Korean J healthc assoc Infect Control Prev.  2024 Dec;29(2):137-145. 10.14192/kjicp.2024.29.2.137.

Evaluation of N95 Respirator Fit Changes in Nurses Working in High-risk Airborne Infection Units

• Han SH
• Cha KS
• Lee H
• Choung Y

• KMID: 2563519
• DOI: http://doi.org/10.14192/kjicp.2024.29.2.137

Abstract

Background
Healthcare workers (HCWs) face an increased risk of airborne infections owing to close patient contact and extended shifts. N95 respirators require routine fit testing to ensure effective protection. This study assessed the fit stability of N95 masks among nurses working in airborne infection units, using annual fit tests to observe changes over time.
Methods
From May 2020 to January 2023, 37 nurses from the high-risk airborne infection units of a university hospital participated in this study. The fit tests followed the Occupational Safety and Health Administration’s Quantitative Fit Testing protocol, and non-parametric statistical analyses were applied. Nurses received formal annual training on N95 mask use and individualized guidance before each fit test.
Results
In the initial test, 46.0% passed; of these, 15 consistently passed the second test (Group 1, Pass-Pass) and 2 failed (Group 2, Pass-Fail). No significant associations were found between demographic or job factors and the fit test outcomes. Average fit scores decreased from 100.79 (±58.22) initially to 32.25 (±66.54) in the second test, showing variability.
Conclusion
Ongoing training and experience improved fit consistency over time, emphasizing the importance of regular education. Rather than testing annually, targeted testing when selecting a new respirator or performing subsequent facial changes may enhance the protection of HCWs and reduce costs.

Keyword

Communicable disease; Infections; Respiratory; Respiratory protective devices; Transmission

Figure

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  Fig. 1 Changes fit factors of N95 mask. 1, Normal breathing; 2, Deep breathing; 3, Turning head side to side; 4, Moving head up and down; 5, Talking; 6, Bending over; 7, Normal breathing.

Reference

1. Korean Society for Healthcare-associated Infection Control and Prevention. 2023. Healthcare-associated infection control and prevention. Koonja.

2. Korea Disease Control and Prevention Agency (KDCA). 2024. Annual report on the notified tuberculosis in Korea, 2023. KDCA.

3. Korea Disease Control and Prevention Agency (KDCA). 2024. Annual report on the notified infectious diseases in Korea, 2023. KDCA.

4. Korea Disease Control and Prevention Agency (KDCA). 2023. Guidelines for infection control in the intensive care unit. 2nd ed. KDCA.

5. Korea Disease Control and Prevention Agency (KDCA). Korean Society for Healthcare-associated Infection Control and Prevention. 2017. Guidelines for prevention and control of Healthcare associated infections. KDCA.

6. Han SH, Cha KS, Yoo SY, Han JO. 2021; Comparison of N95 respiratory mask fit testing. Korean J Healthc assoc Infect Control Prev. 26:108–14. https://doi.org/10.14192/kjicp.2021.26.2.108. DOI: 10.14192/kjicp.2021.26.2.108.

7. National Institute of Food and Drug Safety Evaluation. 2020. Medical respiratory protective equipment approval and review guidelines (guideline for applicants). Available from: https://nifds.go.kr/brd/m_15/view.do?seq=12906&srchFr=&srchTo=&srchWord=&srchTp=&itm_seq_1=0&itm_seq_2=0&multi_itm_seq=0&company_cd=&company_nm=&page=1. updated Oct 28; cited 2024 Oct 1.

8. Zhuang Z, Bradtmiller B, Shaffer RE. 2007; New respirator fit test panels representing the current U.S. civilian work force. J Occup Environ Hyg. 4:647–59. https://doi.org/10.1080/15459620701497538. DOI: 10.1080/15459620701497538. PMID: 17613722.

9. National Institute for Occupational Safety and Health. 2015. Hospital respiratory protection program toolkit: resources for respirator program administrators. DHHS (NIOSH) publication number;Available from: https://doi.org/10.26616/NIOSHPUB2015117revised042022. updated 2022 Apr; cited 2024 Oct 1. DOI: 10.26616/NIOSHPUB2015117revised042022.

10. Korea Occupational Safety & Health Agency (KOSHA). 2020. Guidelines for the use of respiratory protective equipment (KOSHA guide). Available from: https://www.moel.go.kr/local/seoulbukbu/news/notice/noticeView.do;jsessionid=8uqQBog1xxBmkOUjhvuDPOtghqBXdmO3MrA28mJM3FofbTkNVXFp3eCnNK7hfa1d.moel_was_outside_servlet_wwwlocal?bbs_seq=20201000503. updated Oct 15; cited 2024 Oct 1.

11. Seo H, Kwon Y, Myong JP, Kang B. 2021; Fit comparison of domestic N95 medical masks in a fit test. J Korean Soc Occup Environ Hyg. 31:94–104. https://doi.org/10.15269/JKSOEH.2021.31.1.94.

12. Kim H, Baek JE, Seo HK, Lee JE, Myong JP, Lee SJ, et al. 2014; Comparison of fit factor for healthcare workers before and after training with the N95 mask. J Korean Soc Occup Environ Hyg. 24:528–35. https://doi.org/10.15269/JKSOEH.2014.24.4.528. DOI: 10.15269/JKSOEH.2014.24.4.528.

