Prospective observational study of gender and ethnicity biases in respiratory protective equipment for healthcare workers in the COVID-19 pandemic

Objective To describe success rates of respiratory protective equipment (RPE) fit testing and factors associated with achieving suitable fit. Design Prospective observational study of RPE fit testing according to health and safety, and occupational health requirements. Setting A large tertiary referral UK healthcare facility. Population 1443 healthcare workers undergoing quantitative fit testing. Main outcome measures Quantitative fit test success (pass/fail) and the count of tests each participant required before successful fit. Results Healthcare workers were fit tested a median (IQR) 2 (1-3) times before successful fit was obtained. Males were tested a median 1 (1-2) times, while females were tested a median 2 (1-2) times before a successful fit was found. This difference was statistically significant (p<0.001). Modelling each fit test as its own independent trial (n=2359) using multivariable logistic regression, male healthcare workers were significantly more likely to find a well-fitting respirator and achieve a successful fit on first attempt in comparison to females, after adjusting for other factors (adjusted OR=2.07, 95% CI): 1.66 to 2.60, p<0.001). Staff who described their ethnicity as White were also more likely to achieve a successful fit compared with staff who described their ethnicity as Asian (OR=0.47, 95% CI: 0.38 to 0.58, p<0.001), Black (OR=0.54, 95% CI: 0.41 to 0.71, p<0.001), mixed (OR=0.50 95% CI: 0.31 to 0.80, p=0.004) or other (OR=0.53, 95% CI: 0.29 to 0.99, p=0.043). Conclusions Male and White ethnicity healthcare workers are more likely to achieve RPE fit test success. This has broad operational implications to healthcare services with a large female and Black, Asian and minority ethnic group population. Fit testing is imperative in ensuring RPE effectiveness in protecting healthcare workers during the COVID-19 pandemic and beyond.