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    2. Our Vision- Healthy Kansans living in safe and sustainable environments. Center for Public Health Preparedness Good Afternoon, My name is Joshua Buffington. I am the Operations Specialist for the Center for Public Health Preparedness at the Kansas Department of Health and Environment. I was asked to talk to you today about fit testing for respirators for your agencies. Namely to understand the importance of respiratory protection and how to start up and maintain a fit testing program for N95 respirators. Our team at the Center for Public Health Preparedness have made it a priority to help educate our grantees to better understand the roles they will play in an event. We want to make the process as seamless as possible to maintain a continuity of public health across the state of Kansas ensuring the health of our citizens.Good Afternoon, My name is Joshua Buffington. I am the Operations Specialist for the Center for Public Health Preparedness at the Kansas Department of Health and Environment. I was asked to talk to you today about fit testing for respirators for your agencies. Namely to understand the importance of respiratory protection and how to start up and maintain a fit testing program for N95 respirators. Our team at the Center for Public Health Preparedness have made it a priority to help educate our grantees to better understand the roles they will play in an event. We want to make the process as seamless as possible to maintain a continuity of public health across the state of Kansas ensuring the health of our citizens.

    3. Our Vision- Healthy Kansans living in safe and sustainable environments. There was a single day that truly brought preparedness into the spotlight for all of us. But before that, we still had events that caused us to consider preparedness an important role in our state’s public health. It just took an event like this to force preparedness into the mainstream of everyday public health. And 9-11 brought personal protective equipment issues into the focus of responders and public health workers in preparation for a possible W M D or Chemical exposure-Attack. While attacks against the U.S. are still concerns, one of our current focuses of public health is the preparation FOR pandemic influenza. With Pandemic Influenza, it is not an issue of if it will happen, but when. This is why it is imperative to have a plan in place to deal with it. In that plan you should include the consideration of using respiratory protective equipment, such as the N95 masks, to reduce the possible exposure of your employees to the virus. There was a single day that truly brought preparedness into the spotlight for all of us. But before that, we still had events that caused us to consider preparedness an important role in our state’s public health. It just took an event like this to force preparedness into the mainstream of everyday public health. And 9-11 brought personal protective equipment issues into the focus of responders and public health workers in preparation for a possible W M D or Chemical exposure-Attack. While attacks against the U.S. are still concerns, one of our current focuses of public health is the preparation FOR pandemic influenza. With Pandemic Influenza, it is not an issue of if it will happen, but when. This is why it is imperative to have a plan in place to deal with it. In that plan you should include the consideration of using respiratory protective equipment, such as the N95 masks, to reduce the possible exposure of your employees to the virus.

    4. Our Vision- Healthy Kansans living in safe and sustainable environments. As defined by the U.S. Department of Labor’s Occupational Safety and Health Administration, prior to anyone wearing a respirator (and YES an N95 is a respirator),…… they must first be cleared by a physician to wear one. We are going to talk about some of the steps you should take to ensure that you are running an effective respiratory protection program for your agency. One that is within compliance of OSHA’s recommendations and encompasses creating the safest environment possible for your employees. The U.S. Department of Labor’s Occupational Safety and Health Administration’s standards are available on-line at www.osha.gov and I encourage you to take the time to look through 1910.134, which pertains to respiratory protection. As defined by the U.S. Department of Labor’s Occupational Safety and Health Administration, prior to anyone wearing a respirator (and YES an N95 is a respirator),…… they must first be cleared by a physician to wear one. We are going to talk about some of the steps you should take to ensure that you are running an effective respiratory protection program for your agency. One that is within compliance of OSHA’s recommendations and encompasses creating the safest environment possible for your employees. The U.S. Department of Labor’s Occupational Safety and Health Administration’s standards are available on-line at www.osha.gov and I encourage you to take the time to look through 1910.134, which pertains to respiratory protection.

