From the Guidelines
Healthcare providers should undergo N95 respirator fit testing at least annually, with additional testing required whenever there are changes that could affect the fit, as mandated by OSHA regulations and supported by the most recent evidence from 2020 1. The importance of proper fit testing for N95 respirators cannot be overstated, as it directly impacts the effectiveness of the respirator in filtering out airborne pathogens, including SARS-CoV-2. According to the 24th Collegium Ramazzini statement, a NIOSH-certified N95 Filtering Facepiece Respirator (FFR) is the minimal level of respiratory PPE required to protect workers against COVID-19 infection, and proper fit is essential for its effectiveness 1. Key points to consider include:
- Initial fit testing should be performed before first use of an N95 respirator
- Annual retesting is necessary to ensure continued proper fit and protection
- Additional fit testing is required if the healthcare provider experiences physical changes, such as significant weight loss or gain, major dental work, facial surgery, or scarring in the face/neck area
- A new fit test is also required when switching to a different N95 model or size The fit test verifies that the respirator creates an adequate seal against the wearer's face, preventing unfiltered air from entering through gaps, and healthcare facilities typically have respiratory protection programs that coordinate and document these fit testing requirements 1.
From the Research
Frequency of N95 Fit Tests
The frequency of N95 fit tests for healthcare providers is not explicitly stated in the provided studies. However, the studies suggest that fit testing is an important aspect of ensuring the proper fit of respirators for individual healthcare workers.
Importance of Fit Testing
- Fit testing is recommended to ensure a proper fit of respirators for individual healthcare workers 2
- Fit testing has a high educational value and is best performed as part of a hospital respiratory protection programme 2
- Formal fit testing does not predict future adequacy of fit, unless frequent, routine use is made of the respirator 3
Factors Affecting Fit Test Results
- Respirator shape can affect fit test results, with three-piece flat-fold respirators having lower failure rates than duckbill-shaped respirators 4
- Demographic characteristics, such as gender and ethnicity, can also affect fit test results, with female and Asian healthcare workers having lower initial fit pass rates 2
- Training on wearing an N95 or higher respirator can improve the protection performance of respirators among healthcare providers 5
Limitations of Fit Testing
- Fit testing is not performed consistently within all healthcare settings 2
- The utility of fit testing among infrequent users of N95 respirators is questionable 3
- Fit testing may not be necessary for healthcare workers who use respirators frequently, as they may be able to achieve a proper fit through routine use 3