[PDF] Administering the Tuberculin Skin Test (TST)





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Administering the Tuberculin Skin Test (TST)

Select an area 2 to 4 inches (5 to 10 cm) below the elbow free of tattoos Region of Peel – Public Health

Administering the Tuberculin Skin Test (TST)

1) Locate the injection site

¥Place the forearm palm side up

¥Select an area 2 to 4 inches (5 to 10 cm) below the elbow free of tattoos,scars or broken skin ¥Clean site using an alcohol swab and allow to dry

2) Prepare the Tuberculin

¥Check the tuberculin expiration date (use within one month after opening) ¥Use a 1 ml tuberculin syringe with a 1/2 inch, 26 or 27 gauge needle

¥Do not inject air into vial

¥Withdraw 0.1 ml (5 tuberculin units)

¥Administer tuberculin immediately once drawn

3) Inject the Tuberculin

¥Insert the needle just below the skin"s surfaceat a 5 to 15 degree angle with the bevel up ¥Inject the tuberculin - a wheal (smallbubbled area) will form

4) Check the Injection Site

¥Ensure a 6 to 10 mm wheal appears

¥If the wheal is not 6 mm or more, repeat test 2 to 4 inches (5 to 10 cm)from the original site

¥Do not cover with a band-aid

5) Document the following:

¥Location (left arm or right arm)

¥Tuberculin lot number and expiry date

¥Date and time test administered

¥ Signature of health-care professional

Monitor client for 15 minutes post injection and instruct them to return in 48 to 72 hours to have the test read.

Precautions: Be aware and prepared for

anaphylactic/acute allergic reaction. The skin test must be read 48 to 72 hours after administration. If this 'window" is missed, you may need to re-administer the TST.

1) Inspect

¥Inspect the skin test site under good lighting ¥Note the induration (hard, dense, raised formation)

2) Palpate

¥Use your fingertips to determine if anyinduration is present

3) Mark

¥Mark the edges of induration across theforearm with a pen held at a 45 degree angle

4) Measure

¥Using a calliper ruler, measure the distance between pen marks

¥Measure induration - NOT erythema (redness)

5) Record Induration in millimetres (mm)

¥DO NOT record as simply positive or negative

¥If there is no induration, record as 0 mm

Interpretation of the TB Skin Test

Report all positive TST

Under the 1990 Health Protection and Promotion Act, sec. 26 (reporting of carrier ofdisease), all positive TSTs are reportable to Public Health. The physician reading thetest results must report the positive TST, even when referring the patient to anotherphysician or specialist for treatment.

¥Fax all positive skin test resultswith recent chest x-rayto: Region of Peel - Public Health, TB Program at 905-565-8428.

Questions about TB

and TB skin testing?

Call Region of Peel -

Public Health at

905-799-7700 or visit

www.peel-stoptb.ca

Reading the Tuberculin Skin Test (TST)

References

Canadian Lung Association. (2007) Canadian Tuberculosis Standards. (6 th ed.). Ottawa: Canadian Lung Association. Test Photos used with the permission of the Leeds, Grenville & Lanark District Health Unit.

Tuberculin

Reaction Size

(mm of induration)Setting in which reaction is considered positive

0 to 4 mm¥HIV infection AND expected risk of TB infection is high:

patient is immigrant from TB endemic country, is a household contact, or has abnormal chest x-ray

5 to 9 mm¥HIV infection/other immune suppression

¥Close contact of active case

¥Abnormal chest x-ray with fibronodular disease

¥Child suspected of having TB

≥10 mmAll others

CDS-0219 12/03

Two-Step

Tuberculosis

Skin Testing

Should be done on persons who:

¥Require subsequent (serial)testing (e.g., health-careworkers, correctional workersand volunteers)

¥Are new staff, students orvolunteers in daycare centres ¥Are travelling to a TB endemiccountry for a prolonged period of time

Procedure:

¥Administer and read the initialtest to establish a baseline

¥If first step is positive, do notrepeat

¥If the initial reaction does notmeet positive skin test criteria,perform a second test 1 to 4weeks later

¥Document both skin testresults

¥Report a positive skin test resultalong with recent chest x-ray toRegion of Peel - Public Healthby fax to 905-565-8428

Note:If a two-step test isdocumented, any subsequenttesting requires only a singletest. A two-step TST is notrecommended for contactinvestigation.quotesdbs_dbs17.pdfusesText_23
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