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Qualitative fit testing

Simran Mann and Michael Afnan
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DOI: https://doi.org/10.7861/clinmed.Let.20.6.2
Clin Med November 2020
Simran Mann
Imperial College London, London, UK
Roles: Medical student
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Michael Afnan
Imperial College London, London, UK
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Editor – We recently spent 7 weeks coordinating qualitative fit testing (QFT) of FFP3 masks at a major London hospital site. Upon reflection, we believe that fit testing within the NHS should be routine.

Although adequate respiratory protective equipment (RPE) is required for protection from COVID-19 transmission, QFT should already be the norm for NHS workers.1,2 RPE is worn in intensive care, theatres, respiratory wards or side rooms to prevent transmission of various airborne diseases. Although RPE has been proven effective, adequate protection requires prior fit testing and depends upon a ‘good fit’.3–5 Many staff who have worn RPE regularly are only now undergoing QFT for the first time, which highlights a systematic failure of the NHS to protect its workers.

Some research has also suggested that certain facemask models are more suited to male and Caucasian face shapes.6–8 This is important, given the higher rates of COVID-19 cases among black and minority ethnic staff.9 Of the eight different models of mask that we tested, none had a perfect fit rate and only one had a fit rate above 60%: variety is key. Costs and strain on suppliers have limited the variety of masks in hospital sites; however, the range of masks available must reflect the varied demographics across the NHS workforce. Regular QFT before the pandemic would have allowed fit rate comparison between models, and stock could have been prioritised accordingly.

We urge the NHS to review its fit testing policy. Trusts could routinely perform QFT on new staff members, using multiple facemask models to account for changes in availability. Individuals could keep a record of their QFT results so that if they move between sites, they have evidence stating which mask(s) fit and, thus, should be provided by the new site. Finally, NHS trusts could perform regular analysis of anonymised fit testing data and assessment of stock to ensure that all staff, regardless of gender or ethnicity, are adequately protected.

We make these proposals on the grounds of improved public health measures for this country and acceptable working conditions for NHS staff.

  • © Royal College of Physicians 2020. All rights reserved.

References

  1. ↵
    1. European Commission
    . Internal market, industry, entrepreneurship and SMEs: Personal protective equipment (PPE). European Commission, 2020. https://ec.europa.eu/growth/sectors/mechanical-engineering/personal-protective-equipment_en
  2. ↵
    1. Health and Safety Executive
    . Fit testing face masks to avoid transmission during the coronavirus pandemic. HSE, 2020. www.hse.gov.uk/coronavirus/ppe-face-masks/face-mask-ppe-rpe.htm
  3. ↵
    1. Liu M
    , Cheng S, Xu K, et al. Use of personal protective equipment against coronavirus disease 2019 by healthcare professionals in Wuhan, China: cross sectional study. BMJ 2020;369:m2195.
    OpenUrlAbstract/FREE Full Text
  4. ↵
    1. Health and Safety Executive
    . INDG174: Personal protective equipment (PPE) at work. HSE, 2013.
  5. ↵
    1. Health and Safety Executive
    . The control of substances hazardous to health regulations 2002, 6th edn. HSE, 2013:31.
  6. ↵
    1. TUC
    . Personal protective equipment and women: Guidance for workplace representatives on ensuring it is a safe fit. TUC, 2020. www.tuc.org.uk/sites/default/files/PPEandwomenguidance.pdf
  7. ↵
    1. Foereland S
    , Robertsen O, Hegseth M. Do various respirator models fit the workers in the Norwegian smelting industry? Safety and Health at Work 2019;10:370–6.
    OpenUrl
  8. ↵
    1. Lin Y
    , Chen C. Characterization of small-to-medium head-and-face dimensions for developing respirator fit test panels and evaluating fit of filtering facepiece respirators with different faceseal design. PLoS One 2017;12:e0188638.
    OpenUrlPubMed
  9. ↵
    1. Bailey S
    , West M. Ethnic minority deaths and COVID-19. The King's Fund, 2020. www.kingsfund.org.uk/blog/2020/04/ethnic-minority-deaths-covid-19
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Qualitative fit testing
Simran Mann, Michael Afnan
Clinical Medicine Nov 2020, 20 (6) e278-e279; DOI: 10.7861/clinmed.Let.20.6.2

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Qualitative fit testing
Simran Mann, Michael Afnan
Clinical Medicine Nov 2020, 20 (6) e278-e279; DOI: 10.7861/clinmed.Let.20.6.2
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