    5. Our Vision- Healthy Kansans living in safe and sustainable environments. 1910.134(a)(2) respirators shall be provided by the employer when such equipment is necessary to protect the health of the employee. The employer shall provide the respirators which are applicable and suitable for the purpose intended. The employer shall be responsible for the establishment and maintenance of a respiratory protection program which shall include the requirements outlined in paragraph (c) of this section. Moving into OSHA 1910.134 What 1910.134 (a) (2) states is that your agency has the obligation to protect the health of your employees by providing recommended respiratory protection when the working environment is such that it could cause harm to the employee. It also states that if you are going to provide respiratory protection (such as N95s) then you are also going to provide a respiratory protection program which includes documented medical evaluations, respirator fit testing and worksite specific procedures. These procedures must be specific to include elements such as respirator-selection-criteria, procedures for proper use in routine and emergency situations and must include procedures and schedules for maintenance of respirators. This includes changing out masks on a regular basis. (N95s last about 144 hours but must be replaced if they get wet or damaged). You must also consider a procedure for ensuring adequate air quality, quantity and flow of breathing air for air-purifying respirators to the wearers of the masks. (How is the air that they are breathing? Are they getting enough of it?) This program must be administered by a suitably trained program administrator. What this means is someone who understands the importance of respiratory protection, the hazards in your area and what respiratory protection would be recommended for your situations. They will become a subject matter expert if you will. (will that be you? Will you utilize an outside resource?) The goal of this course is to get you to recognize the importance of providing a respiratory protection program for your agency which includes providing those N95s to your employees when the air quality is compromised. We will also be talking about proper fit testing and do a walk through of a typical fit test procedure. Moving into OSHA 1910.134 What 1910.134 (a) (2) states is that your agency has the obligation to protect the health of your employees by providing recommended respiratory protection when the working environment is such that it could cause harm to the employee. It also states that if you are going to provide respiratory protection (such as N95s) then you are also going to provide a respiratory protection program which includes documented medical evaluations, respirator fit testing and worksite specific procedures. These procedures must be specific to include elements such as respirator-selection-criteria, procedures for proper use in routine and emergency situations and must include procedures and schedules for maintenance of respirators. This includes changing out masks on a regular basis. (N95s last about 144 hours but must be replaced if they get wet or damaged). You must also consider a procedure for ensuring adequate air quality, quantity and flow of breathing air for air-purifying respirators to the wearers of the masks. (How is the air that they are breathing? Are they getting enough of it?) This program must be administered by a suitably trained program administrator. What this means is someone who understands the importance of respiratory protection, the hazards in your area and what respiratory protection would be recommended for your situations. They will become a subject matter expert if you will. (will that be you? Will you utilize an outside resource?) The goal of this course is to get you to recognize the importance of providing a respiratory protection program for your agency which includes providing those N95s to your employees when the air quality is compromised. We will also be talking about proper fit testing and do a walk through of a typical fit test procedure.

    6. Our Vision- Healthy Kansans living in safe and sustainable environments. 1910.134(c)(1)(iv) Procedures for proper use of respirators in routine and reasonably foreseeable emergency situations; 1910.134(c)(1)(v) Procedures and schedules for cleaning, disinfecting, storing, inspecting, repairing, discarding, and otherwise maintaining respirators; With any good respiratory protection program you also need to train your employees on the respiratory hazards that they may be potentially exposed to during routine or emergency situations. This is a great time to teach them how to don and doff the masks, explaining the mask’s limitations and when they are no longer effective. Fit testing must be done annually to assure effectiveness of the mask and documentation of that should be kept in your records. As with any program of merit, you must have A quality assurance/ quality improvement process. I cannot stress this enough. THIS PROCESS focuses on the safety of your employees, so evaluating its effectiveness is crucial. With any good respiratory protection program you also need to train your employees on the respiratory hazards that they may be potentially exposed to during routine or emergency situations. This is a great time to teach them how to don and doff the masks, explaining the mask’s limitations and when they are no longer effective. Fit testing must be done annually to assure effectiveness of the mask and documentation of that should be kept in your records. As with any program of merit, you must have A quality assurance/ quality improvement process. I cannot stress this enough. THIS PROCESS focuses on the safety of your employees, so evaluating its effectiveness is crucial.

    7. Our Vision- Healthy Kansans living in safe and sustainable environments. I felt it was appropriate to discuss how OSHA defines fit testing. 1910.134 subsection (b) states that fit test means the use of a protocol to qualitatively or quantitatively evaluate the fit of a respirator on an individual. This statement is trying to help you make the best decisions as part of your respiratory protection program to keep your employees as safe as possible from the airborne contaminants that you have identified THAT THEY may be exposed to. If you feel that your staff are going to be exposed to Tb, then your program should have a section of it geared toward protection from those types of exposures. Most of us are thinking along the lines of pandemic flu. Since there is no #1 method of making sure your employees don’t catch the bug, you should have plans in place to make sure you are ready handle it when it comes. Most of us plan on utilizing social distancing, hygiene education such as hand washing, and if necessary, respirators to help reduce the chance of our employees being exposed. So the more protection that you can offer to your employee, the better. OSHA 1910.134(c)(1) also states that the employer shall include in their program a provision for fit testing for tight-fitting respirators as defined in 134 (b) Proper fit of a tight-fitting respirator is sometimes very difficult. Different manufacturers make their masks differently. This makes no one mask or brand the one to use for your situation. To approach this realistically, you will need to understand that you will have to purchase several different sizes and possibly different brands to get the best protection you can for your employees. I felt it was appropriate to discuss how OSHA defines fit testing. 1910.134 subsection (b) states that fit test means the use of a protocol to qualitatively or quantitatively evaluate the fit of a respirator on an individual. This statement is trying to help you make the best decisions as part of your respiratory protection program to keep your employees as safe as possible from the airborne contaminants that you have identified THAT THEY may be exposed to. If you feel that your staff are going to be exposed to Tb, then your program should have a section of it geared toward protection from those types of exposures. Most of us are thinking along the lines of pandemic flu. Since there is no #1 method of making sure your employees don’t catch the bug, you should have plans in place to make sure you are ready handle it when it comes. Most of us plan on utilizing social distancing, hygiene education such as hand washing, and if necessary, respirators to help reduce the chance of our employees being exposed. So the more protection that you can offer to your employee, the better. OSHA 1910.134(c)(1) also states that the employer shall include in their program a provision for fit testing for tight-fitting respirators as defined in 134 (b) Proper fit of a tight-fitting respirator is sometimes very difficult. Different manufacturers make their masks differently. This makes no one mask or brand the one to use for your situation. To approach this realistically, you will need to understand that you will have to purchase several different sizes and possibly different brands to get the best protection you can for your employees.

