Introduction
Respiratory Protective Equipment (RPE) filter the air to remove harmful substances during the act of breathing to provide clean air for the individual and is part of Health and Safety legislation. RPE is necessary protection for air borne transmission diseases and Brisdoc has a Notifiable and High Consequence Infectious Disease Operational PPE and Cleaning SOP. This is currently operational and as part of RPE, a Respiratory Hood System is used.
This SOP is a preparedness plan in the eventuality of a pandemic where there is a need for a larger number of the Brisdoc workforce to use RPE at the same time. This SOP explains how to wear a filtered face piece (FFP), how to fit test FFP and how Brisdoc intends to keep the trained Fit testers competent in the eventuality of implementing this SOP.
The standard masks to be fitted in a clinical setting are called FFP3, the number ‘3’ is an indication of the filtration size of the particles the mask will be effective in filtering air in a high risk, health care setting.
FFP3 masks need to fit each wearers face by achieving good contact between a wearer’s skin in the facial area and the face seal of the RPE. It is this testing of the fit that is called fit testing.
Related Policies and Documentation
This SOP is to be read in conjunction with the Infection Prevention Policy (2024) and the Notifiable and High Consequence Infectious Disease Operational PPE and Cleaning SOP (2024) for Brisdoc
Other useful resources this SOP is based on are:
Health and Safety Executive (2019) Guidance on Respiratory Protective Equipment Fit Testing
Health and Safety Executive Fit Testing Basics
Definitions
Qualitative Fit Testing – a pass or fail test that is based on the mask wearers subjective assessment of any leakage through the fitted mask and face seal by detecting a taste sensation of bitter thorough the use of an aerosol tester.
Fit Tester – the trained person performing the fit test
Testee – the individual being fit tested for FFP3 mask
Role and Responsibilities
Fit Tester
All Brisdoc Fit Testers have a duty under the Health and Safety at Work legislation to ensure they are up to date with current guidance regarding fit testing of FFP3 in primary and urgent care environment. A Fit Tester is deemed competent if they have completed training from an accredited fit test provider and then has a subsequent refresher from an accredited trainer two yearly. A six-monthly internal refresher will be held within Brisdoc to ensure testers are competent and confident in the process. Please follow instructions and document findings on Appendix 1.
Designated Fit Testers are expected be competent in this process and should liaise with the IPC (Infection Prevention Control) Lead if they have any concerns regarding fit testing. In the eventuality of fit testing the workforce, all enquiries regarding fit testing must be discussed with the IPC Lead.
Co-Owners
All co-owners must only wear FFP3 masks if they have had a successful fit test for that specific make and model of RPE. The wearing of FFP3 is currently not in use in Brisdoc. If individuals have their own FFP3 masks that are correctly fit tested, then these can be worn if there is a need.
Co-owners will be made aware of the Preparedness Plan if is it is implemented and instructed on next steps.
Co-owners can refer to the IPC Policy for further information on Infection Prevention Control (IPC) and RPE use.
IPC Lead
The IPC Lead is responsible for the implementation and management of the Preparedness Plan. This will include ensuring there is an adequate number of Fit Testers across Brisdoc Services to implement the Preparedness Plan if necessary. It will also be necessary to ensure Fit Testers across Brisdoc are aware of the need to remain competent and to organise training as appropriate.
As part of the Preparedness Plan, the IPC Lead will ensure there is a system to record and distribute Fit test reports to co-owners and managers as required. The reports must be available for 5 years post-test.
The IPC Lead will ensure safety of all co-owners, seeking appropriate medical assessment if there are concerns during the fit test process or wearing RPE in the eventuality of a pandemic.
Facilities Manager
The Facilities Manager will liaise with the IPC Lead to ensure the preparedness SOP is viable and training is planned at the specified times for the Fit Tester competence and confidence.
This includes training and equipment.
The Fit Test Process
Before the Fit Test
In the eventuality of the Preparedness Plan being activated, ensure all testees are sent information signposting to the IPC policy including how to wear an FFP3 mask and an explanation of the fit test process. Clear advice on restrictions of eating and drinking must be given in advance as well as guidance on facial hair, piercing and glasses. Advance notice of allergies must be gained from each testee and all testees must be given information about the biiter taste aerosol used in the fit test and potential allergies.
If in doubt discuss with the IPC lead. The fit testing process can be viewed as a potential claustrophobic period, wearing a hood. It is also a physically active process. Please discuss this with the Testee and IPC Lead as a risk assessment may need to be completed.
Furthermore, wearing FFP3 for long periods of time in work can be a physically demanding, if this is required and there are concerns, please discuss with IPC Lead.
Ensure there is a booking process and ensure that all testees have a time slot of an hour (additional if a re-test is required).
Consideration for Testers during fit testing
Testers must run through the fit test process for each testee.
The Fit Tester must check for allergies and check the aerosol spray used as part of the process.
