P2/N95 filtering facepiece respirators: Results of a large-scale quantitative mask fit testing program in Australian health care workers

Maxim Milosevic¹, Raaj Kishore Biswas², Lesley Innes³, Martin Ng⁴, Ali Mehmet Darendeliler⁵, Alice Wong⁵, Elizabeth Denney-Wilson⁶

Affiliations

¹ Community Oral Health Clinic, Sydney Dental Hospital, Sydney Local Health District, Surry Hills, New South Wales, Australia; Discipline of Orthodontics and Paediatric Dentistry, School of Dentistry, Faculty of Medicine and Health, University of Sydney, Surry Hills, New South Wales, Australia. Electronic address: maxim.milosevic@health.nsw.gov.au.
² Sydney Local Health District Clinical Research Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia; Transport and Road Safety (TARS) Research Centre, School of Aviation, University of New South Wales, Sydney, New South Wales, Australia.
³ Centre for Education and Workforce Development, Sydney Local Health District, Rozelle, New South Wales, Australia.
⁴ Cardiovascular Medicine and Bioengineering, National Health and Medical Research Council Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
⁵ Discipline of Orthodontics and Paediatric Dentistry, School of Dentistry, Faculty of Medicine and Health, University of Sydney, Surry Hills, New South Wales, Australia.
⁶ Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.

PMID: 34971710
PMCID: PMC8767955
DOI: 10.1016/j.ajic.2021.12.016

P2/N95 filtering facepiece respirators: Results of a large-scale quantitative mask fit testing program in Australian health care workers

Maxim Milosevic et al. Am J Infect Control. 2022 May.

. 2022 May;50(5):509-515.

doi: 10.1016/j.ajic.2021.12.016. Epub 2021 Dec 29.

Authors

Maxim Milosevic¹, Raaj Kishore Biswas², Lesley Innes³, Martin Ng⁴, Ali Mehmet Darendeliler⁵, Alice Wong⁵, Elizabeth Denney-Wilson⁶

Affiliations

¹ Community Oral Health Clinic, Sydney Dental Hospital, Sydney Local Health District, Surry Hills, New South Wales, Australia; Discipline of Orthodontics and Paediatric Dentistry, School of Dentistry, Faculty of Medicine and Health, University of Sydney, Surry Hills, New South Wales, Australia. Electronic address: maxim.milosevic@health.nsw.gov.au.
² Sydney Local Health District Clinical Research Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia; Transport and Road Safety (TARS) Research Centre, School of Aviation, University of New South Wales, Sydney, New South Wales, Australia.
³ Centre for Education and Workforce Development, Sydney Local Health District, Rozelle, New South Wales, Australia.
⁴ Cardiovascular Medicine and Bioengineering, National Health and Medical Research Council Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
⁵ Discipline of Orthodontics and Paediatric Dentistry, School of Dentistry, Faculty of Medicine and Health, University of Sydney, Surry Hills, New South Wales, Australia.
⁶ Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.

PMID: 34971710
PMCID: PMC8767955
DOI: 10.1016/j.ajic.2021.12.016

Abstract

Background: In response to the COVID-19 pandemic, 6,287 Australian health care workers (HCWs) were fit tested to N95 filtering facepiece respirators (FFRs). This study determined how readily HCWs were fitted to 8 FFRs and how age and sex influenced testing.

Methods: HCWs were fit tested following the quantitative OSHA protocol. After bivariate analysis, a logistic regression model assessed the effect of FFR model, HCW age and sex on fit test results.

Results: Of 4,198 female and 2,089 male HCWs tested, 93.3% were successfully fitted. Fifty-five percent passed the first FFR, 21% required 2 and 23% required testing on 3 or more models. Males were 15% less likely to pass compared to females (P < .001). Individuals aged 18-29 were significantly more likely to pass compared to colleagues aged 30-59. Cup-style 3M 1860S was the most suitable model (95% CI: 1.94, 2.54) while the duckbill BSN TN01-11 was most likely to fail (95% CI: 0.11, 0.15).

Conclusions: Current N95 FFRs exhibit suboptimal fit such that a large proportion (45%) of HCWs require testing on multiple models. Older age and male sex were associated with significantly higher fit failure rates. QNFT programs should consider HCW characteristics like sex, age, racial and facial anthropometric measurements to improve the protection of the health workforce.

