6.04 – Procedure for Tuberculin Testing

Policy

Tuberculin screening of Open Door individuals and employees shall be consistent with current medically recommended measures for the control of tuberculosis.

Definitions

• Mantoux Test – the intradermal injection of PPD
• PPD – purified protein derivative
• Non-significant reaction – an indurated area of less than 10 millimeters
• Significant reaction – an indurated area of more than 10 millimeters
• Conversion – a change in the skin reaction from non-significant to significant

Procedure

All prospective employees working in ICF facilities will be screened for tuberculosis.  The first step will be completed and read prior to the employee having any direct contact with the individuals.  If a new employee has received a Mantoux test at a previous work site, proof of administration must be provided.

• The two-step Mantoux involves the intradermal injection of 5 Tuberculin Units (TU) of Purified Protein derivative (PPD) solution into the volar surface of the forearm.  This produces a tense, white wheal.  The arm is examined in 48 to 72 hours and any induration resulting from this injection is measure in millimeters, across the long axis of the forearm.  The measurement should only consider induration, redness is not significant of tuberculin reaction
• If the first Mantoux is non-significant, a second skin test will be administered within twenty one days.  The results of the second test should be considered the person’s true tuberculin status
• If the results of the first test are significant, the second test should not be given
• Those persons exhibiting a significant reaction should receive a chest x-ray and be evaluated by a physician.  There should be annual documentation for review of signs and symptoms of tuberculosis in such an employee’s record, with physician referral and chest x-rays, should signs and symptoms develop.

Persons converting from non-significant to significant test results should:

• Receive physician evaluation and chest x-ray
• If here is no evidence of active disease, the reactive person should receive prophylaxis unless medical contraindicated and provide the facility with documentation that prophylaxis was completed
• The conversion will be reported to the Health Department

All employees working at ICF locations will receive tuberculin testing, one-step Mantoux, on an annual basis or a negative chest x-ray and/or a symptoms assessment, if applicable.

Admission Screening

• All new individuals admitted to Open Door ICF locations will receive the two-step Mantoux upon admission or have written documentation of previous two-step testing and the reaction to the test
• If either test is significant, the individual will be examined by the attending physician and a chest x-ray will be obtained to confirm or refute the possibility of disease and appropriate prophylaxis will be ordered
• The individual will have tuberculin testing (one step) on an annual basis
• If an individual is hospitalized or on a LOA from the facility for more than eight weeks at a time, a single Mantoux will be given upon return or based on attending physician orders.

Exposure to Tuberculosis

• Active cases of tuberculosis in individuals or personnel will be reported immediately by the Departmental Supervising Licensed Nurse to the Medical Services Coordinator.
  • The Medical Services Manager and/or Associate Directorwill submit to the Health Department a list of those individual(s) or personnel exposed to the affected individual
  • The facility will follow the protocol outlined by the Health Department.

Last Revised: 6/6/22