TUBERCULOSIS TESTING

Effective Date: 
Sun, 04/01/2001
Reviewed: 
Tue, 08/23/2011
Revised: 
Sun, 10/02/2016

SUBJECT: TUBERCULOSIS TESTING

PERSONNEL: RN, LVN, or MA (by clinician order) who has demonstrated competence in tuberculosis testing.

EQUIPMENT/LOCATION:
TB safety syringe, Tubersol, alcohol swab, gloves

PROCEDURE:
Upon patient request for school or work or upon order from a clinician, an appointment is made for the student.  The appointment staff instructs the student to complete the on-line pre-appointment risk assessment questions.  Upon arrival for the appointment if the questionnaire has not been completed, form HC:330 can be completed by the student.  The staff member also insures that patient is able to return in 48-72 hours for PPD reading.

The patient completes upper half of form. The nurse or MA reviews the form to verify no prior positive PPD or other active risk factors.  If prior history of positive PPD or other positive risk factors, LVNs and MAs consult a clinician next steps; RNs can proceed per Standardized Procedures (see attached link).  No PPD is placed on anyone with a history of previous positive PPD. 

If the patient has a history of positive PPD, the patient completes a symptom review (form HC 391: TB Screening for Persons with Positive PPD History). If symptom review is positive, the patient given a mask and is referred for clinician consultation.

If Symptom review is negative, the nurse or MA notes this in the Medical Record. 

To perform PPD:

  • The nurse or MA questions the patient about allergy to preservative.
  • The nurse draws up 0.1cc of Tubersol, cleans inner aspect of patient’s forearm, and injects intradermally, with bevel up, creating a small wheal.
  • Procedure is repeated in another location if no wheal is noted.
  • Safety mechanism is activated, syringe is discarded in sharps container.

DOCUMENTATION AND FOLLOW-UP:

  • The nurse or MA enters the following in the Medical Record:  location of test, agent, lot number, expiration date, date given, date test is to be read, and signs the record.
  • The patient is notified to return in 48 to 72 hours to have the test read by the Triage Nurse.
  • The nurse or MA documents in medical record and immunization log, and completes encounter note.  MAs forward their note to the Clinician Operations Coordinator for review & co-sign.