# NIOSH Recommended Guidelines for Personal Respiratory Protection of Workers in Health-Care Facilities Potentially Exposed to Tuberculosis/Table 1

Table 1—Requirements for and Essential Roles of Fit Tests and Fit Checks
* 1—A qualified representative of an employer must decide for which workers personal respiratory protection is indicated using the guidance given in Table 3 starting on page 40.
* 2—A qualified representative of the employer must identify the "best-fitting" make and size respirator from several different brands and sizes (generally three different sizes are necessary for each brand of respirator). This selection should be done using quantitative fit test(s) (QNFT). Powered masks should be tested and selected while operating in the nonpowered mode.
* 3—A qualified representative of an employer must then accurately fit-test screen, with the same QNFT from step #2, the face-seal protection afforded to each prospective wearer by the face seal of the respirator identified in the previous element as "best fitting." This screening must accurately detect ("diagnose") those respirator-wearer combinations that will not yield substantial protection on the prospective wearers. Powered respirators should be tested and selected while operating in the nonpowered mode. No filter testing is performed, since it is reliably assumed that the HEPA filters to be worn on the facepieces will have essentially zero leakage. The qualified representative of the employer must also periodically retest the fit of each assigned respirator on its wearer with the QNFT.
* 4—A qualified representative of an employer then provides and assigns a respirator make and size to those prospective wearers that passed the preceding QNFT screening.
* 5—Each worker must then (1) decide to wear their respirator, (2) take action to don their respirator, and (3) must properly adjust their assigned respirator on their head and face before each and every entry into any location or before performing any procedure as indicated in Table 3 starting on page 40.
* 6—Each worker must then perform an accurate fit check at the point of use before each use of their assigned respirator. Fit checks are very simple tests compared to the QNFT performed by a qualified person in steps #2 and #3. The fit check must be done to identify ("diagnose") those respirator "fittings" (respirator facepiece position and headstrap adjustments) not providing substantial protection due to point-of-use factors that are preventing a proper fit (e.g., incorrect respirator position on the user's face, incorrect headstrap tension, incorrect headstrap position on and behind the user's head, user failure to use all the headstraps, changes in a user's facial surface such as facial stubble and perspiration, respirator damage, improper respirator maintenance, or beard stubble).
* 7—Each worker seeking personal protection must properly wear their assigned respirator in any location or before performing any procedure indicated in Table 3 starting on page 40. They must not wear their respirator when conditions prevent a proper seal of the facepiece to the wearers skin. For respirator-related causes (e.g., respirator malfunction, detection of room-air leakage at their face seal into the respirator), they must (1) decide to leave the location or procedure and then (2) take action and leave.