Fit-Testing Programs Challenged by Operational Issues

Researchers from the University of Adelaide and the Communicable Disease Control Branch of the Department of Health in South Australia say that while the medical literature supports the need for practical training in the use of personal protective equipment (PPE), theoretical knowledge to do so is often insufficient. They point to the mandate by the U.S. Occupational Safety and Health Administration (OSHA)s Respiratory Protection Standard (29 CFR 1910.134) to fit-test and train workers in proper donning and doffing of respirators and to check the facial seal.

Ahmad, et al. (2010) say that the numerous organizational issues, barriers and facilitating factors involved in implementing a respirator fit-testing (RFT) program for a large healthcare workforce have not been reported, especially from the perspective of those implementing the program. The researchers report on   a largescale, quantitative RFT program implemented by the South Australian Department of Health from October 2006 through July 2007 as part of its pandemic influenza response planning. The program fit-tested nearly 6,000 frontline healthcare workers using TSI PortaCount Plus instruments and with different brands of disposable P2 or N95 respirators. Three-dozen fittesters with nursing backgrounds were recruited and trained, and conducted oneonone fit-testing of participating healthcare workers.

Ahmad, et al. (2010) report that study participants thought broad stakeholder communication was lacking in the program, and explain, Although the department of health secured the support of the upper management of hospitals, fittesters believed that little was done to raise general staff awareness prior to the rollout of the RFT program. Consequently, some testers reported resistance from particular ward directors and some healthcare workers, notably doctors. Because RFT programs may not seem to be a highpriority activity, prior communication and education of middle management and healthcare workers is essential to motivate them to participate. The researchers point to other studies in which it was found that healthcare workers are more likely to use PPE if key individuals expect them to do so.

Challenges to fit-testing programs identified by Ahmad, et al. (2010) include operational matters, program budgeting, time pressures with regard to equipment acquisition, coordination of healthcare units, recruitment and training of fittesters, performance of fit-tests, and compilation and analysis of data from multiple sites.

Reference: Ahmad J, Dino Pisaniello D and Wilkinson IJ. Organizational Issues in Implementation of a LargeScale, Quantitative Respirator Fit-Testing Program. Infect Control Hosp Epidemiol. 2010;31:971-972.