Protection from airborne infectious disease requires respirators and effective, professional fit testing.

Appropriate masks and fit testing for all workers should be mandatory in all health settings, Dr Michelle Ananda-Rajah, a Melbourne physician in general medicine and infectious disease at the Alfred Hospital in Melbourne, told Association members in a recent workplace health and safety webinar.

“Life-saving” protection for health care workers should be non-negotiable, she said.

“The work we do is unpredictable, it’s manual, it’s heavy. You really need to be confident in your respiratory protection when you’re working with patients.”

Loose-fitting surgical masks designed to stop “splash and splatter from the surgical field coming onto the face of the surgeon, or spillage from the surgeon onto the surgical field”, do not provide the wearer with adequate protection for airborne viruses, she said.

Different masks provide different levels of filtering. While an N95 mask filters at 95 per cent with an adequate tight seal, a P3 mask filters at 99.9 
per cent.

Protection from airborne infectious disease requires respirators and effective, professional fit testing. Pandemic guidelines written at the start of the year by 
the infection control expert group avoided the problem, she said.

“They basically said that in the context of a pandemic, fit testing will be difficult due to limited supplies and a range of types and sizes. The guidelines are saying that fit testing is in the too-hard basket. We’re not going to invest in your safety.”

Early guidelines deemed that “a surgical mask was appropriate to see suspected and confirmed COVID patients”.

But when the Victorian second wave kicked off in July “healthcare workers in the hundreds started getting sick. Healthcare workers started falling like flies [and] hundreds were furloughed”.

Fit testing evaluates during movement-based tasks

Fit testing is formal mask evaluation that can be compared to a stress test, Dr Ananda-Rajah says. As you talk, jog and move, the test assesses how compatible a mask is for a healthcare worker.

“If you’re a nurse, you’re washing a patient or you’re turning them over, it’s manual work, and you really need to be certain or confident that your respirator is going to stick and be stable.”

A fit test is more reliable than a fit check; the latter doesn’t take into account movement-based tasks. A fit check is “where you just don your mask and you blow in and you blow out and feel for any sort of gross leakage around your face”.

Because faces come in different shapes and sizes there is no one-size-fits-all solution. Duckbill masks tend to be the ones that fail fit tests on the majority of people, even though they are among the most commonly offered to health workers.

“About 70 to 80 per cent or more will fail. And yet for all of my career, the duckbill is the only thing I’ve ever been given.”

Research has found that “when you have a reasonable range [of] masks or respirators, you can actually fit test most of your staff,” she said.

A South Australian study found that offering four different types of respirators would successfully fit test about 90 per cent of staff. An important qualifier is that the study found that while there was no difference in the failure rates between male and female faces, “Asian faces failed at a higher fail rate than Caucasian faces”.

“An experienced fit tester is able to look at your face and pick a respirator that is more likely to fit you.”

Insist on getting fit tested

Veronica Black, the NSWNMA work health and safety officer, says the NSWNMA campaigned strongly for fit testing for all staff who require the use of P2 or N95 masks at work.

“Fit testing is now being rolled out throughout New South Wales health facilities.

“We’re going to continue to advocate for P2 or N95 masks for all staff who are providing care to people who are suspected, or confirmed, as having COVID-19, not just for people who might be involved with aerosol-generating procedures.”

With some LHDs yet to finalise their roll out, “we need to put the pressure on”, she said. She urged members to contact their local branch officials, or the Association office, to make sure fit testing is rolled out within their facilities.