How Senior Care Facilities Can Improve Respirator Fit Testing for Better Staff and Resident Safety

Josh Schulze, product marketing manager, TSI Incorporated

Keeping both staff and residents safe in senior care settings is always a top priority for facilities. Still, the COVID-19 pandemic has further highlighted the importance of effective disease transmission and prevention practices. Respirators have become a key piece of personal protective equipment. Given the close proximity that caregivers interact with residents, respirators are essential for reducing the risk of infection by minimizing the spread of respiratory droplets containing the virus.

However, respirators are only effective when people are trained to properly wear them, the right respirators have been selected and they are properly fit tested. Facilities that don’t implement fit testing into their written respiratory protection program may jeopardize the safety of both staff and patients. For these facilities, the solution could be as simple as implementing the right respirator fit testing method.

Qualitative Fit Tests

There are two primary OHSA-accepted methods for fit testing respirators, qualitative and quantitative testing. Qualitative fit tests operate on a pass/fail basis and depend on the respirator wearer’s senses to detect leakage. These types of fit tests expose the respirator wearer to a bitter or sweet substance called a challenge agent. The threshold at which the respirator wearer can sense the substance, determines if the respirator passes or fails the test. If the substance goes undetected through the various exercises, then it is assumed that the respirator fits correctly without significant leaks and passes the fit test.

Many facilities have used qualitative fit tests for decades. This type of test is widely available and carries a low initial cost. Unfortunately, qualitative fit tests can also leave some uncertainty. Josh Schulze, product marketing manager at TSI Incorporated, explains that qualitative fit tests provide a subjective result, rather than a data-based result.

“It’s a simple pass-fail, so you may not know if you’re just hovering around passing or if you truly have an effective fit,” notes Schulze. “These tests are performed manually, so they’re open to a wide range of variability when conducted. Not only does this method rely on the fit test administrator to perform the test correctly every time, but also that the person being tested will sense the presence of the challenge agent accurately and provide a truthful answer.”

Additionally, qualitative tests can result in lots of trial and error to identify the correct respirator, size of respirator and best fit for staff, as they do not provide data to help pinpoint these issues.

Quantitative Fit Tests

Quantitative fit tests directly measure the quality of a respirator’s fit and supply data to the user. Instead of relying on the wearer’s sense of taste, instruments measure the number of particles outside and inside of a respirator to determine a fit factor ratio that describes the quality of the fit.

Quantitative fit tests offer many benefits over qualitative tests. Quantitative tests are precise and don’t rely on the wearer to judge whether they can detect the test substance. “Quantitative tests are performed by an instrument that returns objective data describing the respirator’s fit to the face,” notes Schulze. “Beyond fit testing, this real-time data can be used to help choose respirators for staff and train staff in how to wear and adjust respirators for maximum protection. Because the testing is automated, it’s always consistent and accurate, so that you can get a better understanding of a respirator’s fit.”

Polly Jennings, marketing communications specialist, TSI Incorporated

This data-driven feedback can have a significant impact on respirator performance. Polly Jennings, marketing communications specialist at TSI Incorporated, explains that the respirator’s seal quality determines its effectiveness.

“With an N95, if you don’t have a good seal on the mask to the face, unwanted particles can get through, reducing that respirator’s effectiveness,” she says. With the scarcity of respirators during the pandemic, proper fit and use of a respirator creates extra peace of mind. “Many facilities are seeing respirators coming in from overseas, and some may be effective while others are not,” says Schulze.

“With quantitative fit testing, you can tell when a poor-quality respirator isn’t performing. It’s an effective way to keep staff safe while also showing them data that proves the respirator is helping to protect them. It can give staff the confidence they need to do their jobs.”

Implementing Effective Fit Testing

To be effective, respirator fit testing must be performed at key times. The Occupational Safety and Health Administration (OSHA) requires that workers be fit tested initially before they are required wear a respirator in the workplace. OSHA notes that staff must be retested annually (at least every 12 months) to ensure continued appropriate respirator fit. It is also critical to re-test whenever a wearer receives a new brand or size of respirator. Not all respirators will fit the same, due to differences in their designs.

Additionally, changes in staff physical condition, like significant weight gain or loss, major dental work, facial surgery that alters the face’s shape, or significant facial scarring in the area of the respirator seal, warrant a repeated fit test.

If a facility is still using qualitative methods, now is the time to transition to quantitative fit testing. Schulze notes that many healthcare facilities have sought better, faster, and more accurate fit testing since the start of the pandemic, and quantitative tests deliver on all three of these qualities.

TSI’s PortaCount® Respirator Fit Tester is designed to deliver the ease of use, versatility, and detailed data that senior care facilities need. These quantitative fit testers allow the fit test administrator to test any respirator, including any N95. “They also allow a facility to take advantage of OSHA’s new modified condensation nuclei counter (CNC) testing protocols that streamline the fit testing process,” explains Schulze. PortaCount® Fit Testers deliver real-time data detailing respirator fit, including how that fit changes with movement or adjustments. Plus, with the ability to complete a test in under two and a half minutes, they are efficient and ideal for busy or large facilities.

An Investment in Staff and Resident Safety

When a facility invests in quantitative fit testing, it’s investing in its staff and residents’ safety. With real-time data, staff can see and confirm that their respirators fit and can protect them effectively. With this peace of mind, staff can better focus on their jobs and the residents they care for.

Paige Cerulli

Paige Cerulli is a contributing writer to i Advance Senior Care.