Evaluating Fit and Performance of Flat-Fold, Cup, and Three-Panel Respirators Among Thai Healthcare Personnel

Wangsan, Kampanat; Sapbamrer, Ratana; Sirikul, Wachiranun; Kiratipaisarl, Wuttipat; Ongprasert, Krongporn; Assavanopakun, Pheerasak; Surawattanasakul, Vithawat; Kitro, Amornphat; Panumasvivat, Jinjuta; Wongcharoen, Amnart

doi:10.3389/fpubh.2025.1561571

ORIGINAL RESEARCH article

Front. Public Health

Sec. Occupational Health and Safety

Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1561571

This article is part of the Research TopicPatient and Medical Staff Safety and Healthy Work Environment in the 21st CenturyView all 35 articles

Evaluating Fit and Performance of Flat-Fold, Cup, and Three-Panel Respirators Among Thai Healthcare Personnel

Provisionally accepted

Kampanat Wangsan^1,2

Ratana Sapbamrer^1,2*

Wachiranun Sirikul^1,2

Wuttipat Kiratipaisarl¹

Krongporn Ongprasert¹

Pheerasak Assavanopakun^1,2

Vithawat Surawattanasakul^1,2

Amornphat Kitro^1,2

Jinjuta Panumasvivat^1,2

Amnart Wongcharoen³

¹Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
²Environmental and Occupational Medicine Excellence Center (EnOMEC), Faculty of Medicine, Chiang Mai University, Chiang mai, Thailand
³Maharaj Nakorn Chiang Mai, Hospital, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand

The final, formatted version of the article will be published soon.

Introduction: Healthcare personnel (HCP) face high risks of airborne infections, including COVID-19, tuberculosis, and measles. Filtering facepiece respirators (FFRs) are critical for protection but require an adequate fit for effectiveness. Limited studies have explored the fit performance of different FFR designs in Southeast Asian populations. This study evaluates fit factors and pass rates of flat-fold, cup-shaped, and three-panel flat-fold respirators among Thai HCPs and examines the influence of facial anthropometry on fit outcomes.Method: A cross-sectional study was conducted with 223 HCPs at a university hospital in Chiang Mai, Thailand. Quantitative fit testing of three NIOSH-certified N95 respirators—flat-fold, cup-shaped, and three-panel flat-fold—was performed using a TSI Portacount Pro+ 8038 device. The OSHA Condensation Nuclei Counter protocol, comprising bending, talking, and head movement exercises, was followed. Fit factors, calculated as the harmonic mean, required a passing threshold of ≥100. Twenty-two facial anthropometric dimensions were also measured. Statistical analyses included the Kruskal-Wallis test, Fisher’s exact test, and logistic regression.Results: Pass rates were 5.4% for flat-fold respirators (median fit factor [FF]: 25), 51.1% for cup-shaped models (median FF: 104), and 82.5% for three-panel flat-fold designs (median FF: 191), with significant differences (p < 0.001). The three-panel flat-fold maintained FF values near 200 across exercises. Anthropometric predictors varied by FFR type: head length (Adj. OR: 1.16) and nose length (Adj. OR: 1.28) influenced flat-fold models, while nasal bridge breadth (Adj. OR: 1.11) affected cup-shaped models.Conclusion: The three-panel flat-fold respirator exhibited superior adaptability, highlighting its potential as the preferred choice for Thai HCP. The low pass rate of flat-fold designs underscores the need for region-specific respirator designs. Findings emphasize the importance of localized fit testing and the development of regional fit test panels to enhance protection. Further research is needed to explore fit retention, comfort, and usability in real-world conditions.

Keywords: Quantitative fit test, Respiratory protection, Filtering face piece, Respirator, N95, Facial Anthropometric, Health Personnel

Received: 16 Jan 2025; Accepted: 07 Apr 2025.

Copyright: © 2025 Wangsan, Sapbamrer, Sirikul, Kiratipaisarl, Ongprasert, Assavanopakun, Surawattanasakul, Kitro, Panumasvivat and Wongcharoen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Ratana Sapbamrer, Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand

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