13. Or P, Chung J, Wong T. 2012; Does training in performing a fit check enhance N95 respirator efficacy? Workplace Health Saf. 60:511–5. https://doi.org/10.1177/216507991206001202. DOI: 10.1177/216507991206001202. PMID: 23210700.

14. Ng I, Kave B, Begg F, Bodas CR, Segal R, Williams D. 2022; N95 respirators: quantitative fit test pass rates and usability and comfort assessment by health care workers. Med J Aust. 217:88–93. https://doi.org/10.5694/mja2.51585. DOI: 10.5694/mja2.51585. PMID: 35645035. PMCID: PMC9347558.

15. Milosevic M, Kishore Biswas R, Innes L, Ng M, Mehmet Darendeliler A, Wong A, et al. 2022; P2/N95 filtering facepiece respirators: results of a large-scale quantitative mask fit testing program in Australian health care workers. Am J Infect Control. 50:509–15. https://doi.org/10.1016/j.ajic.2021.12.016. DOI: 10.1016/j.ajic.2021.12.016. PMID: 34971710. PMCID: PMC8767955.

16. TSI Incorporated. 2017. Portacount® Pro 8030 and Portacount® Pro+ 8038 respirator fit testers: operation and service manual. TSI Incorporated.

17. Louisiana Department of Health and Hospitals. 2009. KimberlyClark qualitative fit testing instructions. Available from: https://ldh.la.gov/assets/oph/Center-PHCH/Center-CH/infectious-epi/InfectionControl/FitTesting2009.pdf. updated 2009 Nov 16; cited 2024 Oct 1.

18. Zhuang Z, Groce D, Ahlers HW, Iskander W, Landsittel D, Guffey S, et al. 2008; Correlation between respirator fit and respirator fit test panel cells by respirator size. J Occup Environ Hyg. 5:617–28. https://doi.org/10.1080/15459620802293810. DOI: 10.1080/15459620802293810. PMID: 18666022.

19. Wilkinson IJ, Pisaniello D, Ahmad J, Edwards S. 2010; Evaluation of a large-scale quantitative respirator-fit testing program for healthcare workers: survey results. Infect Control Hosp Epidemiol. 31:918–25. https://doi.org/10.1086/655460. DOI: 10.1086/655460. PMID: 20658919.

20. Zhuang Z, Bergman M, Brochu E, Palmiero A, Niezgoda G, He X, et al. 2016; Temporal changes in filtering-facepiece respirator fit. J Occup Environ Hyg. 13:265–74. https://doi.org/10.1080/15459624.2015.1116692. DOI: 10.1080/15459624.2015.1116692. PMID: 26576713. PMCID: PMC5505322.

21. McMahon E, Wada K, Dufresne A. 2008; Implementing fit testing for N95 filtering facepiece respirators: practical information from a large cohort of hospital workers. Am J Infect Control. 36:298–300. https://doi.org/10.1016/j.ajic.2007.10.014. DOI: 10.1016/j.ajic.2007.10.014. PMID: 18455051. PMCID: PMC7115286.

22. Oestenstad RK, Bartolucci AA. 2010; Factors affecting the location and shape of face seal leak sites on half-mask respirators. J Occup Environ Hyg. 7:332–41. https://doi.org/10.1080/15459621003729909. DOI: 10.1080/15459621003729909. PMID: 20379896.

23. Green S, Gani A, Bailey M, Brown O, Hing CB. 2021; Fit-testing of respiratory protective equipment in the UK during the initial response to the COVID-19 pandemic. J Hosp Infect. 113:180–6. https://doi.org/10.1016/j.jhin.2021.04.024. DOI: 10.1016/j.jhin.2021.04.024. PMID: 33940089. PMCID: PMC8087583.

24. Santrock JW. 2019; Educational psychology. Sigmapress,. 1–544.

25. Regli A, Sommerfield A, von Ungern-Sternberg BS. 2021; The role of fit testing N95/FFP2/FFP3 masks: a narrative review. Anaesthesia. 76:91–100. https://doi.org/10.1111/anae.15261. DOI: 10.1111/anae.15261. PMID: 32932556.

26. Regli A, von Ungern-Sternberg BS. 2020; Fit testing of N95 or P2 masks to protect health care workers. Med J Aust. 213:293–5.e1. https://doi.org/10.5694/mja2.50764. DOI: 10.5694/mja2.50764. PMID: 32893356.

27. Fakherpour A, Jahangiri M, Jansz J. 2023; A systematic review of passing fit testing of the masks and respirators used during the COVID-19 pandemic: part 1-quantitative fit test procedures. PLoS One. 18:e0293129. https://doi.org/10.1371/journal.pone.0293129. DOI: 10.1371/journal.pone.0293129. PMID: 37883443. PMCID: PMC10602271.

28. Occupational Safety and Health Administration. 1910. Occupational safety and health standards. 1910 Subpart I: personal protective equipment (1910.134). Available from: https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.134. updated 2006 Aug 24; cited 2024 Apr 23.

29. Yassi A, Moore D, Fitzgerald JM, Bigelow P, Hon CY, Bryce E. BC Interdisciplinary Respiratory Protection Study Group. 2005; Research gaps in protecting healthcare workers from SARS and other respiratory pathogens: an interdisciplinary, multi-stakeholder, evidence-based approach. J Occup Environ Med. 47:41–50. https://doi.org/10.1097/01.jom.0000150207.18085.41. DOI: 10.1097/01.jom.0000150207.18085.41. PMID: 15643158. PMCID: PMC4880470.