Tight-fitting respirators like the N95, need to fit properly to provide protection. The Washington Department of Labor and Industries (L&I) regulates and enforces respirator safety standards, including how facilities conduct fit testing. Currently, the Department of Health (DOH) offers training to help Long Term Care Facilities (LTCF) learn how to do their own respirator fit testing.
Before fit test training can start, there are things that will need to be decided on and pieces of work to complete.
- For the facility’s leadership
- Complete the facility’s written Respiratory Protection Program and have started to use it in the facility.
The written program is described as a how-to-guide for staff to follow.
- Complete and put in place the facility’s Respirator Training program for employees.
The facility must have a training on respiratory protection specific to their facility. There are specific topics that will need to be taught to the staff.
- Decide who will be conducting fit testing.
The person conducting the fit tests will need to understand the L& I rules and regulations on fit testing and the facility’s written program on providing respiratory protection for the staff.
- Recommendation for the number of staff conducting fit tests.
- 1-2 fit test staff: 1-15 workers
- 2-3 fit test staff: 16-30 workers
- 3-4 fit test staff: 31-50 workers
- 4+ fit test staff: >50 workers
- Develop a plan on how fit testing will happen at your facility.
- How will you use your fit test staff?
- How will you conduct fit testing for your night shift?
- These are example questions you will need to think about to develop and plan your fit testing program.
- Purchase enough fit test kits, supplies, and equipment for your fit test staff.
- Schedule your fit test staff to attend the 60-minute Virtual Fit Test Training and time to complete their tasks before attending the Virtual Fit Test Training.
One login per designated fit test staff. Each person will need to register and complete the pre-training tasks before attending the Hands-on Fit Test Training.
- Optional: Schedule your Hands-on Fit Test Training with our fit test vendors to be attended after the Virtual Fit Test Training.
It is best practice if the Hands-on Training is done within the week of the Virtual Fit Test Training.
- For the Fit Test Staff attending the training (must be done before attending)
- Review your facility’s written Respiratory Protection AND Respirator Training Program.
You must understand what your facility policies and procedures are to help your co-workers.
- If you want or need to be fit tested, you must complete the medical evaluation before training.
Your regular job duties may not require you to wear an N95. Because you are training to be a fit test staff, and if you want to experience the fit test process and the use of an N95, you must complete the requirements for getting fit tested.
- Watch the 3 online videos.
There are 3 required videos:
- Introduction to Fit Testing (9 minutes)
- Fit Test Equipment (23 minutes)
- Fit Testing (29 minutes)
- Review the WAC 296-842 Safety Standards for Respirators, focusing on fit testing.
Be familiar with the Washington State rules and regulations for fit testing.
- Come prepared with questions and participate in the Virtual Fit Test Training.
We will go over the paperwork, equipment, demonstrate a fit test, and answer questions. Credit for participating will be determined by participating in the polls during the webinar.
- Check with your leadership to see if they have already scheduled your Hands-on Fit Test Training.
Scheduling the Virtual and Hands-on Fit Test training close together will help you remember the information.
Important! There is no certification for the fit test training. It is the responsibility of the employer to make sure the fit testers conducting the fit tests for their employees are competent, (they know the respiratory program parts very well and any requirements) and can perform fit test according to L&I’s rules.
General Training Information
Your facility must complete the following requirements before the fit test training:
- Facility specific written Respiratory Protection Program.
- This document will provide your staff information on how your Respiratory Protection Program works.
- The Respirator Program Administrator will need to be assigned or designated and listed in the written program. This person is the person your fit test staff will be able to use as a resource on Respiratory Protection.
- LTC Facility written program template.
- Facility specific N95 user training.
- There are resources you can use to help get your staff trained on N95 use. Videos or documents are to add to your training program, not replace it.
- Here is a link to the DOH N95 User Training template created for LTC facilities for you to customize to your facility.
- In your facility’s training program, the fit test staff will focus on:
- How to don and doff all the types of respirators your facility carries.
- Understand the current policy for disposal of the N95, depending on the current situation of supply for N95.
- The limitations of the N95.
- Where the N95 is kept or stored for use for each area of the facility.
- What to do in case the respirator gets knocked off the user.
- The facility must have a way for staff to complete the medical evaluations. There are three options:
- DOH currently has the 3M online medical evaluation system for LTC facilities.
- Send your staff to an Occupational Medicine clinic to get their medical evaluations completed.
- Have your own in-house Licensed Health Care Provider review the medical evaluation questionnaires.
- The questionnaires must be kept confidential and separate from the Human Resource files and kept for 30 years after separation from the facility.
Selecting who will perform your fit testing
Selecting your fit test staff will depend on many things. Consider the following:
- The number of workers you need to fit test.
- The number of shifts you staff to care for your residents/clients.
- The number of locations your organization has.
- The severity of staffing shortage you are experiencing.
