Mask Fit Testing FAQs

According to Australian standards (AS/NZS 1715:2009), mask fit testing should be conducted at least annually for all staff who are required to wear respiratory protection. Additionally, testing should be repeated if there are significant changes to the wearer's facial features (such as weight loss/gain, dental work, or facial surgery) or if a different make, model, or size of respirator is introduced.

The Aged Care Quality Standards also require that staff are properly trained and equipped to prevent and control infection, which includes proper respiratory protection when necessary.

Reference: AS/NZS 1715:2009 Selection, use and maintenance of respiratory protective equipment, Section 8.5.2 - Repeat fit testing.

Qualitative fit testing is a pass/fail test that relies on the wearer's sensory detection of a test agent (such as saccharin or Bitrex). The test subject wears a hood over their head and shoulders while wearing the respirator, and a test solution is sprayed into the hood. If the subject can taste the solution, the test is failed.

Quantitative fit testing uses specialized equipment (such as a PortaCount) to measure the actual amount of leakage into the respirator, providing a numerical fit factor. This method is more objective and provides a specific measurement of how well the respirator fits.

For healthcare settings, especially in high-risk environments like aged care during infectious disease outbreaks, quantitative testing is generally preferred for its objective measurements and higher accuracy.

Reference: AS/NZS 1715:2009 Selection, use and maintenance of respiratory protective equipment, Section 8.5 - Fit testing methods.

A proper mask fit test typically involves the following steps:

1. Medical screening to ensure the staff member can safely wear a respirator
2. Selection of appropriate respirator type and size
3. Training on proper donning, wearing, and doffing procedures
4. Performing a user seal check
5. Conducting the actual fit test (either qualitative or quantitative)
6. For quantitative testing, this includes performing a series of exercises while measurements are taken:
   • Normal breathing
   • Deep breathing
   • Turning head side to side
   • Moving head up and down
   • Talking (reading a passage or counting)
   • Bending over or jogging in place
   • Normal breathing again
7. Documentation of test results

Reference: AS/NZS 1715:2009 Selection, use and maintenance of respiratory protective equipment, Section 8.5.4 - Test exercises.

The duration of a fit test can vary depending on several factors, but typically:

• A qualitative fit test usually takes about 15-20 minutes per person, including preparation and instruction.
• A quantitative fit test typically takes 20-30 minutes per person, including setup and the testing protocol.
• If multiple respirator models need to be tested to find a suitable fit, the process will take longer.

For planning purposes, facilities should allocate approximately 30 minutes per staff member for the complete process, which includes the initial training, documentation, and the actual testing procedure.

It's important to note that this time investment is essential for ensuring proper protection and compliance with health and safety regulations.

A user seal check is a procedure performed by the respirator wearer each time they put on the respirator to determine if it is properly seated on the face. It is not a substitute for a fit test.

Key differences between a user seal check and a fit test:

A proper user seal check involves checking for air leakage around the edges of the respirator by either creating negative pressure (inhaling) or positive pressure (exhaling) while covering the filter or exhalation valve.

Reference: AS/NZS 1715:2009 Selection, use and maintenance of respiratory protective equipment, Section 8.4 - User seal check.

Several factors can influence the results of a respirator fit test:

• Facial hair: Even a day's stubble can significantly compromise the seal between the respirator and the face.
• Facial features: Scars, deep creases, very prominent cheekbones, or deep skin folds around the nose or chin can affect fit.
• Weight changes: Significant weight gain or loss can alter facial dimensions and affect fit.
• Dental changes: New dentures, loss of teeth, or dental procedures can change facial structure.
• Jewelry or piercings: Facial piercings in the seal area can interfere with proper fit.
• Makeup: Heavy makeup can affect the seal between the respirator and skin.
• Eyewear: Glasses or goggles that interfere with the respirator straps or seal.
• Improper donning: Not following the correct procedure for putting on the respirator.
• Respirator condition: Damaged, dirty, or worn-out respirators may not seal properly.
• Movement: Excessive talking or facial movements during the test can break the seal.

It's important to control for these factors both during fit testing and in daily use to ensure proper protection.

Reference: AS/NZS 1715:2009 Selection, use and maintenance of respiratory protective equipment, Section 8.3 - Factors affecting facial seal.

