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. 2023 Oct 26;18(10):e0293129.
doi: 10.1371/journal.pone.0293129. eCollection 2023.

A systematic review of passing fit testing of the masks and respirators used during the COVID-19 pandemic: Part 1-quantitative fit test procedures

Anahita Fakherpour  1 , Mehdi Jahangiri  2 , Janis Jansz  3
Affiliations

A systematic review of passing fit testing of the masks and respirators used during the COVID-19 pandemic: Part 1-quantitative fit test procedures

Anahita Fakherpour et al. PLoS One. .

Abstract

Background: During respiratory infection pandemics, masks and respirators are highly sought after, especially for frontline healthcare workers and patients carrying respiratory viruses. The objective of this study was to systematically review fit test pass rates and identify factors influencing the fitting characteristics.

Methods: Potentially relevant studies were identified using PubMed, Scopus, Web of Science, and Science Direct during the COVID-19 pandemic from February 5, 2020, to March 21, 2023. The search strategy using the following keywords was conducted: Quantitative Fit Test, Condensation Nuclei Counter, Controlled Negative Pressure, PortaCount, Sibata, Accufit, Fit, Seal, Mask, Respirator, Respiratory Protective Device, Respiratory Protective Equipment, Protective Device, Personal Protective Equipment, COVID-19, Coronavirus, and SARS-CoV-2. The quality of the included studies was also assessed using the Newcastle-Ottawa scale.

Results: A total of 137 articles met the eligibility criteria. Fifty articles had a quality score of less than 7 (good quality). A total of 21 studies had a fit test pass rate of less than 50%. 26 studies on disposable respirators and 11 studies on reusable respirators had an FF of less than 50 and less than 200, respectively. The most influential factors include respirator brand/model, style, gender, ethnicity, facial dimensions, facial hair, age, reuse, extensive movement, seal check, comfort and usability assessment, and training.

Conclusion: 37.36% of the disposable respirator studies and 43% of the reusable respirator studies did not report fit test results. 67.86% of the disposable respirator studies had a fit test pass rate greater than 50%, and 35.84% of these studies had an FF greater than 100. Also, 85.71% of the reusable respirator studies had a fit test pass rate greater than 50%, and 52.77% of these studies had an FF greater than 1000. Overall, the fit test pass rate was relatively acceptable. Newly developed or modified respirators must undergo reliable testing to ensure the protection of HCWs. Subject and respirator characteristics should be considered when implementing fit testing protocols. An optimal fit test panel should be developed prior to respirator design, certification, procurement decisions, and selection procedures.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Overview of systematic review execution according to PRISMA 2020 flow diagram.
Fig 2
Fig 2. Numbers of published studies on quantitative fit testing during the COVID-19 pandemic.
Fig 3
Fig 3. Results of quality assessment of included studies in the systematic review.
Fig 4
Fig 4. Numbers of studies conducted in different countries during the COVID-19 pandemic.
Fig 5
Fig 5. Proposed fit test standards in the included studies.
Fig 6
Fig 6. Proposed respirator fit testers by included studies during the COVID-19 pandemic.
Fig 7
Fig 7. Types of masks and respirators assessed during the COVID-19 pandemic.
See this image and copyright information in PMC

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References

    1. NIOSH. Hierarchy of Controls. 2023 Jun 17 [cited 2023 July 14]. In: CDC Web site [Internet]. Available from: https://www.cdc.gov/niosh/topics/hierarchy/default.html.
    1. Ippolito M, Vitale F, Accurso G, Iozzo P, Gregoretti C, Giarratano A, et al.. Medical masks and Respirators for the Protection of Healthcare Workers from SARS-CoV-2 and other viruses. Pulmonology. 2020;26(4):204–12. doi: 10.1016/j.pulmoe.2020.04.009 - DOI - PMC - PubMed
    1. OECD. The face mask global value chain in the COVID-19 outbreak: Evidence and policy lessons,OECD Policy Responses to Coronavirus (COVID-19). OECD Publishing, Paris; 2020.
    1. Sun Y, Otomaru H, Quaye SED, Somani J, Bagdasarian N, Beh DLL, et al.. Scenarios to Manage the Demand for N95 Respirators for Healthcare Workers During the COVID-19 Pandemic. Risk Manag Healthc Policy. 2020;13:2489–96. doi: 10.2147/RMHP.S275496 - DOI - PMC - PubMed
    1. Regli A, Thalayasingam P, Bell E, Sommerfield A, von Ungern-Sternberg BS. More than half of front-line healthcare workers unknowingly used an N95/P2 mask without adequate airborne protection: An audit in a tertiary institution. Anaesth Intensive Care. 2021;49(5):404–11. doi: 10.1177/0310057X211007861 - DOI - PubMed

Publication types

Grants and funding

This study was supported by Shiraz University of Medical Sciences (grant no. 23984). Financial Disclosure This study was supported by Shiraz University of Medical Sciences (grant no. 23984). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.