As the COVID-19 pandemic ramped up in the US and around the world, it became increasingly apparent that personal protective equipment (PPE) like masks and respirators would play an critical role in keeping health care workers safe. Having equipment isn’t enough—it has to fit well and be worn correctly. Fit testing ensures a mask/respirator is providing a tight seal, but not so tight it restricts the user. But not all PPE masks fit the same, and each brand requires a separate fit test. Athena Gonzalez and her team worked to create a plan to quickly make sure residents were wearing properly sized and fitted masks and respirators even as supplies changed. They presented their work in the Poster Hall at the 2021 ACGME Annual Educational Conference.
Poster: Strategies for Optimizing Fit Testing for Residents and the Evolving Role of the Program Coordinator
Author(s): Athena Gonzalez; Deann Ramirez; Jolie A. Limon, MD; Vini Vijayan, MD
ACGME: Tell us about your academic and professional role.
Gonzalez: I am the graduate medical education (GME) program coordinator for the pediatric residency program at Valley Children's Healthcare in Madera, California.
ACGME: Can you briefly describe your project for us?
Gonzalez: Due to the lack of precedent regarding GME operations with respect to respiratory fit testing during a pandemic, it became incumbent on program coordinators at our institution to develop procedures to ensure access and appropriate utilization of PPE for our residents. This was especially critical considering the multiple changes in types/brands of PPE utilized by our institution as the pandemic evolved and the need to ensure resident physician safety. Our study reports the evolution of respiratory fit testing procedures at our institution during the COVID-19 pandemic.
ACGME: What inspired you to do this project?
Gonzalez: The 2019 Novel Coronavirus (COVID-19) pandemic has affected N95 respirator supply and our ability to ensure the safety of our residents. We performed this project to ensure that the residents were able to undergo respiratory fit testing in a timely and efficient manner.
ACGME: What did you discover?
Gonzalez: We were able to create an operational plan to implement fit testing for all residents and nearly 70 percent of visiting learners at our institution within two weeks of a change in N95 inventory at our institution. The majority of residents passed fit testing with the 3M and ProGear® brands of masks but we identified gender-related differences in the likelihood of passing fit testing among our cohort of residents. We were met with multiple logistical challenges in optimizing testing, including obtaining medical clearance for visiting learners, communication with home institutions, and provision of masks to visitors and their institutions.
ACGME: What was the main takeaway?
Gonzalez: With the continued potential for changes in the N95 respirator supply chain as COVID-19 cases rise, establishment of clear protocols specific to program coordinators may help overcome operational challenges encountered when creating a plan for fit testing.
ACGME: Who could benefit from this?
Gonzalez: Program managers and program coordinators may benefit from this information as it will help them to develop an understanding of protocols for respiratory fit testing and be aware of potential challenges in developing a fit test program for learners when N95 supplies changes are required as the pandemic evolves.
ACGME: Any additional follow-up plans?
Gonzalez: We plan to further investigate gender-related differences in the likelihood of passing fit testing as this may have implications for residency programs that educate a larger proportion of females or individuals of different ethnic backgrounds as N95 inventory and supplies may need to be modified accordingly.