This is our recommendation of the number of fit test staff you will need for your facility:
- 1-2 fit test staff: 1-15 workers
- 2-3 fit test staff: 16-30 workers
- 3-4 fit test staff: 31-50 workers
- 4+ fit test staff: >50 workers
It is best practice to have more than one person in charge of the fit testing.
Developing your Fit Test Program
Remember the activities required for the respiratory protection program should be done during paid time. Having fit test staff on the same shift as your staff will help with this requirement and may result in staff following the L&I rules and requirements.
Supplies and Equipment
- Purchase a qualitative fit testing kit with either bitter or sweet solution.
- A complete fit test kit includes the following: sensitivity solution, fit test solution, two nebulizers (each with a bulb, dish, lid, and atomizer), a hood, and extra atomizers and cleaning wires.
- See Fit Test Kit and Hood Options for more information on the fit test kits including where to purchase them.
- The equipment and solutions are also sold separately. Consider purchasing extra hoods and nebulizers to increase the number of fit tests that can be done and/or equipment replacement.
- The number of kits to purchase will depend on how your Fit Testing Program is set up. Each fit test staff will need a kit to conduct a fit test if they are fit testing at the same time. If they are fit testing alone, you may need only one kit.
- Have extra sensitivity and fit test solutions on hand. An open bottle may get knocked over or a box of ampules crushed, you cannot conduct a fit test without the solutions.
Other supplies and equipment are needed to perform the fit test.
- Mirror – To show the person how their respirator fits on their face and to look at the strap placement.
- Gloves – To be used when sanitizing the hood(s). Recommended to be use when prepping equipment and during fit testing.
- Clock with a moving second hand – Our recommendation is to use a clock with a second hand, because it makes it easy to adjust your timing if necessary and it frees your hands.
- Disinfectant wipes – The wipes should be unscented for those who are scent sensitive. Look on the label on the container of the disinfectant wipes for the contact time. The longer the contact time for disinfecting, the longer between fit tests. Do not use wipes with bleach, it is a respiratory hazard.
- Hand sanitizer – The hand sanitizer is there for anyone to use.
- More than one model of N95 respirators – It is possible not all your staff will pass the fit test with one N95 model. If the number of staff is small enough, it is possible to only need one N95 model. But it is very likely more than one model will need to be purchased. If you are not sure where to obtain N95s, please visit our FAQ – Where can we get more N95s?
- Napkins/paper towel – This is for the staff to moisten and wipe the solution off their lips after the sensitivity testing and if the seal on the N95 fails.
- Water, with cups – The water will help get rid of the taste in their mouth after the sensitivity testing and if the N95 seal fails. The solutions are non-toxic and can be swallowed. It is the staff’s preference to either swish and swallow the water or swish and spit out the water. The staff will need to be rid of the taste in their mouth for the next step.
The facility will need to give paid time for the trainee to complete their pieces of work before the Virtual Fit Test Training. Provide time away from any other work for the trainee to focus on the required parts to better understand the rules and regulations.
Virtual Fit Test Training
- Choose a time that will work best for your fit test staff. They will need to have enough time to watch the videos and go over the material to be prepared.
- If the Fit Test staff feels they did not understand everything on the Virtual Fit Test Training, they can repeat it before attending the Hands-on Fit Test Training.
- We understand this is a lot of information for the trainees. It is expected they will have questions even after doing all the required pieces of work and training.
Hands-on Fit Test Training
The DOH Fit Test Vendors will schedule a time to visit your facility to help the trainees become familiar with fit testing.
Having both the Virtual Fit Test Training and the Hands-on Fit Test Training scheduled close together will help the trainee remember and apply what they have learned. This will help your new fit test staff with their newly gained skill.
As of July 1, 2022, Columbia Safety is the DOH Fit Test vendor for all counties in the state. DOH will send the attendance list to Columbia Safety at the end of the Virtual Fit Test Training session. Columbia Safety will schedule a time to visit your facility to help trainees become familiar with fit testing.
Fit test staff must complete pre-training work BEFORE the Virtual Fit Test Training Day!
To have a successful training session, fit test staff need to be familiar with the fit testing process. Pre-training work includes watching the required videos, reviewing sections of the regulations and other resources, and becoming an expert in donning/doffing your facility’s respirators.