For compliance purposes, aged care facilities should maintain comprehensive records of fit testing for each employee. These records should include:

• Employee name, ID number, and job position
• Date of the fit test
• Type of test performed (qualitative or quantitative)
• Specific make, model, style, and size of respirator tested
• Result of the test (pass/fail or fit factor measurement)
• Name and qualification of the person conducting the test
• Expiration date for the current fit test
• Any issues or notes relevant to the testing process

These records should be kept for at least the duration of employment plus 30 years according to Work Health and Safety record-keeping requirements. Records should be readily accessible for inspection by regulatory authorities and during accreditation reviews.

Additionally, facilities should maintain documentation of their overall respiratory protection program, including policies, procedures, training records, and respirator maintenance logs.

Reference: Work Health and Safety Regulations 2011, Regulation 444 - Retention of records.

The primary Australian standards governing respirator fit testing and respiratory protection in healthcare settings include:

• AS/NZS 1715:2009 - Selection, use and maintenance of respiratory protective equipment
  • This is the main standard that outlines requirements for fit testing procedures, respiratory protection programs, and proper use of respirators
  • Section 8 specifically addresses fit testing requirements and methodologies
• AS/NZS 1716:2012 - Respiratory protective devices
  • This standard specifies performance requirements and testing methods for respiratory protective devices
  • It classifies different types of respirators and their protection levels

Additionally, aged care facilities must comply with:

• Aged Care Quality Standards - Particularly Standard 3 (Personal Care and Clinical Care) and Standard 8 (Organizational Governance), which require appropriate infection control measures
• Work Health and Safety Act 2011 and associated regulations, which mandate that employers provide a safe working environment, including appropriate personal protective equipment
• Australian Guidelines for the Prevention and Control of Infection in Healthcare (NHMRC) - Provide guidance on respiratory protection in healthcare settings

Compliance with these standards is essential not only for regulatory requirements but also to ensure the safety of both staff and residents in aged care facilities.

Mask fit testing is directly relevant to several aspects of the Aged Care Quality Standards:

During accreditation assessments, aged care facilities may be required to demonstrate their respiratory protection program, including fit testing procedures, records, and staff training. Failure to maintain appropriate respiratory protection measures could result in non-compliance findings during quality assessments.

Reference: Aged Care Quality Standards, Guidance and Resources for Providers to support the Aged Care Quality Standards.

To conduct mask fit testing in aged care facilities, individuals should have appropriate training and qualifications. While Australia does not have a specific national certification program for fit testers, the following qualifications are generally accepted:

• Formal training: Completion of a recognized respirator fit testing course that covers both theoretical knowledge and practical skills in conducting fit tests according to AS/NZS 1715:2009
• Manufacturer training: Training provided by the manufacturer of the fit testing equipment being used
• Occupational hygienists with experience in respiratory protection
• Infection control practitioners with specific training in respiratory fit testing
• Occupational health and safety professionals with respiratory protection expertise

The person conducting fit testing should be able to demonstrate:

• Knowledge of respiratory hazards and appropriate protection
• Understanding of different respirator types and their limitations
• Proficiency in the specific fit testing method being used (qualitative or quantitative)
• Ability to properly maintain and calibrate testing equipment
• Skills in interpreting test results and troubleshooting fit problems
• Knowledge of documentation requirements

Many aged care facilities choose to engage external specialized service providers who have the expertise, equipment, and experience to conduct fit testing efficiently and in compliance with all relevant standards.

Non-compliance with respirator fit testing requirements can have several serious consequences for aged care facilities:

• Regulatory penalties: Under Work Health and Safety legislation, facilities can face significant fines for failing to provide appropriate personal protective equipment and training
• Accreditation issues: Non-compliance with Aged Care Quality Standards related to infection control and staff training can result in sanctions, including potential loss of accreditation
• Increased infection risk: Without proper fit testing, respirators may not provide adequate protection, potentially leading to respiratory infections among staff and residents
• Outbreak vulnerability: Facilities with inadequate respiratory protection programs are more vulnerable during infectious disease outbreaks
• Workers' compensation claims: Staff who contract work-related respiratory infections due to inadequate protection may file workers' compensation claims
• Legal liability: Potential civil liability if residents or staff become ill due to negligence in providing proper respiratory protection
• Reputational damage: Public awareness of non-compliance can damage the facility's reputation and trust within the community

The COVID-19 pandemic has heightened scrutiny of infection control measures in aged care, with several government inquiries highlighting the importance of proper PPE use, including fit-tested respirators for staff caring for residents with suspected or confirmed respiratory infections.

