Contraindications to Respirator Fit Testing
Few absolute medical conditions preclude respirator fit testing, but severe cardiac or pulmonary disease may limit the ability to safely perform the test with negative-pressure respirators. 1
Medical Screening Requirements
Medical evaluation should begin with a general screening questionnaire to identify pertinent conditions, without requiring routine physical examination, chest radiographs, or spirometry. 1
Relative Contraindications for Negative-Pressure Respirator Fit Testing
The following conditions may make fit testing difficult or unsafe with negative-pressure respirators:
- Severe cardiac conditions that would make the increased work of breathing during fit testing exercises potentially dangerous 1
- Severe pulmonary conditions (e.g., severe COPD, restrictive lung disease) where the resistance to airflow during testing could cause respiratory distress 1
- Active respiratory symptoms that would interfere with the ability to perform the required breathing exercises during testing 1
Important Clinical Context
Healthcare workers with mild cardiac or pulmonary conditions may report discomfort during fit testing but are unlikely to experience adverse health effects from the procedure itself. 1 The key distinction is between mild and severe disease—those with more severe conditions may have difficulty performing the physical activities required during fit testing. 1
Physical Barriers to Achieving Adequate Fit
While not medical contraindications to the testing procedure itself, the following factors will prevent achieving an adequate seal and should be addressed before fit testing:
- Facial hair (especially beards) causes 246-330 fold reduction in protection and must be completely removed before testing negative-pressure respirators 2
- Facial characteristics that prevent proper seal (though recent research suggests under-mask beard covers may allow some bearded individuals to pass quantitative fit testing) 3
Alternative Approach for Those Unable to Use Negative-Pressure Respirators
For healthcare workers with severe cardiopulmonary conditions or those who cannot shave facial hair, powered air-purifying respirators (PAPRs) with hoods should be used instead, as these do not require fit testing and reduce facial seal leakage to less than 2-4%. 2, 4, 5
Key Advantages of PAPRs
- No fit testing required for hood-type PAPRs 4
- Protection factor of 20,000 in government testing 4, 5
- May be better tolerated by those with respiratory conditions due to positive pressure assistance 5
- However, the added weight may be problematic for those with severe cardiac conditions 1
Common Pitfalls to Avoid
Do not confuse contraindications to fit testing with contraindications to respirator use. The screening process should occur as infrequently as every 5 years and is designed to identify workers who need further evaluation, not to exclude them from respiratory protection programs. 1 Most healthcare workers can safely undergo fit testing; the goal is to identify the appropriate respirator type for each individual based on their medical status and facial characteristics.