Qualitative fit test outcomes for N95 filtering facepiece respirators in health care workers


      • Qualitative fit test pass rates varied widely across FFR models.
      • Women had a higher likelihood of failure than men.
      • NIOSH-approved FFRs were designed based on data that underrepresented women.
      • Institutions should collect qualitative fit testing data to guide FFR selection.



      We analyzed the qualitative fit test results of the filtering facepiece respirators (FFRs) used at our institution to determine their performance and utility.


      We retrospectively analyzed 12,582 qualitative fit testing results for several FFR models among 8,809 health care workers (HCWs).


      The overall failure rate for HCWs was 15.2%. Nearly one-third (2933/8809, 33.3%) had multiple FFRs fit tested. HCW sex was a statistically significant indicator of fit testing failure (χ2 = 29.9, df = 1, P < .001), with women having a 44% higher likelihood (OR, 1.4; 95% CI: 1.27–1.65) than men. There were statistically significant differences in the failure rate across FFRs (Fig 4, F[5, 12475] = 8.4, P < .001). Fluidshield 46867S had a significantly higher failure rate (49%) than the 3M 1860 (P = .012), 3M 1860S (P < .001), 3M 8210 (P < .001), and Safelife (P < .001) FFRs.


      There was a large degree of variation in fit testing results for the FFRs tested. Although we were unable to find an FFR that fit more than 95% of the HCWs successfully, we identified poorly functioning FFRs that can help our institution with decision-making and budgeting for acquisition and stocking appropriate FFRs.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Infection Control
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Centers for Disease Control and Prevention
        The national personal protectivetechnology laboratory (NPPTL).
        Respiratory Protection Information Trusted Source. 2021; (Accessed December 18, 2021)
        • Coffey C
        • Miller C.
        The respirator fit capability test: enhancing the efficacy of filtering facepiece respirators.
        Synergist (Akron). 2019; 2019: 2019
        • Hack AL
        • McConville JT.
        Respirator protection factors: part I – Development of an anthropometric test panel.
        Am Ind Hyg Assoc J. 1978; 39: 970-975
        • Zhuang Z
        • Bradtmiller B.
        Head-and-face anthropometric survey of U.S. respirator users.
        J Occup Environ Hyg. 2005; 2: 567-576
        • Manganyi J
        • Wilson KS
        • Rees D.
        Quantitative respirator fit, face sizes, and determinants of fit in South African diagnostic laboratory respirator users.
        Ann Work Expo Health. 2017; 61: 1154-1162
        • Hon CY
        • Danyluk Q
        • Bryce E
        • et al.
        Comparison of qualitative and quantitative fit-testing results for three commonly used respirators in the healthcare sector.
        J Occup Environ Hyg. 2017; 14: 175-179
        • Coffey CC
        • Lawrence RB
        • Campbell DL
        • Zhuang Z
        • Calvert CA
        • Jensen PA.
        Fitting characteristics of eighteen N95 filtering-facepiece respirators.
        J Occup Environ Hyg. 2004; 1: 262-271
        • Centers for Disease Control and Prevention
        The national personalprotective technology laboratory.
        Preparing solutions for qualitative fit testing from available chemicals. 2021; (Accessed December 18, 2021)
        • Ly DP
        • Jena AB.
        Trends in diversity and representativeness of health care workers in the United States, 2000 to 2019.
        JAMA Netw Open. 2021; 4e2117086
        • Zhuang Z
        • Bradtmiller B
        • Shaffer RE.
        New respirator fit test panels representing the current U.S. civilian work force.
        J Occup Environ Hyg. 2007; 4: 647-659
        • Carvalho CYM
        • Schumacher J
        • Greig PR
        • Wong DJN
        • El-Boghdadly K.
        Prospective observational study of gender and ethnicity biases in respiratory protective equipment for healthcare workers in the COVID-19 pandemic.
        BMJ Open. 2021; 11e047716
        • Zhuang Z
        • Landsittel D
        • Benson S
        • Roberge R
        • Shaffer R.
        Facial anthropometric differences among gender, ethnicity, and age groups.
        Ann Occup Hyg. 2010; 54: 391-402
        • Lin YC
        • Chen CP.
        Characterization of small-to-medium head-and-face dimensions for developing respirator fit test panels and evaluating fit of filtering facepiece respirators with different faceseal design.
        PLoS One. 2017; 12e0188638
        • Stobbe TJ
        • daRoza RA
        • Watkins MA
        Facial hair and respirator fit: a review of the literature.
        Am Ind Hyg Assoc J. 1988; 49: 199-204
        • Sandaradura I
        • Goeman E
        • Pontivivo G
        • et al.
        A close shave? Performance of P2/N95 respirators in healthcare workers with facial hair: results of the BEARDS (Benchmarking Adequate Respiratory DefenceS) study.
        J Hosp Infect. 2020; 104: 529-533