When there is a high probability of airborne transmission due to infectious agents or procedures, sound scientific principles support the use of P2/N95 respirators to prevent transmission. Respirators are designed to help reduce the wearer’s respiratory exposure to airborne contaminants such as particles, gases or vapours. P2/N95 respirators are appropriate for the majority of airborne precautions encountered in healthcare facilities.

P2/N95 respirators are also appropriate personal protective equipment (PPE) for all health care workers involved in aerosol-generating procedures when a patient is confirmed or suspected of having a disease that may be transmitted via the airborne route. Aerosol generating procedures may include (list is not intended to be exhaustive):

endotracheal intubation

nebulised medication administration

airway suctioning

bronchoscopy

diagnostic sputum induction

positive pressure ventilation via facemask

high frequency oscillatory ventilation.

Fit checking

Fit checking involves a quick check - each time the mask is put on - to ensure that the respirator is properly applied, that a good seal is achieved over the bridge of the nose and mouth and there are no gaps between the respirator and face. Fit checking is the appropriate minimum standard at the point of use for healthcare workers using P2/N95 respirators.

No clinical activity should be undertaken until a satisfactory fit has been achieved.

Healthcare workers must be informed about how to perform a fit check (PPT, 2.9 MB).

Fit check steps

Follow these steps for a P2/N95 respirator fit check:

Place the respirator on your face.

Place the headband or ties over your head and at the base of your neck.

Compress the respirator to ensure a seal across your face, cheeks and the bridge of your nose.

Check the positive pressure seal of the respirator by gently exhaling. If air escapes, the respirator needs to be adjusted.

Check the negative pressure seal of the respirator by gently inhaling. If the respirator is not drawn in towards your face, or air leaks around the face seal, readjust the respirator and repeat process, or check for defects in the respirator.

Always refer to the manufacturer’s instructions for fit checking of individual brands and types of P2/N95 respirators.

Several companies supply masks for Queensland Health. For further information, please read the product information that is supplied with the product or see the company web page.

If you have facial hair (including a one to two day beard growth) be aware that an adequate seal cannot be guaranteed.

Maintaining the fit and protection from airborne particles

Once you have fitted the P2/N95 mask be careful not to compromise the fit (and your protection).

Don’t

touch the mask while it is being worn

reapply the mask after it has been removed

leave the mask dangling around your neck.

Do

change the mask when it becomes moist

wash your hands if you touch or dispose of a used mask

wait until you are outside the patient care area before removing the mask

dispose of used masks in a closed receptacle.

Fit testing

Fit testing is a qualitative or quantitative method that is used to evaluate the fit of a specific make, model and size of mask on an individual and to ensure that it is worn correctly. It also provides an opportunity to ensure healthcare workers are properly trained in the correct use of the mask.1

A risk-management approach should be applied to ensure that staff working in areas with a significant risk of exposure to diseases transmitted via the airborne route are fit tested and are aware of how to perform a fit check.

All healthcare facilities should:

maintain their fit testing resources and have them accessible

have a respiratory protection program that regularly evaluates the risk to which healhcare workers are exposed and determines which employees are required to undertake fit testing.

When applying an infection prevention risk management approach you should consider:

the location - for example, the risk is higher in an intensive care unit

activities to be undertaken - for example a physiotherapist performing an induced sputum procedure is at risk of exposure to infectious aerosols.

In accordance witht he facility's respiratory protection program, fit testing should be undertaken:

at the commencement of employment for employees who will be working in clinical areas where significant risk of exposure to infectious agents transmitted via the airborne route has been assessed

when there is a significant change in the wearer’s facial characteristics that could alter the facial seal of the respirator (e.g. significant change in body weight, facial surgery).

at regular intervals—AS1715:2009 recommends annual fit testing. Healthcare facilities should ensure that they have a respiratory protection program that regularly evaluates the risk to which healthcare workers are exposed and determines which employees are required to undertake fit testing.

Supporting documents