Investing in a comprehensive respiratory protection program, including regular fit testing, is not only a regulatory requirement but also a critical component of protecting both staff and vulnerable residents.

Quantitative fit testing requires specialized equipment to measure the seal between the respirator and the wearer's face. The main components include:

• Fit testing device: The most commonly used device in healthcare settings is the PortaCount Respirator Fit Tester, which measures particle concentrations inside and outside the respirator to calculate a fit factor
• Probe adapters: Special adapters that allow sampling from inside the respirator without compromising the seal
• Sampling tubes: Twin tubes that connect the respirator to the testing device
• Particle generator: Some systems require a particle generator (such as a salt aerosol generator) to ensure sufficient particles for accurate measurement
• Computer or dedicated control unit: To run the testing software, control the test protocol, and record results
• Calibration equipment: To ensure the accuracy of the testing device
• Probed respirators or fit test adapters: Respirators modified with sampling ports or adapters that allow for sampling without modifying the respirator

Additional supplies needed include:

• Alcohol (typically 99% isopropyl) for PortaCount systems
• Various sizes and models of respirators for testing
• Cleaning supplies for equipment and respirators
• Documentation materials (forms, cards, database)

Due to the specialized nature and cost of this equipment (a PortaCount system can cost $15,000-$20,000), many aged care facilities choose to use external service providers for quantitative fit testing rather than purchasing their own equipment.

Qualitative fit testing requires less specialized equipment than quantitative testing, making it more accessible for facilities with budget constraints. The basic equipment includes:

• Test hood: A clear plastic enclosure that fits over the head and shoulders of the test subject
• Nebulizer(s): Used to generate an aerosol of the test solution
• Test solutions: Depending on the testing protocol, one of the following is used:
  • Saccharin solution (sweet taste)
  • Bitrex solution (bitter taste)
  • Isoamyl acetate (banana smell) - less commonly used in healthcare
  • Stannic chloride (irritant smoke) - less commonly used in healthcare
• Sensitivity solution: A diluted version of the test solution used to verify the subject can detect the substance
• Fit test adaptors: For P2/N95 respirators that have exhalation valves
• Various sizes and models of respirators for testing

Additional supplies needed include:

• Distilled water for preparing solutions
• Cleaning supplies for equipment
• Documentation materials (forms, cards)
• Stopwatch or timer for test exercises

Qualitative fit test kits are more affordable (typically $400-$800) compared to quantitative systems, but they have limitations. They provide only a pass/fail result rather than a numerical fit factor, and they rely on the subject's sensory response, which can be subjective. For healthcare settings dealing with high-risk infectious diseases, quantitative testing is generally preferred when available.

Proper calibration of fit testing equipment is essential to ensure accurate results. Calibration requirements vary by equipment type:

Quantitative Fit Testing Equipment (e.g., PortaCount)

• Daily checks: Zero check and maximum fit factor check should be performed at the beginning of each day of testing
• Regular calibration: According to manufacturer recommendations, typically annually
• After repairs: Any time the equipment is repaired or components are replaced
• When accuracy is questioned: If test results seem inconsistent or questionable

For PortaCount devices specifically:

• Daily particle check to ensure sufficient ambient particles
• Daily zero check with HEPA filter
• Annual factory calibration or calibration by an authorized service provider

Qualitative Fit Testing Equipment

• Nebulizers: Should be checked before each use to ensure they function properly and produce a consistent spray pattern
• Test solutions: Should be replaced according to manufacturer recommendations, typically every 6 months or if contamination is suspected
• Hood and other components: Should be inspected regularly for damage or wear

Facilities should maintain records of all equipment calibration, including:

• Date of calibration
• Person or company performing the calibration
• Calibration method used
• Results of the calibration
• Due date for next calibration

Using uncalibrated equipment can lead to inaccurate fit test results, potentially compromising the safety of staff and residents.

