Fit testing can be a hairy dilemma
October 1, 1996 4 minutes read
Fit testing can be a hairy dilemma
Bearded workers require hooded respirators
Question: Are hospitals requiring employees with beards to shave them off before fit-testing and using N95 respirators, or should employees with beards be excused from caring for tuberculosis patients?
Submitted by Toni Theys, RN, BSN, manager, employee occupational health, Westmoreland Regional Hospital, Greensburg, PA
Answer: Employees with beards cannot be forced to shave them off, nor is the presence of facial hair reason to excuse workers from necessary duties. The question then becomes: Can employees with beards use the standard N95 respirators recently certified by the National Institute for Occupational Safety and Health (NIOSH) for protection of health care workers against tuberculosis infection?
The answer is no, according to U.S. Occupa-tional Safety and Health Administration (OSHA) spokesman Frank Kane in Washington, DC.
"OSHA’s policy is if a respirator fits on the face, no facial hair can be worn with it," Kane states.
Bearded HCWs whose job duties necessitate TB protection must wear a loose-fitting hooded respirator, which does not require fit-testing, he adds.
While OSHA enforces the use of respirators in the workplace, NIOSH certifies the devices to ensure standard performance levels. Rich Metzler, chief of NIOSH’s certification and quality assurance branch in Morgantown, WV, explains the reason behind OSHA’s policy.
Protection requirements: Filtration and fit
Effective respirator protection involves two components, Metzler says. One is the device’s filtration efficacy, or its ability to filter the hazardous aerosol without leakage. The other is the respirator’s face-fit.
"What you need to do in a respiratory protection program is one, ensure that the respirator is effective in filtering the aerosol of concern, and two, ensure that it fits tightly so there is no leakage around the face," he says. "NIOSH does not recommend the use of tight-fitting facepieces any kind of facepiece that makes contact between the respirator and the face for employees with facial hair because facial hair prevents a seal and compromises the face fit."
Written NIOSH guidelines define facial hair and reinforce the message:
"Facial hair that lies along the sealing area of the respirator, such as beards, sideburns, moustaches, or even a few days’ growth of stubble, should not be permitted on employees who are required to wear respirators that rely on a tight facepiece fit to achieve maximum protection. Facial hair between the wearer’s skin and the sealing surfaces of the respirator will prevent a good seal."1
Critics of federal respirator policies have noted that NIOSH’s guidelines are based upon respirator use in industrial settings rather than in hospitals for TB control. Officials at one medical center decided to evaluate the use of N95 respirators on employees with facial hair to determine whether fit testing could identify certain workers who could wear the new masks, which are much less expensive and cumbersome than a hooded particulate air-powered respirator (PAPR).
Aaron E. Glatt, MD, chief of infectious diseases and chairman of the infection control committee at Catholic Medical Center of Brooklyn and Queens, a four-hospital system, says that in a pilot study last year, three (25%) of 12 bearded employees passed the standard 3M saccharin fit test wearing N95 respirators.
Glatt recently reported his findings at the annual meeting of the Association for Professionals in Infection Control and Epidemiology (APIC) held in Atlanta.2
Of the 12 employees tested, five had heavy beards, three had moderate goatees, one had a close beard covering the chin and cheeks, one had a goatee with moderate moustache and facial scarring, and two had short curly beards extending beneath the chin.
The fit test failed in eight (67%) employees; one (8%) had an inconclusive result. The three who passed were: one with a close beard covering the chin and cheeks, one with a moderate goatee, and one with a short curly beard.
Glatt is cautious about the results, though. First, because federal agencies require employees with facial hair to wear hooded respirators only, he does not recommend that those employees be allowed to use N95s even if they can pass a fit test. Also, because the length and lay of facial hair changes frequently, an employee’s ability to pass a fit test on one day doesn’t mean he could pass the same test on another day.
"This was just a pilot study. If everybody had failed it, then we would be wasting our time, but if 25% were able to pass it, that means there’s room to explore this further scientifically, and maybe regular retesting would be indicated if the beard changes," Glatt tells Hospital Employee Health.
The three employees who passed fit testing have not been retested, nor are they using N95 masks, he notes.
Metzler also emphasizes that if bearded employees can pass required fit tests, they still should not be permitted to use N95s, so fit-testing those workers is pointless.
"The health care industry seems to be trying to find a way for beards and tight-fitting facepieces to go together, but fit tests were developed with a clean-shaven face," he points out. "Fit-test protocol procedures used might not be adequate for use with a beard."
In the absence of any peer-reviewed research to the contrary, employees with facial hair should use appropriate loose-fitting hooded respirators, Metzler says.
References
1. Bollinger NJ, Schutz RH. NIOSH Guide to Industrial Respiratory Protection. Washington, DC: U.S. Department of Health and Human Services, NIOSH; September 1987.
2. Glatt AE, Maliga L, Ahmed J, et al. Dust/mist respirator fit testing (Poster). Presented at the 23rd annual educational conference and international meeting of the Association for Professionals in Infection Control and Epidemiology. Atlanta; June 1996.
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