    8. Our Vision- Healthy Kansans living in safe and sustainable environments. Important OSHA Facts 1910.134(c)(4)- The employer shall provide respirators, training, and medical evaluations at no cost to the employee. 1910.134(e)(2)(I)-The employer shall identify a physician or other licensed health care professional (PLHCP) to perform medical evaluations using a medical questionnaire or an initial medical examination that obtains the same information as the medical questionnaire. I wanted to take a minute to bring up some other important OSHA facts. The employer shall provide the respiratory protection and all of the medical evaluations, training etc. at no cost to the employee. Consider this insurance on your agency to keep you from having to pay a substantial work comp claim later. It is the employers responsibility to identify the physician or other licensed health care provider to perform the medical evaluations. You must decide what and who is best for your agency. I wanted to take a minute to bring up some other important OSHA facts. The employer shall provide the respiratory protection and all of the medical evaluations, training etc. at no cost to the employee. Consider this insurance on your agency to keep you from having to pay a substantial work comp claim later. It is the employers responsibility to identify the physician or other licensed health care provider to perform the medical evaluations. You must decide what and who is best for your agency.

    9. Our Vision- Healthy Kansans living in safe and sustainable environments. Before You Fit Test As part of your respiratory protection program you need to evaluate if your employees are able to wear a tight fitting respirator. This process begins with a medical evaluation questionnaire that is completed by the employee. A medical evaluation form is available on our website at www.ksprepared.org. These evaluation forms will be reviewed by an occupational health physician or other licensed health care provider of your agency’s choice, who can determine whether or not an employee is able to wear a respirator. In some cases the physician may ask for a follow up with the employee to discuss any concerns or limitations he or she may have with wearing a respirator. As the employer, the physician will send you a reply as to whether an employee can wear a respirator. This may include any restrictions the physician may place on the employee. Such as the employee being able to wear an N95 but not a Self Contained Breathing Apparatus type device. Please remember that not all employees will pass this evaluation so you should plan for this. In the case where an employee is not able to wear an N95, you may consider re-evaluating the need to have that employee participate in the activities that put them at risk. Or you can consider alternative devices to use such as a powered air-purifying respirator. These devices, while expensive, take stress off the user’s respiratory and circulatory systems and allow them to perform in the areas where there is concern for air quality. As part of your respiratory protection program you need to evaluate if your employees are able to wear a tight fitting respirator. This process begins with a medical evaluation questionnaire that is completed by the employee. A medical evaluation form is available on our website at www.ksprepared.org. These evaluation forms will be reviewed by an occupational health physician or other licensed health care provider of your agency’s choice, who can determine whether or not an employee is able to wear a respirator. In some cases the physician may ask for a follow up with the employee to discuss any concerns or limitations he or she may have with wearing a respirator. As the employer, the physician will send you a reply as to whether an employee can wear a respirator. This may include any restrictions the physician may place on the employee. Such as the employee being able to wear an N95 but not a Self Contained Breathing Apparatus type device. Please remember that not all employees will pass this evaluation so you should plan for this. In the case where an employee is not able to wear an N95, you may consider re-evaluating the need to have that employee participate in the activities that put them at risk. Or you can consider alternative devices to use such as a powered air-purifying respirator. These devices, while expensive, take stress off the user’s respiratory and circulatory systems and allow them to perform in the areas where there is concern for air quality.

    10. Our Vision- Healthy Kansans living in safe and sustainable environments. What Are You Protecting Them From? Something else to keep in mind.. is proper respirator choice. Are we attempting to protect our employees from dust particles or flu viruses? Different respirators are made for different purposes. Before you purchase, check to see what you need. If you have already purchased, check to see what you have; AND if it fits in with your respiratory protection program or the hazards that you have identified within your plan. Dust particles have a different particle size than a flu virus and YOU must make the safest choices you can for your staff.Something else to keep in mind.. is proper respirator choice. Are we attempting to protect our employees from dust particles or flu viruses? Different respirators are made for different purposes. Before you purchase, check to see what you need. If you have already purchased, check to see what you have; AND if it fits in with your respiratory protection program or the hazards that you have identified within your plan. Dust particles have a different particle size than a flu virus and YOU must make the safest choices you can for your staff.