Reference: Equipment manufacturer's instructions and AS/NZS 1715:2009 Section 8.5.3 - Equipment calibration and maintenance.

In aged care settings, fit testing is required for all tight-fitting respirators that rely on a seal between the respirator and the wearer's face. The most common types include:

It's important to note that during outbreaks of airborne infectious diseases (such as tuberculosis, measles, or certain pandemic viruses like SARS-CoV-2), aged care facilities should follow current public health guidance regarding the appropriate level of respiratory protection required.

Each staff member who may need to wear a tight-fitting respirator should be fit tested for the specific make, model, and size of respirator they will use. If multiple types or models of respirators are used in the facility, separate fit testing may be required for each type.

Before undergoing fit testing, staff should receive comprehensive training on respiratory protection. This pre-fit testing training should include:

• Respiratory hazards awareness:
  • Types of respiratory hazards in aged care settings (infectious agents, chemicals)
  • How these hazards can affect health
  • Transmission routes for respiratory pathogens
• Respirator basics:
  • Different types of respirators and their purposes
  • How respirators work
  • Limitations of respiratory protection
  • When respiratory protection is required
• Proper donning and doffing procedures:
  • Step-by-step instructions for putting on respirators
  • Proper adjustment of straps and nose clips
  • Safe removal procedures to prevent contamination
  • Hand hygiene before and after handling respirators
• User seal check procedures:
  • How to perform positive and negative pressure checks
  • Importance of performing seal checks each time a respirator is donned
• Fit test preparation:
  • What to expect during the fit test
  • Requirements for the day of testing (e.g., clean-shaven, no eating/drinking/smoking before qualitative testing)
  • Test exercises that will be performed
• Care and maintenance of respirators:
  • Proper storage of respirators
  • Inspection for damage or contamination
  • When to replace disposable respirators
  • Cleaning procedures for reusable respirators

This training should be documented and should include both theoretical knowledge and hands-on practice. Staff should have the opportunity to ask questions and practice donning and doffing procedures before the actual fit test.

Effective pre-fit test training increases the likelihood of successful fit testing and ensures that staff understand the importance of proper respirator use in protecting themselves and residents.

Proper preparation is essential for accurate fit testing results. Staff should follow these guidelines before their scheduled fit test:

24 Hours Before the Test

• Facial hair: Male staff should be clean-shaven where the respirator seals against the face. Even a day's stubble can significantly affect the seal.
• Avoid facial injuries: If possible, avoid activities that might cause facial injuries that could affect the fit.

On the Day of the Test

• For qualitative testing (taste/smell methods):
  • Do not eat, drink (except water), smoke, or chew gum for at least 15-30 minutes before the test
  • Avoid strong scents or perfumes that might affect smell sensitivity
• Appearance:
  • Come with the same appearance you will have when wearing the respirator at work
  • If you normally wear makeup at work, wear it to the fit test
  • If you wear glasses at work, bring them to the fit test
• Jewelry and accessories:
  • Remove facial piercings in the seal area
  • Remove earrings that might interfere with respirator straps
  • Tie back long hair that might interfere with the respirator straps
• Clothing:
  • Wear comfortable clothing
  • For women, avoid high-necked clothing that might interfere with the bottom strap
• Health considerations:
  • Be prepared to disclose any medical conditions that might affect respirator use
  • If you have a respiratory infection or congestion, consider rescheduling

What to Bring

• Any prescription glasses you wear while working
• Any other PPE you typically wear with your respirator (e.g., safety goggles, face shields)
• Information about any previous fit testing results or respirator issues

Staff should also be mentally prepared to perform the required test exercises, which include normal and deep breathing, head movements, talking, and bending. The entire process typically takes 15-30 minutes per person.

