Breathing Easy: How Respirator Fit-Testing in Washington State Led Me on an Adventure
I’m Brittany, a Medical Assistant and Digital Marketing Manager for Performance Occupational Health Services (POHS) in Vancouver WA. I started with our clinic in early 2021, where I jumped right into the world of respirator fit-testing. This post is a brief look into my exciting first year.
My journey in fit-testing began during the midst of the pandemic when there were no signs of what was to come. Angie, my supervisor at POHS, asked me to join her at a local assisted living facility to learn how to perform a qualitative fit test for N95 respirators. At that time, all those technical terms seemed like jargon to me, but little did I know that I would become an expert in just a few weeks.
POHS had partnered a large Washington State agency with the aim of fit-testing as many caregivers in the state as possible for N95 respirators as quickly as we could. It was an ambitious task, but we were not alone. Several other clinics across the state were also assisting with this project, dividing the state into different territories to cover as many facilities as possible.
On my first day, I discovered that we used a substance called Bitrex during the testing process. Bitrex is a non-toxic and extremely bitter aerosol. For fit-testing, a person would don their N95 and then a large hood. Bitrex is sprayed into the hood for several minutes. The person is instructed to perform exercises while wearing their mask. If at any point they begin to strongly taste Bitrex while masked, we would consider this a fail. Bitrex was able to filter through the mask and therefore, the mask would be ineffective for the wearer.
I had the opportunity to experience its taste firsthand when Angie fit tested me for my own N95 respirator. Before beginning the test, it’s important to have the person taste Bitrex to make sure they are able to detect the flavor. Some people aren’t able to taste Bitrex; we would find an alternative way to fit-test these few. She gave me a taste so I knew what to look for during the fit test. It’s not a flavor I will easily forget. I rinsed my mouth and prepared to be fitted for my N95 mask.
Following Angie’s instructions, I donned my 3M 9205+ respirator and performed exercises while wearing it. To my relief, I couldn't taste the Bitrex during the test. This indicated that my mask fit properly and I passed!
With my N95 mask fitted, I watched Angie as she continued to test caregivers at the assisted living facility. Caregivers would arrive, complete a Respirator Questionnaire, and patiently wait for their turn. The questionnaire asked basic health history questions and helped us identify any potential issues, such as claustrophobia or health conditions that might prevent someone from participating in the N95 fit test. We privately went through these questionnaires with each person, addressing any concerns they had. Understandably, there was a lot of anxiety and stress surrounding the testing process, as it was a new experience for many.
The testing procedure began with the "Sensitivity Test." The caregiver would put on a yellow hood with a plastic window in the front. A diluted version of Bitrex would be sprayed through a small opening, and the person would be instructed to open their mouth and inform us when they detected the spray. As the taste of Bitrex is unmistakable, this usually happens quickly.
After rinsing their mouth and lips to remove any trace of Bitrex, the caregiver would then put on their preferred N95 mask. At this point, we would guide them on proper strap placement and creating a seal with negative air pressure.
During the actual test, the caregiver would wear the hood again, and we would proceed with several one-minute exercises. If at any point the caregiver tasted Bitrex while wearing their mask, we would stop the test, check the mask for proper fit, and troubleshoot accordingly. Once a person passed their fit test, we would mark the mask they used and provide final instructions on how to store it and where to find replacements at their facility. Then, it was the next person’s turn!
That was the entire process. After observing for a while, I started assisting with the fit-testing. When the afternoon session concluded, I helped Angie pack up all our supplies and load them into her car. We planned to meet early the next morning (5am!) for a roadtrip to Lacey, Washington, which was about a 2.5-hour drive from Vancouver. I was thrilled to start this new journey and explore more of Washington state.
As months went by, I frequently accompanied Angie or traveled alone to various parts of the state. Our team ventured as far as Bellingham, which was near the Canadian border, and made multiple trips to Yakima and Ellensburg, enjoying the breathtaking scenery as we passed Mount Rainier. It was a fantastic way to experience the beauty of our state.
Our efforts in fit-testing allowed us to provide this crucial service to hundreds of caregivers; these individuals worked with one of the most vulnerable populations and required proper personal protective equipment (PPE) to ensure the safety of their residents. It was incredibly fulfilling to be able to contribute during such a scary and uncertain period.
To this day, we continue to offer fit-testing services both at our clinic and on-site at various facility locations. Additionally, the Washington Department of Health (DOH) has implemented a training program to teach individuals how to perform their own fit tests, which is fantastic. The more people equipped with this skill, the better!
During this project, I had the privilege of driving through some of the most remote and breathtaking parts of Washington. Exploring these areas on my own allowed me to immerse myself in the stunning scenery and gain a deep appreciation for the natural beauty of our state. Overall, being a part of the fit testing initiative has been an incredible journey.
