title: Health care workers and respiratory protection: is the user seal check a surrogate for respirator fit-testing?
abstract: Many agencies recommend that health care workers wear N95 filtering facepiece respirators (N95-FFR) to minimize occupational exposure to bioaerosols, such as tuberculosis and pandemic influenza. Published standards outline procedures for the proper selection of an N95-FFR model, including user seal checks and respirator fit-testing. Some health officials have argued that the respirator fit-test step should be eliminated altogether, given its additional time and cost factors, and that only a user seal check be utilized to ensure that an adequate face seal has been achieved. One of the aims of the current study is to examine whether a user seal check is an appropriate surrogate for respirator fit-testing. Subjects were assigned an N95-FFR and asked to perform a user seal check (as per manufacturer's instructions) after which they immediately underwent a respirator fit-test. Successfully passing a respirator fit-test was based on not detecting a leakage through the face seal (either qualitatively with a test agent or quantitatively with a particulate counter). The sample population consisted of 647 subjects who had never been previously fit-tested (naive), while the remaining 137 participants were experienced respirator users. Only four of the 647 naive subjects (0.62%) identified an inadequate seal during their user seal check. Of the 643 remaining naive subjects who indicated that they had an adequate face seal prior to fit-testing, 158 (25%) failed the subsequent quantitative fit-test and 92 (14%) failed the qualitative fit-test. All 137 experienced users indicated that they had an adequate seal after performing the user seal check; however, 41 (30%) failed the subsequent quantitative fit-test, and 30 (22%) failed the qualitative fit-test. These findings contradict the argument to eliminate fit-testing and rely strictly on a user seal check to evaluate face seal.
authors.affiliation: Workplace Health, Fraser Health, Burnaby, BC, Canada. quinn.danyluk@fraserhealth.ca
authors.forename: Quinn
authors.initials: Q
authors.lastname: Danyluk
authors.forename: Chun-Yip
authors.initials: CY
authors.lastname: Hon
authors.forename: Mike
authors.initials: M
authors.lastname: Neudorf
authors.forename: Annalee
authors.initials: A
authors.lastname: Yassi
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Bryce
authors.forename: Bob
authors.initials: B
authors.lastname: Janssen
authors.forename: George
authors.initials: G
authors.lastname: Astrakianakis
mesh_terms: D004867:Equipment Design; D005145:Face / Q000033:anatomy & histology*; D005260:Female; D006282:Health Personnel; D006801:Humans; D008297:Male; D008422:Materials Testing; D008875:Middle Aged; D016273:Occupational Exposure / Q000517:prevention & control*; D011446:Prospective Studies; D012134:Respiratory Protective Devices / Q000592:standards*