Respirator Fit Test: The Cornerstone of Occupational Medicine

It is an employer’s responsibility to provide adequate safety equipment for all their employees, depending on the scope and needs of their job. Respirators are essential safety equipment for many workers, and they must fit correctly in order to provide all the intended safety benefits. For occupational health departments, understanding the purpose, procedures, and follow ups for respirator fit tests are important to prevent injuries and follow safety protocols and regulations.

What Is a Respirator Fit Test?

Anyone who uses a tight-fitting respirator at work should go through a respirator fit test. Occupational health departments generally monitor these tests and are trained to ensure that respirators fit correctly, keep particulates out, and allow the employee to perform their job functions while wearing the respirator without decreased efficacy.

Respirator fit tests generally follow a specific procedure.

1. Complete a medical questionnaire, as required by OSHA, to uncover any medical concerns that would prevent the individual from safely using a respirator.
2. Obtain a medical clearance prior to the respirator fit test to ensure that the individual is healthy and can work in a respirator. A written recommendation is required from a physician stating that it is safe for the patient to work while in a respirator.
3. A trained administrator monitors the employee during the test to measure the outcomes, make adjustments, and record the results.
4. The respirator seals are examined to ensure that there are no gaps or leaks .
5. The respirator is worn with other personal protective equipment (PPE) that is required for the tasks. The administrator will ensure that the respirator works correctly in conjunction with the rest of the PPE.
6. Move as you would during a work shift to make sure that the respirator doesn’t move out of place or create gaps.
7. In low-risk environments, qualitative tests, which rely on the wearer’s senses, are sufficient. The wearer can determine if the respirator fits comfortably and prevents exposure to dangerous conditions.
8. In high-risk or enclosed environments, a quantitative test is necessary. This precisely measures the amount of leakage allowed by the respirator and must meet a specified threshold to be considered correctly fitted and safe.

Respirator fit tests should be performed for all new employees, when there is new equipment, when work environments change, if the employee experiences any physical changes, and annually or as required by policy and law. This is done at no cost to the employee.

What Is the Purpose of This Test?

Not all respirators require a fit test before being used, though this can be industry- and model-dependent (for example, it’s required in healthcare to have a fit test). Loose fitting respirators and any models that do not create a tight seal to the face do not need the same type of fit testing. However, if employees at your company or in your industry use filtering facepiece respirators, elastomeric half- or full-facepiece respirators, tight-fitting powered-air-purifying respirators, or self-contained breathing apparatus (SCBA), OSHA requires that they be tested for an appropriate fit.

Respirators come in a variety of sizes and models. An administrator can ensure that every employee whose role requires one has a respirator that fits properly and filters out as much as possible. A respirator fit test ensures that the respirator is  the correct size for the wearer and properly filtering out as it should be.

What Industries Use a Respirator Fit Test?

Tight fitting respirators are used in a wide variety of occupations and industries where workers may be exposed to hazardous materials, fumes, gases, or vapors or where there might be situations with insufficient breathable oxygen in the environment. Any of the following industries and workplaces may require employes to wear respirators while at work and will need those respirators to fit correctly to keep their employees safe:

• Healthcare
• Construction, including welders, masons, carpenters, mold remediation, and drywall professionals
• Manufacturing
• Emergency or first responders
• Mining, oil, and gas
• Firefighters
• Medical labs
• Veterinarians
• Painting
• Chemical plants
• Equipment or vehicle maintenance and repair
• Pest control

An estimated five million US employees wear a respirator at least some of the time during their workday.

What Is the Difference Between Qualitative and Quantitative Respirator Fit Tests?

The two different kinds of respirator fit tests are qualitative and quantitative. Which test should be used depends on the work environment and materials the employee may be subject to.

A qualitative fit test (QLFT) uses the wearer’s perception to determine if the respirator filters to the degree that it should, resulting in a pass or fail of the equipment.

1. The worker wears the respirator as they would in a usual work environment.
2. A challenge substance is introduced. OSHA has approved four substances for tested.
3. The wearer is asked if they can sense the substance. This mean be tasting something that is bitter or sweet, coughing, or smelling bananas.
4. If the substance is detectable by the wearer, the respirator does not fit adequately.
5. If the substance is not detectable and the wearer does not respond to the substance by coughing, the respirator fits and is graded a pass.

