List all the steps for how a Qualitative Respiratory Fit Test is completed.

A qualitative fit test (QLFT) is a pass/fail test that relies on the test subject's response to a test agent to assess the adequacy of respirator fit. QLFTs are only permitted for negative pressure air-purifying respirators that must achieve a fit factor of 100 or less. [3]

General Requirements:

• The employer is responsible for complying with the requirements for the written program, medical clearances, fit testing, and training following 29 CFR 1910.134, including appendices A and B1.
• The employer is also responsible for following the recommendations of the respirator and fit testing kit manufacturers.
• Persons administering QLFT must be able to prepare test solutions, calibrate equipment, perform tests properly, recognize invalid tests and ensure that test equipment is in proper working order.
• QLFT equipment will be kept clean and well maintained so as to operate within the parameters for which it was designed.

[1] [1] [5] Here is the general procedure for performing a qualitative fit test:

1. Select the appropriate respirator: Ensure the respirator is the correct model and size for the test subject.
2. Prepare the test area: The fit test should be performed in a well-ventilated room.
3. Perform a user seal check: Ensure the test subject can perform a positive and negative pressure seal check.
4. Don appropriate PPE: The appropriate PPE should be worn during the fit test procedure.
5. Perform a sensitivity check: Before the fit test, verify that the test subject can detect the test agent.
6. Don the enclosure: The test subject will don the test enclosure.
7. Perform the fit test exercises: The test subject will perform a series of exercises for one minute each to simulate workplace movements.
8. Assess the respirator fit: If the test subject detects the test agent at any time during the test, the fit is deemed unsatisfactory and the test is failed.
9. Record the results: Record the test subject's name, date of the test, the respirator make, model, and size, and the test results.

The exercises that must be performed during the fit test include:

• Normal breathing
• Deep breathing
• Turning head side to side
• Moving head up and down
• Talking/counting/reciting
• Bending over or jogging
• Normal breathing

[1] There are several different QLFT protocols, including:

• Isoamyl Acetate Protocol
• Bitrex (Denatonium Benzoate) Solution Aerosol Qualitative Fit Test Protocol
• Irritant Smoke (Stannic Chloride) Protocol

Isoamyl Acetate Protocol:

• This protocol is not appropriate to use for the fit testing of particulate respirators. If used to fit test particulate respirators, the respirator must be equipped with an organic vapor filter.
• Odor threshold screening, performed without wearing a respirator, is intended to determine if the individual tested can detect the odor of isoamyl acetate at low levels.
• The screening test will be conducted in a room separate from the room used for actual fit testing. The two rooms will be well-ventilated to prevent the odor of the IAA from becoming evident in the general room air where testing takes place.
• Allow two minutes for the IAA test concentration to stabilize before starting the fit test exercises. This would be an appropriate time to talk with the CSHO; to explain the fit test, the importance of his/her cooperation, and the purpose for the test exercises; or to demonstrate some of the exercises.
• If at any time during the test, the subject detects the banana-like odor of IAA, the test is failed. The CSHO will quickly exit from the test chamber and leave the test area to avoid olfactory fatigue.
• If the test is failed, the CSHO will return to the selection room and remove the respirator. The CSHO will repeat the odor sensitivity test, select and put on another respirator, return to the test area and begin the fit test procedure described above. The process continues until a respirator that fits well has been found. Should the odor sensitivity test be failed, the subject will wait at least 5 minutes before retesting. Odor sensitivity will usually have returned by this time.
• If the CSHO passes the test, the efficiency of the test procedure will be demonstrated by having the CSHO break the respirator face seal and take a breath before exiting the chamber.
• When the CSHO leaves the chamber, he/she will remove the saturated towel and return it to the person conducting the test, so that there is no significant IAA concentration build-up in the chamber during subsequent tests. The used towels will be kept in a self-sealing plastic bag to keep the test area from being contaminated.