    11. Our Vision- Healthy Kansans living in safe and sustainable environments. N95 Recommended by OSHA More effective than a surgical mask Many different types Educate yourself! The focus of today’s fit testing information is based upon the N95 respirator. The US Department of Labor recommends air-purifying respirators (for example., N95, N99, or N100) as part of a comprehensive respiratory protection program for workers directly involved with avian influenza (1). N95 respirators have 2 advantages over simple cloth or surgical masks; they are greater than or equal to 95% efficient at filtering smaller than the size of large droplets—created during talking, coughing, and sneezing—which usually transmit influenza) and the masks are fit tested to ensure that infectious droplets and particles do not leak around the mask (2–4). Even if N95 filtration is unnecessary for avian influenza, N95 fit offers advantages over a loose-fitting surgical mask by eliminating leakage around the mask. A point I would like to bring up, you should educate yourself on the type of N95 masks that are out there what their capabilities are. Several types of N95 masks are particulate masks that are not compatible with bio hazard or infectious type droplets. I took an excerpt from a very popular N95 mask that is in circulation across the state. It states, “this respirator can help reduce inhalation exposures to certain airborne biological particles, but cannot eliminate the risk of contracting infection, illness or disease. OSHA and other government agencies have not established safe exposure limits for these contaminants.” Basically, while most N95s can reduce exposures to harmful contaminants, there are ones made specifically for an infectious droplet type of exposure. And they are not going to eliminate the chance of exposure to flu for your employees. There is a wealth of good knowledge on the internet about respiratory protection and N95s. I would encourage you to do some research to find out more. I would also suggest that you discuss with your medical supply vendors what they have to offer and see if what your purchasing is really what you need or want.The focus of today’s fit testing information is based upon the N95 respirator. The US Department of Labor recommends air-purifying respirators (for example., N95, N99, or N100) as part of a comprehensive respiratory protection program for workers directly involved with avian influenza (1). N95 respirators have 2 advantages over simple cloth or surgical masks; they are greater than or equal to 95% efficient at filtering smaller than the size of large droplets—created during talking, coughing, and sneezing—which usually transmit influenza) and the masks are fit tested to ensure that infectious droplets and particles do not leak around the mask (2–4). Even if N95 filtration is unnecessary for avian influenza, N95 fit offers advantages over a loose-fitting surgical mask by eliminating leakage around the mask. A point I would like to bring up, you should educate yourself on the type of N95 masks that are out there what their capabilities are. Several types of N95 masks are particulate masks that are not compatible with bio hazard or infectious type droplets. I took an excerpt from a very popular N95 mask that is in circulation across the state. It states, “this respirator can help reduce inhalation exposures to certain airborne biological particles, but cannot eliminate the risk of contracting infection, illness or disease. OSHA and other government agencies have not established safe exposure limits for these contaminants.” Basically, while most N95s can reduce exposures to harmful contaminants, there are ones made specifically for an infectious droplet type of exposure. And they are not going to eliminate the chance of exposure to flu for your employees. There is a wealth of good knowledge on the internet about respiratory protection and N95s. I would encourage you to do some research to find out more. I would also suggest that you discuss with your medical supply vendors what they have to offer and see if what your purchasing is really what you need or want.

    12. Our Vision- Healthy Kansans living in safe and sustainable environments. Are We Fit Testing Yet? At this point, I would like to think that you have a good grasp on the importance of a respiratory protection program within your agency. So let’s say you have REVIEWED the possible hazards in your community and decided that you will select and provide an appropriate respirator based on those hazards to which your employees are exposed, or potentially could be exposed. This respirator will be a NIOSH certified respirator. NIOSH stands for the (National Institute for Occupational Safety and Health) What’s next you ask? The physician should have all of the results of your medical evaluations back to you. You will have ordered several different models and sizes of respirators for the fit testing of your employees. Don’t just buy a big old’ box of masks as you may find out that no one can wear them and you will then be stuck with a resource that you cannot use. Next we will see how to test to ensure a tight-fit for the N95 mask. At this point, I would like to think that you have a good grasp on the importance of a respiratory protection program within your agency. So let’s say you have REVIEWED the possible hazards in your community and decided that you will select and provide an appropriate respirator based on those hazards to which your employees are exposed, or potentially could be exposed. This respirator will be a NIOSH certified respirator. NIOSH stands for the (National Institute for Occupational Safety and Health) What’s next you ask? The physician should have all of the results of your medical evaluations back to you. You will have ordered several different models and sizes of respirators for the fit testing of your employees. Don’t just buy a big old’ box of masks as you may find out that no one can wear them and you will then be stuck with a resource that you cannot use. Next we will see how to test to ensure a tight-fit for the N95 mask.

