By Richard B. Jaffe
Despite the fact that respirators are worn by more than 5 million U.S. workers at more than 1.3 million worksites across the county, mandatory face-fit testing remains an enigma; an enormous challenge faced on a regular basis by already over-burdened healthcare facilities. Yet little if anything has been done in the name of confronting this challenge. Rather than attempting to meet it head-on, respirator manufacturers and healthcare providers alike have instead chosen to quietly accept it as a necessary evil. Simply put, when it comes to the development, sale and purchase of N95 respirators, fit-testing is the elephant in the room.
At minimum, the fit-testing process costs healthcare facilities valuable time, money and human resources. At worst, however, it can stop innovation dead in its tracks, as the mere thought of having to conduct fit testing is often enough to discourage healthcare providers from embracing the latest advancements in N95 respirator technology. Yet fit testing is mandatory for a reason, and a good one at that: It ensures that healthcare workers are getting the protection they need when they put their trust in an N95 respirator.
For too long, the response from both sides of the industry to this unique challenge has been no response at all. In order to kick the elephant out of the room once and for all, this has to change. Healthcare providers and respirator manufacturers must work together to meet the challenges of fit testing head-on. By doing so, we can make fit testing less burdensome than ever before, in the process enabling a new wave of next-generation, N95 respirators to make their way into the marketplace and deliver a cutting-edge brand of respiratory protection to the nation’s healthcare workers.
The Fit-Test Basics
Required by the Occupational Safety and Health Administration (OSHA), fit-testing is a process used to determine whether a given product provides an adequate seal around the wearer’s face. It must be conducted before a new respirator can be worn in a workplace setting for the first time. There are two methods healthcare facilities can use to conduct fit-testing. The first, referred to as quantitative fit-testing, is a process in which a computerized system known as a PortaCount is used to measure the number of ambient particles inside and outside of a given respirator after it has been properly donned by the wearer.
Though effective, the time and money required to conduct quantitative fit-testing makes it an unrealistic option for most healthcare facilities. Most facilities instead choose to conduct qualitative fit-testing, a process in which atomized sweetener or bitrex is sprayed into a hood that has been placed over the wearer’s head. If after performing a series of activities, the wearer cannot taste or smell the testing agent, the respirator is deemed to have achieved an adequate seal and is approved for that individual.
A Considerable Set of Challenges
Though generally less expensive and less time consuming than its quantitative counterpart, qualitative fit-testing still represents a significant burden for healthcare facilities, according to renowned fit-testing expert Dr. Warren Myers, professor and associate dean for academic affairs at the West Virginia University College of Engineering and Mineral Resources.
"Qualitative fit-testing is one of the single biggest administrative challenges hospitals face," said Myers. "Any employee whose job requires them to wear an N95 respirator must undergo testing. For larger healthcare facilities, this means having to devote the time and resources to test thousands of employees. More importantly, the time those employees spend getting fit tested is time they aren’t spending caring for patients."
Depending on the size of the healthcare facility, qualitative fit-testing can take days if not weeks, and the costs, real or intangible, can pile up quickly. For starters, a healthcare facility needs to purchase the extra respirators needed conducting fit-testing. But that’s the easy part, according to Myers.
"The hard part is determining who is going to physically conduct the testing," Myers added. "If you have internal staff members conduct it, you’re taking important workers away from their jobs for a significant length of time. If you hire temporary workers to do it, you’re incurring another additional cost, often a considerable one. And in either case, the individuals assigned to conduct fit testing will likely need some degree of training before they can begin."
Adding to the challenge for healthcare facilities is the fact that not all N95 respirators are donned the same way. Moreover, those individuals conducting qualitative fit-testing have usually not received formal training with regard to the specific donning instructions for a given product, and an improperly donned respirator can lead directly to a failed fit-test.
Whether caused by poor donning technique, poor respirator design, or both, failed fit tests are not without consequence. For an individual healthcare facility, a failed fit test means having to purchase a new respirator for each employee unable to achieve a satisfactory fit with a given model. For larger entity such as state of California, low fit-testing success rates meant having to order a major recall of its stockpile of 3M 800 respirators. In either case, time, money and human resources are wasted.