After initial fit testing, ongoing training is essential to maintain staff competency in respiratory protection. A comprehensive respiratory protection program should include:

Annual Refresher Training

• Review of respiratory hazards in the workplace
• Updates on respiratory protection policies and procedures
• Refresher on proper donning, use, and doffing techniques
• Practice performing user seal checks
• Review of respirator limitations and capabilities
• Maintenance and storage procedures

Just-in-Time Training

• Rapid refresher training during outbreaks or emergencies
• Supervision of first-time respirator use after fit testing
• Hands-on practice sessions during high-risk periods

Competency Assessments

• Regular observation of staff donning and doffing respirators
• Evaluation of proper user seal check technique
• Assessment of knowledge regarding when and how to use respirators

Training When Changes Occur

• Introduction of new respirator models or types
• Changes in workplace conditions that affect respirator use
• Updates to respiratory protection standards or guidelines
• After workplace respiratory exposure incidents

All training should be documented, including:

• Date of training
• Names of staff who received training
• Name and qualifications of the trainer
• Content covered in the training
• Results of any competency assessments

Effective ongoing training ensures that the benefits of fit testing are maintained through proper respirator use in daily practice. It also helps staff retain critical knowledge that may be needed during emergency situations when there is limited time for instruction.

Ensuring staff compliance with respiratory protection protocols is crucial for maintaining an effective respiratory protection program. Facilities can implement the following strategies:

Education and Communication

• Explain the "why": Ensure staff understand the reasons behind respiratory protection requirements
• Real-world examples: Share case studies or examples of how proper respiratory protection has prevented infections
• Clear communication: Provide clear, concise information about when and how to use respirators
• Visual aids: Use posters, infographics, and videos to reinforce proper techniques

Accessibility and Convenience

• Easy access: Ensure respirators are readily available in appropriate sizes and types
• Convenient locations: Place respirators and donning/doffing instructions at point of use
• Comfort considerations: Select respirators that balance protection with comfort for extended wear
• Address barriers: Identify and address issues that make compliance difficult

Leadership and Culture

• Leadership modeling: Ensure managers and supervisors consistently follow protocols
• Safety culture: Foster a culture where respiratory protection is valued and normalized
• Peer champions: Identify and support staff members who can serve as respiratory protection advocates
• Recognition: Acknowledge and reward consistent compliance

Monitoring and Feedback

• Regular audits: Conduct periodic observations of respirator use
• Constructive feedback: Provide immediate, specific feedback when improper use is observed
• Anonymous reporting: Create systems for staff to report concerns about respiratory protection
• Data tracking: Monitor compliance rates and share results with staff

Policy and Accountability

• Clear policies: Develop and communicate clear respiratory protection policies
• Include in performance reviews: Make compliance part of staff evaluation
• Progressive discipline: Implement fair, consistent consequences for non-compliance
• Respiratory protection program coordinator: Designate a responsible person to oversee the program

Effective compliance strategies should focus on removing barriers and building a culture of safety rather than relying solely on enforcement. By understanding the challenges staff face and addressing them proactively, facilities can achieve higher compliance rates and better protection for both staff and residents.

A comprehensive respiratory protection training program for aged care facilities should include the following components:

1. Respiratory Hazards in Aged Care

• Common airborne infectious agents (e.g., tuberculosis, influenza, COVID-19)
• Chemical hazards (e.g., cleaning and disinfection products)
• How these hazards can affect staff and residents
• Transmission routes and risk factors

2. Respiratory Protection Basics

• Types of respiratory protection (surgical masks vs. respirators)
• How respirators work (filtration, fit principles)
• Limitations of different types of protection
• Regulatory requirements and standards

3. Selection of Appropriate Respiratory Protection

• Risk assessment and determining when respirators are needed
• Selecting the right type of respirator for specific hazards
• Understanding protection factors and ratings
• Facility-specific respirator selection protocols

4. Medical Evaluation

• Purpose of medical evaluation
• Health conditions that may affect respirator use
• Facility's medical evaluation process
• Confidentiality of medical information

5. Fit Testing

• Purpose and importance of fit testing
• Types of fit testing (qualitative vs. quantitative)
• Frequency requirements
• Preparation for fit testing
• What to expect during the fit test

6. Proper Use Procedures

• Inspection before use
• Proper donning techniques (step-by-step)
• User seal check procedures
• Safe doffing techniques to prevent contamination
• Hand hygiene in relation to respirator use

7. Maintenance and Storage

• Cleaning and disinfection of reusable respirators
• Proper storage conditions
• Inspection for damage or deterioration
• When to replace disposable respirators
• Record-keeping requirements

8. Emergency Procedures

• What to do if a respirator fails during use
• Procedures during infectious disease outbreaks
• Reporting problems or exposures
• Emergency response protocols

9. Practical Training

• Hands-on practice with actual respirators
• Supervised donning and doffing
• User seal check practice
• Troubleshooting common problems

10. Evaluation and Documentation

• Knowledge assessment (written or verbal)
• Skills demonstration and competency verification
• Documentation of training completion
• Process for addressing knowledge or skill gaps

Training should be tailored to the specific needs and literacy levels of staff, and should include a combination of theoretical knowledge and practical skills. Regular refresher training should be provided at least annually and whenever there are changes to the respiratory protection program or equipment.