Keywords: COVID-19; SARS-CoV-2; airborne; infection control; respiratory protection.

PubMed Disclaimer

Figures

Image, graphical abstract — **Graphical abstract**

**Fig 1**
Fit testing pass rate by FFR model and sex.

See this image and copyright information in PMC

Cited by

Comparison of the inward leakage rate between N95 filtering facepiece respirators and modified surgical masks during the COVID-19 pandemic.
Onishi K, Nojima M. Onishi K, et al. Environ Health Prev Med. 2024;29:8. doi: 10.1265/ehpm.23-00303. Environ Health Prev Med. 2024. PMID: 38369324 Free PMC article.
Safety Goggles with Elastic Headband to Improve N95 Fit Following Failed Quantitative Fit Test.
Kamal M, Bhatti M, Stewart WC, Johns M, Collins D, Shehabi Y, Thambiraj SR, Arora S. Kamal M, et al. Indian J Crit Care Med. 2023 Jun;27(6):386-391. doi: 10.5005/jp-journals-10071-24473. Indian J Crit Care Med. 2023. PMID: 37378367 Free PMC article.
Thermal imaging and deep learning-based fit-checking for respiratory protection.
Kim H, Kim TM, Choi SW, Ko T. Kim H, et al. Sci Rep. 2024 Oct 17;14(1):24407. doi: 10.1038/s41598-024-52999-0. Sci Rep. 2024. PMID: 39420011 Free PMC article.
The effect of N95 designs on respirator fit and its associations with gender and facial dimensions.
Khairul Hasni NA, Ismail R, Muhamad Robat R, Mohamad N, Suib FA, Pahrol MA, Mahmud H, Osman B, Lim YC, Seman Z, Shaharudin R. Khairul Hasni NA, et al. PLoS One. 2023 Nov 29;18(11):e0288105. doi: 10.1371/journal.pone.0288105. eCollection 2023. PLoS One. 2023. PMID: 38019763 Free PMC article.
Striving to be the fittest: quantitative P2/N95 respirator fit test results among hospital staff during the COVID-19 pandemic.
Zhang MM, Hackett L, Smith J, Pritchard Z, Casey M, Low C, Buntine P. Zhang MM, et al. Antimicrob Steward Healthc Epidemiol. 2023 Dec 15;3(1):e233. doi: 10.1017/ash.2023.503. eCollection 2023. Antimicrob Steward Healthc Epidemiol. 2023. PMID: 38156215 Free PMC article.

See all "Cited by" articles

References

1. World Health Organization. Weekly epidemiological update on COVID-19 - 21 December 2021. Ed 71. Accessed December 22, 2021 from https://www.who.int/publications/m/item/weekly-epidemiological-update-on....
1. Shepard J., Kling S.M.R., Lee G., Wong F., Frederick J., Skhiri M. The prevalence of COVID-19 in healthcare personnel in an adult and pediatric academic medical center. Am J Infect Control. 2021;49:542–546. - PMC - PubMed
1. Nguyen L.H., Drew D.A., Graham M.S., Joshi A.D., Guo C.-G., Ma W. Risk of COVID-19 among front-line health-care workers and the general community: a prospective cohort study. Lancet Public Health. 2020;5 e475-e83. - PMC - PubMed
1. CDC Covid-19 Response Team. Characteristics of health care personnel with COVID-19 - United States, February 12-April 9, 2020. MMWR Morb Mortal Wkly Rep. 2020;69:477-81. - PMC - PubMed
1. Washington N.L., Gangavarapu K., Zeller M., Bolze A., Cirulli E.T., Schiabor Barrett K.M. Emergence and rapid transmission of SARS-CoV-2 B.1.1.7 in the United States. Cell. 2021;184:2587–2594. e7. - PMC - PubMed

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

LinkOut - more resources

Full Text Sources
Medical
- MedlinePlus Health Information
Miscellaneous
- NCI CPTAC Assay Portal

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

P2/N95 filtering facepiece respirators: Results of a large-scale quantitative mask fit testing program in Australian health care workers

Affiliations

P2/N95 filtering facepiece respirators: Results of a large-scale quantitative mask fit testing program in Australian health care workers

Authors

Affiliations

Abstract

Figures

Similar articles

Cited by

References

MeSH terms

LinkOut - more resources

Full Text Sources

Medical

Miscellaneous