    13. Our Vision- Healthy Kansans living in safe and sustainable environments. Qualitative vs. Quantitative What’s best for your agency? There are two types of OSHA recognized fit tests for tight fitting respirators, such as (N95s). Qualitative or Quantitative. Today we are going to focus on the Qualitative testing as it is simplest to use; it is a pass/ fail test; and is adequate at effectively testing FIT for N95 respirator masks. If your agency has the need to focus on a higher level of protection, your fit testing may vary or you may need to consider the Quantitative methods. This may be a consideration when you have employees who will regularly wear respirators such as supplied-air respirators. The Quantitative test will assess the adequacy of the respirator’s fit to the wearer by measuring the amount of leakage into the respirator. There are many examples of Quantitative testing devices on-line and if you feel this what you agency would need, I encourage you to do an internet search for more information. There are two types of OSHA recognized fit tests for tight fitting respirators, such as (N95s). Qualitative or Quantitative. Today we are going to focus on the Qualitative testing as it is simplest to use; it is a pass/ fail test; and is adequate at effectively testing FIT for N95 respirator masks. If your agency has the need to focus on a higher level of protection, your fit testing may vary or you may need to consider the Quantitative methods. This may be a consideration when you have employees who will regularly wear respirators such as supplied-air respirators. The Quantitative test will assess the adequacy of the respirator’s fit to the wearer by measuring the amount of leakage into the respirator. There are many examples of Quantitative testing devices on-line and if you feel this what you agency would need, I encourage you to do an internet search for more information.

    14. Our Vision- Healthy Kansans living in safe and sustainable environments. Qualitative Testing Pass/ Fail test Cost effective ($250-$500) Does someone already do this in your area? As we are focusing on Qualitative testing today, I wanted to highlight a few things about it. First off, it is a Pass/ Fail test. If the employee can communicate to you that they are able to recognize whether or not the testing agent is getting through, then your test is effective. However, I caution you about using N95s with exhalation vents. (Show them the Mask with vent) While they can be more comfortable for the user, they can be much more difficult to fit test. Keep that in mind and weigh your options before deciding on a mask to use. These Qualitative kits can be purchased piece by piece or by a start up kit. The kits run anywhere from $250 on up. You can piece together a kit, if needed, to suit the needs of your agency and your respiratory protection program. I suggest you contact your regular vendors and see what they may have to offer you. You should also consider that if you have a local Emergency Manager, they may be able to get you in contact with someone with experience in fit testing. They may even already have kits available that your staff can use. Haz Mat teams are REQUIRED to fit test as well, and YOU can at least get some guidance from their experience. As we are focusing on Qualitative testing today, I wanted to highlight a few things about it. First off, it is a Pass/ Fail test. If the employee can communicate to you that they are able to recognize whether or not the testing agent is getting through, then your test is effective. However, I caution you about using N95s with exhalation vents. (Show them the Mask with vent) While they can be more comfortable for the user, they can be much more difficult to fit test. Keep that in mind and weigh your options before deciding on a mask to use. These Qualitative kits can be purchased piece by piece or by a start up kit. The kits run anywhere from $250 on up. You can piece together a kit, if needed, to suit the needs of your agency and your respiratory protection program. I suggest you contact your regular vendors and see what they may have to offer you. You should also consider that if you have a local Emergency Manager, they may be able to get you in contact with someone with experience in fit testing. They may even already have kits available that your staff can use. Haz Mat teams are REQUIRED to fit test as well, and YOU can at least get some guidance from their experience.

    15. Our Vision- Healthy Kansans living in safe and sustainable environments. Testing Agents Sweet or Bitter? Prior recognition of agent Allergic reactions to Saccharin Now we should talk about testing agents. When we talk about Testing agents, we are specifically talking about the Sweet or Bitter testing agents or solutions that come in most qualitative fit testing kits. These are generally Saccharin for (sweet) or Bitrex for (bitter). These agents will be used to determine if there are any leaks in the fit of the mask to the wearer. You should determine which agent will work best for each wearer. Some people can have Saccharin allergies and some people cannot taste the agents. There ARE Alternative sweet agents out there beside Saccharin. But you must expose the wearers to the sensitivity solutions prior to the actual testing. They need to be able to recognize the agent, then get a drink to clear the taste before the actual Fit test.Now we should talk about testing agents. When we talk about Testing agents, we are specifically talking about the Sweet or Bitter testing agents or solutions that come in most qualitative fit testing kits. These are generally Saccharin for (sweet) or Bitrex for (bitter). These agents will be used to determine if there are any leaks in the fit of the mask to the wearer. You should determine which agent will work best for each wearer. Some people can have Saccharin allergies and some people cannot taste the agents. There ARE Alternative sweet agents out there beside Saccharin. But you must expose the wearers to the sensitivity solutions prior to the actual testing. They need to be able to recognize the agent, then get a drink to clear the taste before the actual Fit test.