A quantitative fit test (QNFT) measures the amount of leakage of the respirator via machine calculations.

1. The worker wears the respirator as they would in a work environment.
2. The respirator is attached to a probe and hose that measures particles inside the respirator.
3. Aerosols or negative pressure are used for the test.
4. The probe compares the particles inside the respirator to those outside.
5. The wearer performs movements, such as talking, deep breathing, and bending over, to measure any change in the fit and detection of particles during these changes in position.
6. If the equipment passes,  the specific model and size that was tested is approved for use.

How Can Organizations Track Respirator Fit Test Results?

Occupational health electronic health record systems should enable a company to track all the relevant details about each employee’s health, including details about their respirator fit tests. The occupational health department should be able to monitor all the following information about respirator’s use, fit, and testing status:

• Employee identification
• The medical clearance provided by a healthcare provider
• The make, model, style, and size of the tested respirator
• If the test was qualitative or quantitative
• Test results
• Details about the appropriate fit of the respirator
• The name of the administrator that performed the test
• Dates of the test and alerts for retesting

It is the organization’s responsibility to ensure that respirator fit tests are performed at regular intervals and all employees using the equipment have been sufficiently tested for protective factors. Tests should be done:

• Annually for every employee who uses a respirator at work
• When new employees start at the company and will need to use a respirator at least some of the time
• If there are any changes to the face including gaining or losing weight or dental work
• If the make, model, or size of the equipment is changed
• If a new piece of equipment is introduced or used equipment is replaced
• If the worker has facial hair that can impact the seal or fit of the respirator (generally, there shouldn’t be facial hair between the respirator seal and the skin)

A good employee health record keeping system will help you manage dates  so you can easily see when each employee needs to be retested.

Consequences of Missing Tests for Employees and Administrators

Respirator fit testing is required by OSHA and should be regularly monitored by occupational health departments and safety teams. For employees, failing to comply with respirator testing can result in exposure to dangerous substances, poor quality of health, and a dangerous working environment. Using respirators that are old or ill-fitting negates the positive effects of the filtering capability. All respirator fit tests should be done at no expense to the employees in order to provide the safety precautions necessary when working with potentially dangerous contaminates.

Since OSHA requires these tests, there is a financial penalty to companies that do not comply. A fine of up to $15,000 per infraction can be placed on organizations that do not follow standards for respirator fit testing. If a respirator malfunctions, does not fit correctly, or fails to filter out hazards, the company can be held liable for damages or even death in court. Companies that have been found to be neglectful in maintaining respirator fit test schedules are audited more often by OSHA to encourage greater compliance.

In addition, companies that do not prioritize the safety and well-being of their employees in these ways experience more workers compensation claims, a negative reputation in the community, and lower  worker morale. All of these can eventually have negative financial consequences for the organization.

How to Become Qualified to Administer Respirator Fit Tests

While a medical professional is required to clear any worker to be eligible for a respirator fit test, you do not need to be a medical professional to administer these tests. OSHA sets the standards for administrators and has established the classwork and testing procedures. To become a certified administrator for respirator fit testing:

1. Read and understand the regulations that govern respirator use and fit testing.
2. Enroll in an OSHA-aligned training course.
3. Complete the modules, either in person or online, on the types of respirators, regulations, equipment, and testing methods. This course generally takes about two hours to complete.
4. Pass the knowledge test.
5. Maintain your certification by keeping up to date with changes in regulations and equipment.

Respirator Fit Tests Are Crucial for Health and Safety in Hazardous Work Environments

One of many items that an occupational health team needs to track is respirator equipment that employees use. They also are responsible for ensuring that they fit appropriately and are not worn or damaged. Any occupation where workers can be exposed to dangerous substances will need respirators that fit each employee correctly and filter out as much as possible to keep them safe. If you are tasked with managing this program, you will need to be correctly certified and be able to prove that you are tracking respirator fit testing to comply with federal regulations.