[2] [2] [2] [4] [4] [4] [4] [4] Bitrex (Denatonium Benzoate) Solution Aerosol Qualitative Fit Test Protocol:

• The BitrexTM (Denatonium benzoate) solution aerosol QLFT protocol uses the published saccharin test protocol because that protocol is widely accepted.
• The entire screening and testing procedure will be explained to the CSHO prior to the conduct of the screening test.
• The Bitrex taste threshold screening, performed without wearing a respirator, is intended to determine whether the individual being tested can detect the taste of Bitrex.
• During threshold screening as well as during fit testing, CSHOS will wear an enclosure about the head and shoulders that is approximately 12 inches (30.5 cm) in diameter by 14 inches (35.6 cm) tall. The front portion of the enclosure will be clear from the respirator and allow free movement of the head when a respirator is worn.
• The test enclosure will have a 3/4 inch (1.9 cm) hole in front of the CSHO's nose and mouth area to accommodate the nebulizer nozzle.
• The CSHO will don the test enclosure. Throughout the threshold screening test, the CSHO will breathe through his or her slightly open mouth with tongue extended. The CSHO is instructed to report when he/she detects a bitter taste.

[4] [4] [4] [4] [4] [4] Irritant Smoke (Stannic Chloride) Protocol:

• The test operator shall carefully direct a small amount of the irritant smoke in the test subject's direction to determine that he/she can detect it.
• The person being fit tested shall don the respirator without assistance, and perform the required user seal check(s).
• The test subject shall be instructed to keep his/her eyes closed.
• The test operator shall direct the stream of irritant smoke from the smoke tube toward the face seal area of the test subject, using the low flow pump or the squeeze bulb. The test operator shall begin at least 12 inches from the facepiece and move the smoke stream around the whole perimeter of the mask. The operator shall gradually make two more passes around the perimeter of the mask, moving to within six inches of the respirator.
• If the person being tested has not had an involuntary response and/or detected the irritant smoke, proceed with the test exercises.
• The exercises identified in section I.A. 14. of this appendix shall be performed by the test subject while the respirator seal is being continually challenged by the smoke, directed around the perimeter of the respirator at a distance of six inches.
• If the person being fit tested reports detecting the irritant smoke at any time, the test is failed. The person being retested must repeat the entire sensitivity check and fit test procedure.
• Each test subject passing the irritant smoke test without evidence of a response (involuntary cough, irritation) shall be given a second sensitivity screening check, with the smoke from the same smoke tube used during the fit test, once the respirator has been removed, to determine whether he/she still reacts to the smoke. Failure to evoke a response shall void the fit test.
• If a response is produced during this second sensitivity check, then the fit test is passed.

[7] [7] [7] [7] [7] [7] [7] [7] [7] Safety Precautions:

• Facial hair cannot cross the seal of the facepiece.
• The test shall not be conducted if there is any hair growth between the skin and the facepiece sealing surface, such as stubble beard growth, beard, mustache, or sideburns which cross the respirator-sealing surface. Any type of apparel which interferes with a satisfactory fit shall be altered or removed.
• If a test subject exhibits difficulty in breathing during the tests, she or he shall be referred to a physician or other licensed health care professional, as appropriate, to determine whether the test subject can wear a respirator while performing her or his duties.
• If the employee finds the fit of the respirator unacceptable, the test subject shall be given the opportunity to select a different respirator and to be retested.

[1] [6] [6] [6] Regulatory Compliance:

• It is the responsibility of the employer to follow and comply with requirements for the written program, medical clearances, fit testing, and training following 29 CFR 1910.134 (including appendix A and B1).
• The employer shall ensure that persons administering QLFT are able to prepare test solutions, calibrate equipment, and perform tests properly, recognize invalid tests, and ensure that test equipment is in proper working order.
• The employer shall ensure that QLFT equipment is kept clean and well maintained so as to operate within the parameters for which it was designed.

[1] [8] [8]