The Fit Tester must explain that RPE can be constraining and the on-going use of FFP3 masks can lead to feelings of claustrophobia. Furthermore, the testing process with a hood is an activity-based process. Please discuss this with the IPC Lead and defer the test if there are concerns regarding medical fitness.
The Fit Tester must train the testee on correct donning of the mask before the fit test as well as ensuring optimum fit through positioning, particularly the nose seals and setting the strap tension to determine an acceptable fit. See Appendix 2
Ensure the equipment is functioning, particularly the nebuliser as it is prone to clogging. Regular cleaning will prevent this but in the event of clogging during a test, the test will be deemed invalid.
The Fit Tester will be observing and caring for the testee during the fit process.
Considerations for Testees during fit testing
Testees must not eat or drink (except still water), smoke or chew gum at least 30minutes before the test.
A fit test will not be performed if there is any facial hair between the testees skin and the face piece sealing surface. Once tested and successful, the FFP3 mask allocated will only be therapeutic if used in this manner with no further facial hair in the specified area.
Any change to the face shape, piercings may affect the future use of the FFP3 in terms of appropriate fit.
A successful fit test
A pass in a qualitative fit test is when the testee does not taste a bitter taste at any time during any of the test exercises.
Please ensure that palate and lips are cleansed before the fit test and after the sensitivity test.
Before the test is carried out a sensitivity test is performed. If the testee cannot detect the taste test aerosol (bitter) then a different agent needs to be used. This can be discussed with the IPC Lead.
The fit testing process must be a continuous test and done on the same day, in one sitting.
Repeat fit test
Fit tests are valid for 2 years but sometimes it may be necessary to repeat fit tests if the mask that has been tested has changed in terms of size, make or model or is unavailable. Furthermore, the testee may have had a change of facial shape, dental work or piercings which may require a retest.
Version Control
| Date | Version | Author | Change Details |
Appendix 1 – How to do a Fit Test Documentation
Qualitative Fit test
Please keep a copy for Brisdoc records and give one to the individual tested. This test is valid for 2 years with exception of changes in face shapes. Please stand for the whole test.
| Date Tested | Retest Date | Location |
| Personal Details | Bitrex | Saccharin | PPE Details | |||||||||
| Name | PPE worn | |||||||||||
| ID | ||||||||||||
| No facial hair / clean shaven | PPE Make | |||||||||||
| Medically fit for fit testing – activities | ||||||||||||
| Medically fit to wear a mask | PPE Model | |||||||||||
| Not smoked or eaten for 30mins | ||||||||||||
| Allergies / Claustrophobia/ wearing mask/ | ||||||||||||
| Mask Details | RPE pre-checks | |||||||||||
| Mask Make | Visual inspection- hold up to light | |||||||||||
| Mask Model | Donning | |||||||||||
| Mask Size | Pre-use fit check | |||||||||||
| Cover mask and breath in – -ve pressure | ||||||||||||
| Check fit with glasses | ||||||||||||
| The sensitivity test
Use nebulizer A and solution A (sensitivity) Check function of nebulizer, bungs removed, wearer breathing through mouth tongue slightly out
|
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| Up to 10 squeezes | Up to 20 squeezes | Up to 30 squeezes | ||||||||||
| Clean mouth, palate and lips with water | ||||||||||||
| The fit test
Use Nebulizer B and Solution B (Fit Test). Don mask and check fit – check nose area and remould nose piece, negative pressure check Check palate and lips are clean by sipping water, function of nebulizers, both bungs removed, wearer breathing through mouth with tongue slightly out |
||||||||||||
| Use 10 initial squeezes, start stop watch and then 5 squeezes every 30 seconds | Use 20 initial squeezes, start stop watch and then 10 squeezes every 30 seconds | Use 30 initial squeezes, start stop watch and then 15 squeezes every 30 seconds | ||||||||||
| Normal breathing 60 seconds | Pass/fail | Procedure if Fit test fails
1. Remove hood 2. Examine fit on mask on face 3. Remove and inspect mask 4. Advise to drink water and clean palate and lips/ wipe face 5. Wait 30mins -no smoking / food 6. Conduct new sensitivity test 7. New fit test with new mask 8. Re-test same make & model & size |
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| Deep breathing 60 seconds | Pass/fail | |||||||||||
| Head side to side 60 seconds | Pass/fail | |||||||||||
| Head up and down 60 seconds | Pass/fail | |||||||||||
| Counting 100 backwards 60 seconds | Pass/fail | |||||||||||
| Bending 60 seconds | Pass/fail | |||||||||||
| Normal breathing 60 seconds | Pass/fail | |||||||||||
| Overall Pass | Pass/fail | |||||||||||
| Reveal test | Pass/fail | |||||||||||
| User Print & Sign | ||||||||||||
| Fit Tester Print & Sign | ||||||||||||