Particulate filter respirators (P2/N95 respirators)
Particulate filter respirators (PFR) are designed to reduce the wearer’s respiratory exposure to airborne contaminants such as particles, gases or vapours. P2/N95 respirators are types of PFR.
PFR are appropriate for use for respiratory protection as part of the personal protective equipment (PPE) required for airborne precautions applied in healthcare facilities (for both clinical and non-clinical healthcare workers).
PFR are also appropriate as part of the PPE required for all health care workers involved in aerosol-generating procedures when a patient is confirmed or suspected of having a disease that may be transmitted via the droplet or airborne route (including COVID-19).
Aerosol generating procedures include (list is not intended to be exhaustive):
- endotracheal intubation and extubation
- nebulised medication administration
- high-flow nasal oxygen
- airway suctioning
- diagnostic sputum induction
- non-invasive ventilation
- high frequency oscillatory ventilation
- surgery involving the upper or lower respiratory tract.
A further list of potentially aerosol-generating procedures can be found in the Queensland Health infection prevention and control guidelines for the management of COVID-19 in healthcare settings
For information on powered air-purifying respirators (PAPR) refer to Queensland Health Guideline for CleanSpace HALO
Fit checking must be done each time a PFR is put on to ensure that the respirator is properly applied, a good seal is achieved over the bridge of the nose and mouth, and there are no gaps between the respirator and face. Fit checking is the appropriate minimum standard at the point of use for healthcare workers using PFR.
No clinical activity should be undertaken until a satisfactory fit has been achieved.
Healthcare workers must be trained in the correct use of personal protective equipment (PPE), including fit checking of PFR and safe fitting and removal of PPE. Refer to the following resources:
Correct use of PPE
How to fit and remove personal protective equipment in the correct order
Correct use of PPE
In this video, we will walk you through the correct process for fitting and removing personal protective equipment for the management of patients with suspected, probable, or confirmed COVID-19.
Fitting PPE-- this process is also known as donning PPE. First, perform hand hygiene either by using alcohol hand rub or soap and water. Put on a long-sleeve fluid-impervious gown. Make sure to tie the straps securely around your waist and behind your neck.
Put on an appropriate mask. In this example, we are donning an N95 mask. Put the mask on your face. The upper strap should be positioned on the crown of the head. The lower strap should be positioned below the ears. Straps should not be twisted. Ensure the mask is pulled up over your chin and nose.
Nose clips should be molded around the nose and cheeks to ensure a good fit. A fit check must be performed every time an N95 mask is fitted, and instruction on how to do this will be determined by the brand of N95 mask worn. The general principle of fit checking is to ensure a good seal is achieved every time.
With this brand of mask, a fit check is performed by gently inhaling and exhaling. If air escapes or if the mask is not drawn in towards the face, then readjust the mask and repeat the process. Remember, a fit check must be performed every time you put on an N95 mask.
The next step is to put on protective eyewear. And lastly, put on your gloves.
Removing PPE-- this is a process known as doffing. To remove your PPE, firstly, remove your gloves and place into the appropriate waste receptacle. All waste generated in the care of a COVID-19 patient is considered clinical waste.
Perform hand hygiene. Remove gown by loosening the tie at the back, undo the Velcro, and fold the gown into itself. Roll it up and place in the bin.
Perform hand hygiene. Remove eye protection. If using reusable eye protection, place into a dedicated receptacle or onto a dedicated surface in preparation for cleaning. All reusable eye protection must be clean between use by using a TGA-listed disinfectant with known activity against viruses. Perform hand hygiene.
Remove your mask. As you remove your mask, make sure it is controlled as you move it down and away from your face. Place into the waste receptacle. Perform hand hygiene.
Fit check steps
Follow these steps for a PFR respirator fit check:
- Perform hand hygiene.
- Select correctly fitting PFR, holding outer edges, separate edges and straps.
- Slightly bend nosepiece to form a gentle curve.
- Separate the headbands and position PFR under chin with nosepiece up.
- Pull headbands up over head, ensuring top strap is resting high at back of head and bottom strap is positioned below ears.
- Use fingertips to mold nosepiece and ensure good facial fit around face, cheeks and bridge of nose.
- Positive seal check – exhale sharply. A positive pressure inside PFR = no leakage. If leaking, adjust position and/or tension straps.
- Negative seal check – inhale deeply. If no leakage, negative pressure will make PFR cling to face, readjust if required.
Several companies supply PFR for Queensland Health. For information about fit checking specific respirators please refer to the product information from the relevant supplier.
An adequate seal may be difficult, or impossible, to achieve with facial hair.
If an adequate seal cannot be achieved, healthcare workers should not proceed with clinical care and should speak to their line manager.
Maintaining the fit and protection from airborne particles
It is essential that the fit of the PFR is not compromised once the fit check has been successfully completed.
- touch the PFR while it is being worn
- reapply the PFR after it has been removed – don new PFR if required
- leave the PFR dangling around the neck.
- change the PFR when it becomes moist
- wash hands after a used PFR is touched or disposed of
- leave the patient room/care area before removing the PFR
- dispose of used PFR in a closed receptacle.
Fit testing is a validated method to determine whether a specific make, model and size of respirator achieves an adequate seal on an individual’s face.
An inadequate fit reduces the protection provided and can put the healthcare worker at risk. Fit testing should be carried out before wearing a PFR for the first time.
Fit testing also provides an opportunity to ensure healthcare workers are properly trained in the correct use of the PFR and are aware of how to perform a fit check.
All healthcare facilities should undertake fit testing as part of a respiratory protection program in line with the Queensland Health Fit Testing of P2/N95 respirators in respiratory protection programs guidance (PDF, 393kb)
- Australian Guidelines for the Prevention and Control of Infection in Healthcare
- Fit Testing of P2/N95 respirators in respirator protection programs – Guidance. Queensland Health (PDF, 393kb)
- Infection prevention and control guidelines for the management of COVID-19 in healthcare setting. July 2021 Queensland Health (PDF, 1.07mb)