    16. Our Vision- Healthy Kansans living in safe and sustainable environments. Sensitivity Tests Very diluted version of the Fit Test solution Detecting the agent The sensitivity test is done to assure that the employee being fit tested can detect the taste of the test solution at very low levels. The sensitivity test solution is a very diluted version of the Fit Test solution that should be able to help the employee recognize the taste and be prepared to expect that taste if a leak is present in the respirator. The employee should not eat, drink, or chew gum (except a drink of water) for 15 minutes prior to the test. (Get out the Fit Testing kit and show everyone the parts within. Explain what they look like and how simple the instructions are to follow.) Next we will look through this test kit and follow the listed directions to perform a sensitivity test and Fit Test on our Test subject.The sensitivity test is done to assure that the employee being fit tested can detect the taste of the test solution at very low levels. The sensitivity test solution is a very diluted version of the Fit Test solution that should be able to help the employee recognize the taste and be prepared to expect that taste if a leak is present in the respirator. The employee should not eat, drink, or chew gum (except a drink of water) for 15 minutes prior to the test. (Get out the Fit Testing kit and show everyone the parts within. Explain what they look like and how simple the instructions are to follow.)

    17. Our Vision- Healthy Kansans living in safe and sustainable environments.

    18. Our Vision- Healthy Kansans living in safe and sustainable environments. Almost Fit Testing! Put on the hood and collar assembly without a respirator. These are the basic steps of a popular brand of fit testing kit for sensitivity testing. Your brand may vary. I will use a volunteer to demonstrate how to do a sensitivity test using this brand of fit testing kit. #1 Have the subject put on the hood and collar assembly without a respirator. These are the basic steps of a popular brand of fit testing kit for sensitivity testing. Your brand may vary. I will use a volunteer to demonstrate how to do a sensitivity test using this brand of fit testing kit. #1 Have the subject put on the hood and collar assembly without a respirator.

    19. Our Vision- Healthy Kansans living in safe and sustainable environments. 2. Position the hood assembly #2 Position the hood assembly forward so that there is about six inches between the subject’s face and the hood window. #2 Position the hood assembly forward so that there is about six inches between the subject’s face and the hood window.

    20. Our Vision- Healthy Kansans living in safe and sustainable environments. 3. Breathe through mouth #3 Instruct the subject to breathe through his/ her mouth with tongue extended. #3 Instruct the subject to breathe through his/ her mouth with tongue extended.

    21. Our Vision- Healthy Kansans living in safe and sustainable environments. 4. Inject aerosol of sensitivity solution #4 Using the nebulizer with sensitivity test solution, inject the aerosol into the hood through the hole in the hood window. Inject ten squeezes of the bulb, fully collapsing and allowing the bulb to expand fully on each squeeze. Both plugs on the nebulizer must be removed from the openings during use. The nebulizer must be held in an upright position to ensure aerosol generation. #4 Using the nebulizer with sensitivity test solution, inject the aerosol into the hood through the hole in the hood window. Inject ten squeezes of the bulb, fully collapsing and allowing the bulb to expand fully on each squeeze. Both plugs on the nebulizer must be removed from the openings during use. The nebulizer must be held in an upright position to ensure aerosol generation.

    22. Our Vision- Healthy Kansans living in safe and sustainable environments. 5. Can they taste the solution? #5 Ask the subject if they can detect the taste of the solution. If tasted, note the number of squeezes as ten and proceed to the fit test. #5 Ask the subject if they can detect the taste of the solution. If tasted, note the number of squeezes as ten and proceed to the fit test.

    23. Our Vision- Healthy Kansans living in safe and sustainable environments. 6. If not, inject more solution #6 If not tasted, inject an additional ten squeezes of the aerosol into the hood. Repeat with ten more squeezes if necessary. Note how many squeezes were needed to produce the taste response. #6 If not tasted, inject an additional ten squeezes of the aerosol into the hood. Repeat with ten more squeezes if necessary. Note how many squeezes were needed to produce the taste response.

    24. Our Vision- Healthy Kansans living in safe and sustainable environments. Almost Fit Testing… Still can’t taste it? If they do taste it…. 8. Take off the hood and get a drink of water You are now ready to test the respirator! 7) If 30 squeezes are inadequate, in that the subject does not detect a taste of the solution, the test is ended. Another type of solution or fit test will be needed. If they do taste the solution the next step is to….. 8) Have the subject remove the test hood WITH your help and give them a few minutes to clear the taste from their mouth. It is generally helpful for them to grab a quick drink of water to rinse out the taste. You are now ready to test your respirator!7) If 30 squeezes are inadequate, in that the subject does not detect a taste of the solution, the test is ended. Another type of solution or fit test will be needed. If they do taste the solution the next step is to….. 8) Have the subject remove the test hood WITH your help and give them a few minutes to clear the taste from their mouth. It is generally helpful for them to grab a quick drink of water to rinse out the taste. You are now ready to test your respirator!