Review the regulations and resources
In addition to the videos, fit test staff need to be familiar with the regulations for fit testing, and other training materials below:
- The WAC relating to fit testing:
- Conduct fit testing – WAC 296-842-15005
- Prevent sealing problems with tight-fitting respirators – WAC 296-842-18005
- Make sure employees leave the use area before removing respirators – WAC 296-842-18010
- Use this medical questionnaire for medical evaluations – WAC 296-842-2205
- Follow these fit-testing procedures for tight-fitting respirators – WAC 296-842-22010
- Follow procedures established for seal checking respirators – WAC 296-842-22020
- The facility’s written Respiratory Protection Program
- The facility’s employee Respirator User training
- Reminder sheet for fit testing
- Evaluating the fit tester
- N95 Fit Test Tips
- Filtering Facepiece Respirator Fit Test Record
Trainees must watch the following 3 videos to be prepared for the Virtual Fit Test Training session:
Be an expert or highly skilled in donning and doffing all the N95 respirators in your facility:
If the trainee is not familiar with donning and doffing a N95 respirator, review the following resources:
- OSHA Respiratory Training information: https://www.osha.gov/respiratory-protection/training
- Donning/Doffing: https://www.youtube.com/watch?v=pGXiUyAoEd8
- Fit testing L&I: https://wisha-training.lni.wa.gov/training/articulate/N-95RespiratorFit-Testing/story.html (At the end of this video, there is a short quiz. You can have your staff get a screen shot of their quiz result and keep it for recordkeeping purposes.)
- How to don and doff various types of N95 respirators: https://www.utmb.edu/ehs/radiation-occupational-safety-program/OccSafety/respirator-fit-testing/n-95-donning-doffing-instructions
- Review the manufacturer’s instructions on how to don and doff the N95.
NOTE: If the trainee has not yet been fit tested and would like to be fit tested, the medical evaluation and respirator training will need to be done prior to the Hands-on Fit Test Training date.
- Virtual Fit Test Training Requirements
Fit test staff must come the Virtual Fit Test Training session ready to learn by having finished all requirements listed above. Participants will need the following:Completion of the pre-training requirements A computer with internet access, as well as video and audio capabilities
If you have questions ahead of time, email them to HAI-FitTest@doh.wa.gov to include them in the Virtual Fit Test Training you are attending.
- Ability to connect to Zoom
- A room or area away from distractions
- Enough table space to open your kit and examine your equipment
- Hands-on Fit Test Training Requirements
The Hands-on Fit Test Training is an opportunity for fit test staff to show or demonstrate their knowledge and skills with experienced fit testers. Before the Hands-on Fit Test Training, participants will need the following:Completion of the Virtual Fit Test Training Staff to be fit tested, each other if there are more than one person training, or staff that need to be fit tested.
Hands-on Fit Test Training room requirements:A room large enough to hold the trainers and the staff comfortably, away from distractions Access to tables and chairs Trash cans Water, napkins, and cups for the staff A sink in the room or a bathroom nearby
- Have access to the medical evaluation letter of recommendation(s) for those staff being fit tested
- Fit test kit
- Other supplies:
- Disinfectant wipes
- Hand sanitizer
- Printed handouts
- DOH – Reminder sheet
- Rainbow passage
- List of fit test exercises
- Fit test record
Day of Hands-on Fit Test Training
Bring your fit testing equipment, supplies, N95s, blank fit test records, copies of the medical evaluation recommendation letters, and the Evaluating the Fit Tester forms to the room where you will be trained.
Be sure your facility’s room is large enough for the staff, the trainees, the vendor, and all the supplies.
During the Hands-on Fit Test Training, the DOH vendor will briefly review the fit test equipment, procedures, and exercises if necessary. The vendor will observe and provide coaching to make sure a valid fit test is being done.
After the Fit Test Training is Complete
There is no certification for this training. When the training is completed, a letter will be sent out to acknowledge completion of the training from DOH and the vendor you worked with.
Once you have successfully completed the training, if possible, partner with a fellow fit test staff to perform a couple of fit tests. Have your partner use the evaluation sheet to be sure you have followed all the steps for conducting a fit test.
Remember, it is the facility’s responsibility to be sure the fit test staff is performing a valid fit test. For recordkeeping, send your evaluations to the Respiratory Program Administrator.
DOH recommends fit testing no more than 2 people at a time for LTC facilities, to be able to stay within the boundaries of the rules and regulations on conducting a valid fit test. It is possible to fit test more than one person at a time, but it takes time and practice to be ready to do this. The fit test staff must be able to fit test one person easily, without a lot of starting and stopping when getting stuck!
When you are ready to conduct your own fit testing, allow 30 minutes per fit test. If the worker being fit tested are new to using the N95 or they are being fit tested due to a change in their physical appearance, expect that it may take longer to complete a valid fit test. At times, finding a N95 that will properly fit the worker is challenging.
Sign up for Fit Test Training
Available dates will be listed on the sign-up form. ALL the prerequisite work must be completed prior to the Virtual Fit Test Training session. It is our expectation that you will attend the training session prepared and will come with questions.
- Sign up for Fit Testing training
- Tuesday, October 4, 2022, 1pm-2pm
- Monday, October 10, 2022, 9:30am-10:30am
- Thursday, October 20, 2022, 11am-12pm
- Wednesday, October 26, 2022, 1pm-2pm
- Monday, October 31, 2022, 11am-12pm
- Wednesday, November 9, 2022, 3pm-4pm
- Thursday, November 17, 2022, 1pm-2pm
- Tuesday, November 29, 2022, 11am-12pm