Respirator-fit testing: does it ensure the protection of healthcare workers against respirable particles carrying pathogens?
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).


METHODS
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 achieve 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.
Lee
M C
MC
Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. maocheng@ualberta.ca
Takaya
S
S
Long
R
R
Joffe
A M
AM
D015331:Cohort Studies; D004867:Equipment Design / Q000379:methods; D006282:Health Personnel / Q000193:education / Q000706:statistics & numerical data*; D019570:Inhalation Exposure / Q000517:prevention & control*; D016273:Occupational Exposure / Q000517:prevention & control*; D011446:Prospective Studies; D012134:Respiratory Protective Devices / Q000592:standards / Q000706:statistics & numerical data*; D012141:Respiratory Tract Infections / Q000517:prevention & control*; D013997:Time Factors