Respirators and Fit Testing

Abstract

Hannum and colleagues' report this month on their experiences in training and fit testing different groups of healthcare workers to use respirators for protection against occupational exposure to tuberculosis. Beginning in 1993, in a large Veterans' Affairs Hospital with 2,100 full-time-equivalent employees, they were able to train 200 employees in a 6-month period when an industrial hygienist performed respirator training and fit testing on one employee at a time. Due to the slow nature of this process, their epidemiology unit began respirator training for groups of healthcare workers as part of their didactic tuberculosis education, but fit testing was not performed. A third group of employees received no training, only fit testing. Fit testing of the high-efficiency particulate air (HEPA) respirators (3M model 9970) initially was performed with a hood and saccharin. Three months into the study, saccharin was replaced with irritant smoke. One hundred seventy-nine healthcare workers (mostly nurses) were enrolled in the three different groups; 94% of employees trained by the industrial hygienist passed qualitative fit testing, a rate that did not significantly differ from the 91% pass rate for employees trained in groups by the epidemiology unit nurses. Only 79% of the group without any training passed the fit test, a significant difference from the group trained by the industrial hygienist, but not from the group trained by the epidemiology unit. The highest rates of successful fit testing occurred among those who had used respirators previously. Of note, 22 (12%) of 179 healthcare workers i itially failed fit testing; however, with repeat trainng, 21 of these 22 employees passed on repeat testing. T train 2,100 employees who have direct pati nt-care responsibilities, using the industrial hygieni t training, one employee at a time, would take 400 hours and cost approximately $20,600. If the infection control specialists train groups of employees, the cost was estimated to be $1,485. It is interesting to note that the infection control specialist's ou ly wage is substantially lower than the industrial hygieni t's and lower than the cost given for the employees to be off work for an hour to be trained. Over the past several years, there have been substantial changes in the recommendations for respiratory protection against occupational exposure to tuberculosis, as well as increasing diversity and availability of devices to choose from. The role of respiratory protective devices in the control of tuberculosis h s been reviewed by Hodous, Nardell, Jarvis, and Vesley, among others.'-6 Adal and colleagues7 and Nettleman et al8 both contributed to our understanding of the substantial costs attributable to the use of particulate respirators for prevention of tuberculosis in healthcare workers. As yet, there are very few data on he actual resources required in personnel, time, and direct expenses to perform respirator training and f t testing to prevent occupational exposure to tuberculosis in healthcare settings using the newer N-95 respirators.9 Nor is there much published information on the most efficient method of training and fit testing workers. Hannum and colleagues' have