Facial hair that lies along the sealing area of a respirator, such as beards, mustaches, or long sideburns, can significantly interfere with the respirator's seal and compromise protection. According to AS/NZS 1715:2009, wearers must be clean-shaven where the respirator seals against the face.

Key points regarding facial hair and fit testing:

• Cannot be fit tested with tight-fitting respirators: Staff with facial hair that interferes with the seal area cannot be successfully fit tested with N95/P2 respirators or other tight-fitting respirators.
• Even stubble is problematic: Even 1-2 days of stubble growth can significantly reduce protection. Research has shown that protection factors can decrease by 20-100% with just 24 hours of beard growth.
• Facial hair styles that may be acceptable: Some facial hair styles may be acceptable if they don't interfere with the seal area:
  • Small, neatly trimmed mustaches that don't extend beyond the corners of the mouth or over the upper lip
  • Small soul patches or goatees that don't interfere with the seal area
  • Sideburns trimmed above the level where the respirator seals

Options for Staff with Facial Hair

1. Shaving: The most effective solution is for staff to be clean-shaven in the seal area when respirator use is required.
2. Alternative respiratory protection: If a staff member cannot or will not shave for religious, medical, or personal reasons, alternative options include:
   • Powered Air-Purifying Respirators (PAPRs) with loose-fitting hoods: These do not rely on a face seal and can be used with facial hair
   • Hooded or helmeted respirators: These cover the entire head and do not require a face seal
3. Job reassignment: In some cases, staff with facial hair may need to be reassigned to roles that don't require respirator use during high-risk periods.

Facilities should have clear policies regarding facial hair and respirator use, including accommodations for religious or medical reasons. These policies should be communicated during hiring and reinforced during respiratory protection training.

It's important to note that surgical masks (which are not respirators) do not require fit testing and can be worn with facial hair, but they do not provide the same level of protection against airborne hazards as properly fitted respirators.

Reference: AS/NZS 1715:2009 Selection, use and maintenance of respiratory protective equipment, Section 8.3.3 - Facial hair.

If a staff member fails a fit test with a particular respirator, a systematic approach should be followed to find a suitable solution:

1. Check donning technique:
   • Review and demonstrate proper donning procedures
   • Ensure the staff member understands how to correctly position the respirator
   • Check that straps are properly tensioned and positioned
   • Verify that the nose clip is properly molded around the nose
2. Try a different size of the same model:
   • Many respirators come in multiple sizes (small, medium, large)
   • A different size may provide a better fit for the individual's facial features
3. Try a different model of respirator:
   • Different brands and models have varying shapes and designs
   • Some models may better accommodate certain facial features
   • Test at least 2-3 different models if available
4. Check for interfering factors:
   • Facial hair in the seal area
   • Jewelry or piercings
   • Makeup or facial creams
   • Eyewear that interferes with the fit
5. Consider alternative respiratory protection:
   • If multiple disposable respirators fail to provide an adequate fit, consider reusable elastomeric respirators
   • For staff who cannot achieve a proper fit with any tight-fitting respirator, consider powered air-purifying respirators (PAPRs) with loose-fitting hoods

Documentation and Follow-up

• Document all fit test attempts, including models, sizes, and results
• Record the final solution (successful respirator or alternative protection)
• Ensure the staff member is trained on the specific respirator they will be using
• Schedule a follow-up fit test if there were any unusual circumstances

It's important to approach fit test failures as a problem to be solved rather than a deficiency in the staff member. Some individuals may have facial features that make it difficult to achieve a proper fit with certain respirator types, but with persistence, a suitable solution can usually be found.

If a staff member consistently fails fit tests with multiple respirator types and cannot use a PAPR due to job requirements, consultation with occupational health professionals may be necessary to determine appropriate work restrictions or accommodations.

