Can annual fit-tests be streamlined?

OSHA considers new Bitrex protocol

Fit-testing of N95 filtering facepiece respirators could become significantly quicker under a new protocol proposed by the U.S. Occupational Safety and Health Administration.

Employers using the Bitrex fit-testing method would be able to conduct the exercises for 15 seconds each rather than 60 seconds. Only those with the highest sensitivity to Bitrex — who could detect Bitrex in 10 squeezes of the nebulizer bulb in a pretest — would be able to use the quicker fit-testing protocol.

"For this proposal, the Agency preliminarily determined that the proposed [abbreviated Bitrex] fit-testing protocol provides employees with protection that is comparable to the protection afforded to them by the existing Bitrex® qualitative fit-testing provisions," OSHA stated in a Federal Register notice. "In this regard, the proposal is not expected to replace existing fit-testing protocols, but instead would be an alternative to them."

OSHA was accepting comments through Feb. 25 on the protocol, which was initially proposed by the 3M Corp. The National Institute for Occupational Safety and Health was still evaluating the protocol. American National Standards Institute (ANSI) standard for Bitrex fit-testing calls for exercises that last at least 30 seconds.

The proposed protocol could cover as many as 85% of employees, based on the prevalence of level one sensitivity to Bitrex, says John E. Steelnack, an industrial hygienist with OSHA's Directorate of Standards and Guidance and project officer for OSHA's respiratory standard.

Health care employers are looking forward to a streamlined fit-test method, but Steelnack cautioned, "It's not a valid method until ultimately it's published as an approved method." It's not clear how long it would take for final approval, he said.

Meanwhile, OSHA began enforcing the rule requiring annual fit-testing of N95 filtering facepiece respirators. The so-called Wicker Amendment, a Congressional caveat that prohibited OSHA from using federal funds to enforce annual fit-testing related to tuberculosis, expired in December.

"If we fit employees wearing respirators for protection from any hazard including TB and they have not been fit-tested in the past 12 months, then the employer may be cited," says Craig Moulton, industrial hygienist with OSHA's Office of Health Enforcement.

Some hospitals have altered their respiratory protection programs in response to the renewed enforcement policy. For example, the Marshfield (WI) Clinic has purchased powered air-purifying respirators (PAPRs), which do not require fit-testing, and is reducing the number of employees who will receive annual fit-testing for N95s.

The 45 clinics of Marshfield Clinic only encountered four cases of tuberculosis last year, says Bruce Cunha, RN, MS, COHN-S, manager of employee health and safety. Fit-testing should be risk-based, he says.

But Cunha also notes that PAPRs are a practical alternative. "It's just not feasible for large facilities to do annual testing, not of thousands of people," he says.

PAPRs also are more comfortable to wear for long periods and provide a higher level of protection, Cunha notes. "To me, it doesn't make sense to tell people to wear masks when there are better [respirators] out there," he says.

(Editor's note: A copy of the Federal Registernotice is available at _document?p_table=FEDERAL_REGISTER&p_id=20236.)