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Respirator-Fit Testing: Does It Ensure the Protection of Healthcare Workers Against Respirable Particles Carrying Pathogens? [Chicago Journals]
Infect Control Hosp Epidemiol 2008;29:000?000
? 2008 by The Society for Healthcare Epidemiology of America. All rights reserved.
0899-823X/2008/2912-00XX$15.00
DOI: 10.1086/591860
Original Article
Respirator-Fit Testing: Does It Ensure the Protection of Healthcare Workers Against Respirable Particles Carrying Pathogens?
M. C. Lee, MD;S. Takaya, MD;R. Long, MD;A. M. Joffe, MDFrom the Divisions of Infectious Diseases (M.C.L., A.M.J.) and of Pulmonary Medicine (R.L.), Department of Medicine, University of Alberta, Edmonton, Alberta, and the Division of Infectious Diseases, Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan (S.T.), Canada.
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.
Received January 28, 2008; accepted July 1, 2008; electronically published November 3, 2008.
Address reprint requests to M. C. Lee, MD, University of Alberta Hospital, 2E4.16, Walter C. McKenzie Centre, 8440, 112 Street, Edmonton, AB T6G 2B7, Canada (maocheng@ualberta.ca).
* Presented in part: 2005 Annual Meeting of the Association of Medical Microbiology and Infectious Diseases / Canadian Association for Clinical Microbiology and Infectious Diseases; Ottawa, Canada; April 14?17, 2005; and 15th Annual Meeting of the Society for Healthcare Epidemiology of America; Los Angeles, California; April 9?12, 2005 (Abstract 45).
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<cite cite="http://www.journals.uchicago.edu/doi/abs/10.1086/591860">Chicago Journals - Infection Control and Hospital Epidemiology</cite>
? 2008 by The Society for Healthcare Epidemiology of America. All rights reserved.
0899-823X/2008/2912-00XX$15.00
DOI: 10.1086/591860
Original Article
Respirator-Fit Testing: Does It Ensure the Protection of Healthcare Workers Against Respirable Particles Carrying Pathogens?
M. C. Lee, MD;S. Takaya, MD;R. Long, MD;A. M. Joffe, MDFrom the Divisions of Infectious Diseases (M.C.L., A.M.J.) and of Pulmonary Medicine (R.L.), Department of Medicine, University of Alberta, Edmonton, Alberta, and the Division of Infectious Diseases, Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan (S.T.), Canada.
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.
Received January 28, 2008; accepted July 1, 2008; electronically published November 3, 2008.
Address reprint requests to M. C. Lee, MD, University of Alberta Hospital, 2E4.16, Walter C. McKenzie Centre, 8440, 112 Street, Edmonton, AB T6G 2B7, Canada (maocheng@ualberta.ca).
* Presented in part: 2005 Annual Meeting of the Association of Medical Microbiology and Infectious Diseases / Canadian Association for Clinical Microbiology and Infectious Diseases; Ottawa, Canada; April 14?17, 2005; and 15th Annual Meeting of the Society for Healthcare Epidemiology of America; Los Angeles, California; April 9?12, 2005 (Abstract 45).
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