Some staff members may have medical conditions that make it difficult or unsafe to wear tight-fitting respirators. Facilities should have a process to accommodate these individuals while maintaining workplace safety:

Medical Evaluation Process

• All staff required to wear respirators should undergo a medical evaluation before fit testing
• This evaluation should be conducted by a healthcare professional familiar with respiratory protection requirements
• Staff should disclose relevant medical conditions that might affect respirator use, such as:
  • Respiratory conditions (asthma, COPD, etc.)
  • Cardiovascular conditions
  • Claustrophobia or anxiety disorders
  • Facial injuries or surgeries
  • Neurological conditions affecting facial sensation

Accommodation Options

1. Alternative respirator types:
   • Powered Air-Purifying Respirators (PAPRs) with loose-fitting hoods may be suitable for staff with breathing difficulties, as they provide positive airflow and reduce breathing resistance
   • Different models of N95/P2 respirators with varying breathing resistance
   • Respirators with exhalation valves (when not contraindicated for infection control)
2. Modified work arrangements:
   • Reassignment to roles that don't require respirator use
   • Job sharing or rotation to limit respirator wear time
   • Scheduled breaks from respirator use when safe to do so
3. Temporary accommodations:
   • For staff with temporary conditions (e.g., recovery from facial surgery)
   • Reassessment after the condition resolves

Legal Considerations

• Accommodations should be made in accordance with disability discrimination legislation
• The accommodation process should be interactive, involving the staff member, management, and healthcare professionals
• Accommodations must not compromise the safety of residents or other staff
• All accommodation decisions should be documented, including the rationale and any medical recommendations

Confidentiality

• Medical information should be kept confidential
• Only the accommodation requirement, not the underlying condition, should be shared with supervisors
• Medical records should be stored separately from personnel files

Each accommodation should be assessed on a case-by-case basis, considering both the individual's needs and the facility's obligation to provide a safe environment for all staff and residents. Regular reassessment may be necessary as medical conditions or job requirements change.

Managing fit testing during a respiratory disease outbreak presents unique challenges. Facilities should have plans in place to address these challenges while maintaining respiratory protection for staff:

Preparation Before an Outbreak

• Proactive fit testing: Ensure all staff are fit tested during non-outbreak periods
• Multiple respirator options: Fit test staff on multiple models/sizes to provide alternatives if supply chain issues occur
• Documentation: Maintain clear records of fit test results, including specific make, model, and size
• Training: Ensure all staff are trained on proper respirator use before an outbreak occurs

During an Outbreak

1. Prioritization:
   • Prioritize fit testing for staff working directly with confirmed or suspected cases
   • Prioritize staff who have not been previously fit tested
   • Prioritize staff whose previous fit test has expired
2. Modified testing protocols:
   • Consider abbreviated fit testing protocols if approved by regulatory authorities during emergencies
   • Use quantitative testing when possible as it can be conducted more quickly
   • Consider on-site fit testing to minimize staff time away from duties
3. Supply chain management:
   • If the usual respirator model is unavailable, prioritize fit testing for new models
   • Maintain communication with suppliers about available models
   • Consider reusable respirators that can be cleaned and disinfected
4. Infection control during fit testing:
   • Conduct fit testing in well-ventilated areas
   • Maintain physical distancing except during the actual test
   • Clean and disinfect equipment between users
   • Screen fit test operators and participants for symptoms

Temporary Measures During Emergencies

• Extended use of previous fit test results: During severe emergencies, regulatory authorities may allow extension of fit test validity beyond the usual annual requirement
• Just-in-time fit checking: Enhanced focus on user seal checks before each use
• Alternative protection: Use of PAPRs for staff who cannot be immediately fit tested
• External assistance: Engage with public health authorities or industry partners for fit testing support

Documentation During Emergencies

• Document any deviations from standard protocols due to emergency conditions
• Record the rationale for prioritization decisions
• Maintain records of temporary measures implemented
• Document plans for returning to standard protocols post-outbreak

Facilities should stay informed about any temporary guidance or regulatory flexibility offered by health authorities during outbreaks. However, the fundamental principle remains that staff should not use tight-fitting respirators for which they have not been successfully fit tested unless absolutely necessary in emergency situations.