CrossRefGoogle ScholarPubMed
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 Epidem. 1996;17(10):636-640. doi: 10.1086/647195 CrossRefGoogle Scholar
Fakherpour, A, Jahangiri, M, Yousefinejad, S, et al. Feasibility of replacing homemade solutions by commercial products for qualitative fit testing of particulate respirators: a mixed effect logistic regression study. MethodsX. 2019;6:1313-1322. doi: 10.1016/j.mex.2019.05.034 Google ScholarPubMed
McKay, RT, Davies, E. Capability of respirator wearers to detect aerosolized qualitative fit test agents (sweetener and Bitrex) with known fixed leaks. Appl Occup Environ Hyg. 2000;15(6):479-484. doi: https://doi.org/10.1080/104732200301269 CrossRefGoogle ScholarPubMed
Fakherpour, A, Jahangiri, M, Yousefinejad, S, et al. Assessment of aloe vera for qualitative fit testing of particulate respirators: a logistic regression approach. Ind Health. 2020;58(1):46-53. doi: 10.2486/indhealth.2109-0019 CrossRefGoogle ScholarPubMed
Alison Bowry, H. Effect of hood size on aqualitative fit test 2018. Available: https://www.hsl.gov.uk/media/1270950/hood%20size%20powerpoint.pdf. Accessed 28 September, 2020.Google Scholar
O’Kelly, E, Arora, A, Pearson, C, et al. Performing Qualitative Mask Fit Testing without a Commercial Kit: Fit Testing Which can be Performed at Home and at Work. medRxiv. 2020; doi: 10.1017/dmp.2020.352 Google Scholar
Janssen, LL, Luinenburg, DM, Mullins, HE, et al. Comparison of three commercially available fit-test methods. AIHA J. 2002;63(6):762-767. doi: 10.1080/15428110208984767 Google ScholarPubMed
Coffey, CC, Lawrence, RB, Zhuang, Z, et al. Comparison of five methods for fit-testing N95 filtering-facepiece respirators. Appl Occup Environ Hyg. 2002;17(10):723-730. doi: 10.1080/10473220290107002 Google ScholarPubMed
Hon, C-Y, Danyluk, Q, Bryce, E, et al. Comparison of qualitative and quantitative fit-testing results for three commonly used respirators in the healthcare sector. J Occup Environ Hyg. 2017;14(3):175-179. doi: 10.1080/15459624.2016.1237030 CrossRefGoogle ScholarPubMed
Huang, S-H, Hsu, C-W, Kuo, W-C, Chen, C-W, Chen, C-C. A Study on the Feasibility of Conducting Qualitative Fit Test by Using Pneumatic Medical Nebulizers. J Labor, Occup Safety and Health. 2016;24(3):213-236.Google Scholar
Myong, JP, Byun, J, Cho, Y, et al. The education and practice program for medical students with quantitative and qualitative fit test for respiratory protective equipment. Ind Health. 2016;54(2):177-182. doi: 10.2486/indhealth.2015-0072 Google ScholarPubMed
Jahangiri, M, Oriad, H. Evaluation of half-face respirator fit in an Iranian petrochemical company’s workers. Hormozgan Med J. 01/16 2009;13:41-46.Google Scholar
Accumed. Handheld Piston Accumed NF60 Nebulizer 2019. Available: https://www.accumed.ch/images/products/documents/AM_Epaper_NF60_EN.pdf. Accessed 20 April, 2022Google Scholar
Bitter, Allegro I. (Denatonium Benzoate) Fit Test Kit. 2020. Available: https://www.allegrosafety.com/wp-content/uploads/2017/12/2041-Bitter-Denatonium-Benzoate-Fit-Test-Kit.pdf.Google Scholar
Pompeii, LA, Kraft, CS, Brownsword, EA, et al. Training and Fit Testing of Health Care Personnel for Reusable Elastomeric Half-Mask Respirators Compared With Disposable N95 Respirators. JAMA. 2020;323(18):1849-1852. doi: 10.1001/jama.2020.4806 Google ScholarPubMed
ISO16976-2. International Organization for Standardization (ISO), Respiratory protective devices — Human factors — Part 2: Anthropometrics. 2015.Google Scholar
TSI. Qfit Respirator Fit Tester Manual US - TSI Incorporated. 2010.Google Scholar
SKC. Multi-FIT Tester Qualitative Fit Testing 260-Series. 2010. Available: https://usermanual.wiki/Document/1857.2509215817/view. Accessed September 20, 2020.Google Scholar
Zhang, H, Zanto, W, Shi, Q, et al. Inventors; Google Patents, assignee. Automated qualitative mask fit tester. 2012.Google Scholar
Mullins, HE, Martinson, PA, Johnston, AR. Inventors; Google Patents, assignee. Automated respirator fit testing method and system. 2005.Google Scholar
Li, J. Doctoral Dissertation Academic Year 2018. 2018.Google Scholar
Nelson, T, Janssen, L, Luinenburg, M, et al. Development of an abbreviated qualitative fit test using bitter aerosol. J Int Soc Respir Protect. 2003;20:102-109.Google Scholar