Learning from NHS England and NHS Improvement’s quality improvement project

Using a rapid quality improvement approach, NHS England and NHS Improvement worked with 11 NHS organisations to identify the steps needed to ensure all staff required to wear an FFP3 mask are successfully fit tested, enabling the participating organisations to rapidly identify barriers and implement solutions using small-scale tests of change.

The project identified the following areas of good practice and recommendations.


  • Consider the departments and teams which are key for facilitating successful fit testing to ensure an integrated approach that coordinates supply, implementation, and education to deliver a programme with staff safety at its core.

Education and communication with clinical and non-clinical staff

  • Ensure appropriate education and communication is in place for staff about the reasons for fit testing, and the process.
  • Trusts have introduced education programmes which have involved the use of posters, dedicated intranet pages, regular bulletins. “PPE marshals” can also support and train staff.

Accessibility of fit testing, including out of hours availability

  • Trusts should identify risk-assessed, accessible and safe locations and consider increasing the frequency of fit test sessions, drop-in fit testing, a single port of call to arrange a fit test, and the use of a checklist.

Quality of fit testing

  • Trusts should ensure clear policies and guidelines, based on HSE guidance, are in place, and that robust training is available for fit testers, including competency assessment and supervised sessions to ensure safe, high quality testing for staff.
  • A number of trusts use checklists on how to correctly undertake a fit test. An example of a checklist is available.
  • Other measures included training of fit testers by the mask supplier, inclusion of fit testing as part of organisational mandatory training and ensuring a supply of a variety of types of mask.

Mask alternatives

  • Alternatives to FFP3 masks, for example, hoods and powered respirators, are available and were used where fitting an FFP3 mask was not possible (on a case by case basis).
  • HSE guidance on fit testing explains that facial hair (stubble and beards) make it impossible to achieve a good seal of the respirator to the face. Where a fit test is not possible due to facial hair, alternative forms of RPE should be made available.
  • Facial hair and FFP3 respirators guidance can be accessed via the GOV.UK website.

Staff experience

  • Staff experience should be discussed, with a broad range to ensure any issues are resolved quickly. Examples include trusts using wellbeing charts, focus groups, surveys and analysis of staff journeys through the fit test process.

Recording of results

  • Organisations should record fit testing results at individual staff, departmental and trust level, continuously measure progress of fit testing using key benchmarks and ensure all staff who are required to wear a FFP3 mask are regularly fit tested. Board level assurance should also be in place.
  • Examples of recording fit test results include a central database linked to health roster, registers, and certificates for staff.


Compliance and governance

  • Governance structures must ensure that fit testing methodology meets with HSE standards and that clear policies and guidelines are in place.