    25. Our Vision- Healthy Kansans living in safe and sustainable environments. A Few More Things to Consider Other PPE PAPR or Quantitative Fit Test? Depends on need and cost A few more things to consider. Most of your employees will not be donning a mask alone. They will need to consider the use of other personal protective equipment. In doing so, some PPE such as goggles and hard hats can effect the proper fit of the mask. Consider what PPE your employees will need to wear in a given situation and Fit Test them while wearing it. There are situations where an employee cannot wear a respirator or cannot taste the solutions you have purchased for testing. You may decide it is imperative for this employee to participate in a possible hazardous area. You can consider do Quantitative fit testing, which costs a little more to get started into, but is a much more accurate way of fit testing. Another option is considering the use of a Powered-AIR PURIFYING device. While the cost and maintenance is more than your standard N95, it may be what is needed to bridge the gap for the safety of your employee.A few more things to consider. Most of your employees will not be donning a mask alone. They will need to consider the use of other personal protective equipment. In doing so, some PPE such as goggles and hard hats can effect the proper fit of the mask. Consider what PPE your employees will need to wear in a given situation and Fit Test them while wearing it. There are situations where an employee cannot wear a respirator or cannot taste the solutions you have purchased for testing. You may decide it is imperative for this employee to participate in a possible hazardous area. You can consider do Quantitative fit testing, which costs a little more to get started into, but is a much more accurate way of fit testing. Another option is considering the use of a Powered-AIR PURIFYING device. While the cost and maintenance is more than your standard N95, it may be what is needed to bridge the gap for the safety of your employee.

    26. Our Vision- Healthy Kansans living in safe and sustainable environments. Now We Are Fit Testing! Don the proper respirator mask Put on any other PPE Have the subject don the respirator they will be testing and perform a user seal check if recommended by the manufacturer. Put on any other PPE that the user will required to wear with the respirator such as goggles.Have the subject don the respirator they will be testing and perform a user seal check if recommended by the manufacturer. Put on any other PPE that the user will required to wear with the respirator such as goggles.

    27. Fit Testing.. Put on the Hood as before Perform Fit Test with solution Helpful hint Our Vision- Healthy Kansans living in safe and sustainable environments. Put on the hood and position the test hood as before. Now breathe through your open mouth. Now begin injecting the fit test aerosol using the same number of squeezes as required in the initial Sensitivity test. A minimum of ten squeezes is required, fully collapsing and allowing the bulb to expand fully on each squeeze. The nebulizer must be held in an upright position to ensure aerosol generation. TO maintain an adequate concentration of aerosol during the test, inject one-half the number of squeezes every 30 seconds for the duration of the fit test procedure. If you used 10 squeezes initially, then follow up with 5 additional squeezes every 30 seconds. Put on the hood and position the test hood as before. Now breathe through your open mouth. Now begin injecting the fit test aerosol using the same number of squeezes as required in the initial Sensitivity test. A minimum of ten squeezes is required, fully collapsing and allowing the bulb to expand fully on each squeeze. The nebulizer must be held in an upright position to ensure aerosol generation. TO maintain an adequate concentration of aerosol during the test, inject one-half the number of squeezes every 30 seconds for the duration of the fit test procedure. If you used 10 squeezes initially, then follow up with 5 additional squeezes every 30 seconds.

    28. Now Test For Leakage Normal Breathing Deep Breathing Turning head side to side, up and down Talking Rainbow Passage Our Vision- Healthy Kansans living in safe and sustainable environments. After the initial injection of aerosol, ask the test subject to perform the following test exercises for 60 seconds each: Normal Breathing-In a normal standing position, without talking, the subject shall breathe normally. Deep Breathing- In a normal standing position, the subject shall breathe slowly and deeply, taking caution so as not to hyperventilate. Turning Head side to side- Standing in place, the subject shall slowly turn his/her head from side to side between the extreme positions on each side. The subject shall hold the position at each extreme momentarily so they can inhale at each side. Moving head up and down- Standing in place, the subject shall slowly move his/her head up and down. The subject shall be instructed to inhale in the up position (i.e. looking toward the ceiling). Talking- The subject shall talk out loud slowly and loud enough so as to be heard clearly by the test conductor. The subject can read from a prepared text such as the rainbow passage, count backward from 100, or recite a memorized poem or song. After the initial injection of aerosol, ask the test subject to perform the following test exercises for 60 seconds each: Normal Breathing-In a normal standing position, without talking, the subject shall breathe normally. Deep Breathing- In a normal standing position, the subject shall breathe slowly and deeply, taking caution so as not to hyperventilate. Turning Head side to side- Standing in place, the subject shall slowly turn his/her head from side to side between the extreme positions on each side. The subject shall hold the position at each extreme momentarily so they can inhale at each side. Moving head up and down- Standing in place, the subject shall slowly move his/her head up and down. The subject shall be instructed to inhale in the up position (i.e. looking toward the ceiling). Talking- The subject shall talk out loud slowly and loud enough so as to be heard clearly by the test conductor. The subject can read from a prepared text such as the rainbow passage, count backward from 100, or recite a memorized poem or song.

