Quantitative Respirator Fit, Face Sizes, and Determinants of Fit in South African Diagnostic Laboratory Respirator Users

Respirators are widely used in health care settings but there is scant information on adequacy of fit and its determinants, particularly in resource-constrained settings. The aim of the study is to describe the proportion of South African diagnostic laboratory respirator users with adequate quantitative respirator fit while wearing their currently selected respirators which were generally supplied without regard to face size, and to identify determinants of fit test pass and fail.

This was a cross-sectional study with 562 participants. Quantitative respirator fit testing was conducted using a PortaCount fit testing machine. Four facial dimensions were taken using callipers and a tape measure. STATA 14 was used to perform descriptive and inferential statistics. The effect of the independent variables including face dimensions, race, smoking, respirator make and size, and age group was explored using multiple logistic regression stratified by sex.

Ninety one percent of the respirators supplied were medium-sized. Seventy eight percent of respirator users failed fit testing and were thus probably not protected by their currently supplied respirator. Multiple logistic regression analysis showed that face length in mm (odds ratio [OR] = 1.04, 95% confidence interval [CI] = 1.00-1.09), nasal root breadth in mm (OR = 1.16, 95% CI = 1.06-1.28), and respirator shape (OR = 0.56, 95% CI = 0.39-0.78) were significant predictors of overall fit for all subjects and for women alone, but these factors explained only a small percentage of fit test outcomes.

A large proportion of diagnostic laboratory employees were using poorly fitting respirators. This creates a false impression of protection. Fit testing of respirators is therefore important and recommended. The determinants evaluated described only a small portion of the variability in fit; important determinants were absent from the models.