A Medical Nebulizer as a Substitute for the OSHA-Approved Nebulizer for Qualitative Fit Testing of Respirators During the Respiratory Infectious Pandemics: An Experimental Feasibility Study

Abstract

Abstract Objective: The qualitative fit testing procedure would be challenging due to severe shortages, high cost, and unavailability of commercial fit test kits in the marketplaces during pandemics of respiratory infectious diseases. Assessment of alternatives for commercial fit test kits to be prepared for emergencies is critically required. This study aimed to investigate the feasibility of an alternative of the Accumed NF60 nebulizer for the Occupational Safety and Health Administration (OSHA)-approved Allegro nebulizer. Methods: Thirty-two participants were randomly allocated to 6 filtering facepiece respirators (FFRs). They were qualitatively fit tested by both manual Allegro and automated Accumed NF60 nebulizers. Results: There was no statistically significant difference between the Allegro and Accumed NF60 nebulizers by passing rates. The odds for passing fit testing using the Accumed NF60 nebulizer was similar to that of the Allegro one (odds ratio=1.0, 95% confidence interval [0.58-1.74]). Conclusions: The Accumed NF60 nebulizer could be used as a cost-benefit substitute for the standard fit test nebulizers in the pandemic situation where there is a shortage and difficulty of access. It is more convenient, decreases the time investment, and reduces the contact stress in the operators’ hands as it does not require squeezing the nebulizer bulb frequently. The test solutions’ preparation and fit testing procedures on many personnel are more straightforward, efficient, and hygienic than the Allegro one.