Respiratory Protection Equipment Fit Testing

Purpose and Importance

The Centers for Disease Control and Prevention recommends that a fit test is an essential procedure to determine if a specific respirator fits a healthcare worker's face, evaluating facial seal leaks using qualitative or quantitative methods 1
The Occupational Safety and Health Administration requires fit testing to detect facial seal leaks, which is the critical point of failure in respirators with HEPA filters, as the filter efficiency is effectively 100% 1, 2
Fit testing identifies the appropriate respirator for each worker, as it may be necessary to try several devices to find the one that offers the best fit 1
Fit testing reduces exposure to infectious aerosols, as disposable cup-shaped respirators can have 0-20% facial leakage without proper fit testing 3

Qualitative fit testing (QLFT) is based on the subjective response of the healthcare worker being evaluated, using aerosolized substances that can be tasted to detect leaks 1, 2
Quantitative fit testing (QNFT) uses detectors to objectively measure leakage into the respirator, and is more reliable and objective than QLFT 1, 2

Fit testing only detects leaks at the time of the test and cannot predict fit during actual use 1
Fit testing does not distinguish between facial seal leakage and filter leakage 1
The initial pass rates for fit testing vary between 40-90%, with lower rates for female and Asian healthcare workers 1

Factors that affect facial seal include incorrect size or shape of the face piece, beard growth, facial sweat or oils, not using all head straps, incorrect positioning on the face, and inadequate maintenance or damage to the respirator 3
Respirators of a single size produce more leakage in individuals with smaller or harder-to-fit faces 4, 5
Reusable and positive-pressure respirators are available in up to three different sizes, improving fit 4, 5

The Occupational Safety and Health Administration recommends fit testing as it is required by respiratory protection standards 1, 3

The respirator must achieve a facial seal leakage of less than or equal to 10% to pass the test, as recommended by the Centers for Disease Control and Prevention (CDC) and reported in the MMWR Recommendations and Reports 6

Workers with initial fit factors greater than 200 typically demonstrate better protection during simulated activities, although this specific fact is not directly cited, a related guideline from the Occupational Safety and Health Administration (OSHA) implies the importance of proper fit testing in ensuring respirator effectiveness 6

The Centers for Disease Control and Prevention (CDC) recommends that respirators achieve a facial seal leakage of less than or equal to 10% to pass the fit test 7

Powered Air-Purifying Respirators (PAPRs) with hoods do not require fit testing and generally provide higher levels of protection than standard air-purifying respirators, with a protection factor of 20,000 in government tests 7

The American National Standards Institute recommends using powered air-purifying respirators (PAPR) with hoods, which do not require fit testing and provide higher levels of protection with a protection factor of 20,000 in government tests 8

The Occupational Safety and Health Administration (OSHA) requires mandatory fit testing to be performed by qualified personnel before the initial use of the respirator, and the test must be repeated annually or when there are changes in the worker's facial characteristics that may affect the fit 8