    29. The Rainbow Passage “When the sunlight strikes raindrops in the air, they act like a prism and form a rainbow. The rainbow is a division of white light into many beautiful colors. These take the shape of a long round arch, with its path high above, and its two ends apparently beyond the horizon. There is, according to legend, a boiling pot of gold at one end. People look, but no one ever finds it. When a man looks for something beyond reach, his friends say he is looking for the pot of gold at the end of the rainbow.” Our Vision- Healthy Kansans living in safe and sustainable environments. The Rainbow Passage is an articulation exercise that includes all the normal sounds of spoken English. This makes this a very useful tool when test fitting for respirators as it covers almost every spoken sound that the user may encounter and checking for mask fit during the same time. Using techniques such as this allow you to assure the best fit you can for your employees.The Rainbow Passage is an articulation exercise that includes all the normal sounds of spoken English.

    30. Still Testing for Leaks Bending over And MORE normal breathing RELAX… it’s done! Our Vision- Healthy Kansans living in safe and sustainable environments. The test subject will now be asked to bend at their waist and touch towards his/her toes. Jogging in place my be substituted for this exercise. If you have someone who cannot touch their toes by bending over, they may not be able to jog in place either. Remember that safety (health) is the key!! Perform testing techniques that are realistic for the subject to do. End with 60 seconds of normal breathing again.The test subject will now be asked to bend at their waist and touch towards his/her toes. Jogging in place my be substituted for this exercise. If you have someone who cannot touch their toes by bending over, they may not be able to jog in place either. Remember that safety (health) is the key!! Perform testing techniques that are realistic for the subject to do. End with 60 seconds of normal breathing again.

    31. A Few More Things.. What if they taste the solution before the test is over? How do we know if the Fit Test was successful? What if the nebulizer becomes clogged? Our Vision- Healthy Kansans living in safe and sustainable environments. The test is terminated at any time the taste of the solution is detected by the subject because it indicates an inadequate fit. Wait 15 minutes and perform the sensitivity test again (starting over). They may need a different size or brand of mask to complete the test effectively. If the entire test is completed without the subject detecting the taste of the aerosol, the test is successful and the respirator fit has been demonstrated. Periodically check the nebulizer to make sure that it is not clogged. If clogging is found, clean the nebulizer and retest the subject.The test is terminated at any time the taste of the solution is detected by the subject because it indicates an inadequate fit. Wait 15 minutes and perform the sensitivity test again (starting over). They may need a different size or brand of mask to complete the test effectively. If the entire test is completed without the subject detecting the taste of the aerosol, the test is successful and the respirator fit has been demonstrated. Periodically check the nebulizer to make sure that it is not clogged. If clogging is found, clean the nebulizer and retest the subject.

    32. Cleaning At the end of each session or at least every four hours, discard the unused solutions from the nebulizers. Our Vision- Healthy Kansans living in safe and sustainable environments. DO NOT pout unused solutions back into the bottles. Rinse the nebulizers with warm water to prevent clogging and shake dry. Wipe out the inside of the hood with a damp cloth or paper towel to remove any deposited test solution. Let air dry and then put back into its original packaging.DO NOT pout unused solutions back into the bottles. Rinse the nebulizers with warm water to prevent clogging and shake dry. Wipe out the inside of the hood with a damp cloth or paper towel to remove any deposited test solution. Let air dry and then put back into its original packaging.

    33. Our Vision- Healthy Kansans living in safe and sustainable environments. To keep your employees and community safe, you must take the necessary steps to remain in compliance with the guidelines. I hope this was an informative learning session to help you take the next step in establishing your respiratory protection program. If you have further questions, please feel free to contact us at The Center for Public Health Preparedness.To keep your employees and community safe, you must take the necessary steps to remain in compliance with the guidelines. I hope this was an informative learning session to help you take the next step in establishing your respiratory protection program. If you have further questions, please feel free to contact us at The Center for Public Health Preparedness.

    34. Questions? Contact us! www.ksprepared.org www.kdheks.gov/cphp Our Vision- Healthy Kansans living in safe and sustainable environments.

    35. Joshua Buffington, MICT Operations Specialist (785) 296-3380 jbuffington@kdheks.gov Kansas Department of Health & Environment Center for Public Health Preparedness Our Vision- Healthy Kansans living in safe and sustainable environments.

    36. Our Vision- Healthy Kansans living in safe and sustainable environments.

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