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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 ,
S. Takaya ,
R. Long  and
A. M. Joffe
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 ([email protected])
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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
Information
Infection Control & Hospital Epidemiology , Volume 29 , Issue 12 , December 2008 , pp. 1149 - 1156
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2008

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