Respiratory Fit Test Program for N95 Mask and Other Tight Fitting Respirators

UTRGV employee wearing a respirator. The Occupational Safety and Health Standards (OSHA) respirator standard, 29 CFR 1910.134, requires the use of respirators to protect employees from breathing contaminated and/or oxygen-deficient air when effective engineering controls are not feasible, or while they are being instituted. Several other OSHA regulations also require the use of respirators. Respirators are selected based on the hazards (particulates, vapors, oxygen-deficiency, or combination) to which the worker is exposed. This may include the use of chemicals that are above the Permissible Exposure Level (PEL) or Short-Term Exposure Level (STEL), or potential exposure to infectious agents during routine patient care (TB; COVID- 19) All personnel who use respiratory protection are required to be fit tested.

The UTRGV Fit Testing Program and the associated training is for those who are required to wear a tight-fitting respirator as required by the nature of their work with UTRGV. Both Qualitative (QLFT) and Quantitative (QNFT) Fit Testing is available to personnel requiring respiratory protection. The main difference between quantitative mask fit testing and qualitative mask fit testing is that quantitative testing objectively measures the amount of leakage (quantity) while qualitative testing relies subjectively on the users taste and smell to detect leakage.

Qualitative Fit Testing

A qualitative fit test (QLFT) relies on the respirator wearer’s senses to determine if there is a gap in the seal of the respirator to the wearer’s face. For the first part of the mask (respirator) fit test a sensitivity test is performed to see if you have a strong or weak sense of taste with the testing agent. Once we know how well you taste the testing solution, you are fitted with a respirator and a seal check is completed. Then, with your mask on, you don a hood into which we will spray the atomized testing solution. While the smell within your hood becomes stronger and stronger, we will help you through a series of exercises designed to test your respirator seal (head movement, talking, breathing, et cetera). If by the end of the exercises you do not detect any of the solution leaking through your respirator, then we can be confident that you have a good seal, and you have the correct respirator! The Qualitative Fit testing process consists of an in-person session which covers the selection of the right style of respirator, fit testing procedures for qualitative fit testing (QLFT) through the use of bitrex or saccharine, completion of a medical evaluation, and proper use of the mask (cleaning, storing, inspecting, donning/doffing, use of glasses/goggles with mask, seal checks, cartridge/filter replacement and other limitations).

Quantitative Fit Testing

A quantitative fit test uses a fit testing instrument(s) to provide quantitative, or numerical, measurements of the amount of face seal leakage present when a user wears a respirator. It uses a machine (called a PortaCount) instead of your sense of smell and/or taste to determine whether or not you have the proper mask size. Quantitative fit testing requires a hole punched in the respirator to perform the test and therefore must dispose of the respirator after the test. This kind of testing is more expensive and time consuming than qualitative fit testing. We do not offer quantitative mask fit testing but have a relationship with a local vendor, if necessary.

Fit testing shall be conducted prior to initial use of the tight fitting respirator and annually thereafter (see validation period below for additional requirements). Pass/Fail results will be scanned and submitted to the supervisor of the individual and each department is responsible for maintaining those records. Those who are seeing patients virtually are exempt from wearing a tight fitting respirator. EHSRM will refer individuals who are unable to taste either testing medium (bitrex/saccharine) to local clinic for quantitative fit testing (QNFT). Fit Testing on students/employees who have facial hair that comes between the sealing surface of the mask and the face.

CDC COVID Guidelines

The CDC recommends the use of PPE including NIOSH approved particulate respirators with N95 or higher to be used for:

All aerosol-generating procedures (refer to "Which procedures are considered aerosol generating procedures in healthcare settings?")
All surgical procedures that might pose higher risk for transmission if the patient has SARS-CoV-2 infection (e.g., that generate potentially infectious aerosols or involving anatomic regions where viral loads might be higher, such as the nose and throat, oropharynx, respiratory tract).
NIOSH Approved particulate respirators with N95 filters or higher can also be used by HCP working in other situations where additional risk factors for transmission are present, such as when the patient is unable to use source control and the area is poorly ventilated. They may also be considered if healthcare-associated SARS-CoV-2 transmission is identified and universal respirator use by HCP working in affected areas is not already in place.
To simplify implementation, facilities in counties with higher levels of SARS-CoV-2 transmission may consider implementing universal use of NIOSH Approved particulate respirators with N95 filters or higher for HCP during all patient care encounters or in specific units or areas of the facility at higher risk for SARS-CoV-2 transmission.

If your job description meets these criteria, you should take the steps to get fit tested.

Environmental Health, Safety & Risk Management