Date of Last Review 3/16/10
Date of Last Review 10/18/10
Date of Last Review 10/31/11
SME: Infection Control Manager
This topic provides information about screening patients for Tuberculosis (TB)
during admissions.
UTHCPC must document all known TB tests and test results, past and present, in the patient's record.
This table describes when UTHCPC needs to test/retest a patient for TB:
WHEN the patient has... |
AND... |
THEN the patient... |
Documentation of a negative tuberculin skin test |
The test was performed more than a year ago |
Needs to be retested |
Documentation of a negative tuberculin skin test performed within the last year |
Is asymptomatic AND has no known exposure since his/her last TB test |
Does not need to be retested |
Documentation of a negative tuberculin skin test performed within the last year |
Exposure status cannot be determined |
Needs to be tested |
Documentation of a negative tuberculin skin test performed within the last year |
Has symptoms OR has been exposed to TB since the test |
Needs to be tested |
Documentation of a positive tuberculin skin test |
Is asymptomatic |
Does not need to be retested Note: The Center for Disease Control (CDC) no longer recommends yearly chest X-rays for asymptomatic patients. |
Documentation of a positive tuberculin skin test |
Has symptoms |
Follow the protocol for symptomatic patients |
Never had a tuberculin skin test |
OR has no documentation of a tuberculin skin test |
Needs to be tested |
This table describes the process for diagnosing a patient who refuses TB testing:
Stage |
Description | ||||||||||||||||||
1 |
This table describes what happens:
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2 |
This table describes what happens next:
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3 |
This table describes what happens next:
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4 |
This table describes what happens next:
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This table explains how to interpret the results of the Tuberculin skin test:
WHEN the induration measures... |
AND the patient is HIV... |
THEN the nurse interprets | ||||
10 mm or more |
Positive or negative |
Positive for past or present infection with mycobacterium tuberculosis due to an indication of hypersensitivity to tuberculoprotein | ||||
5-9 mm |
Positive |
Positive | ||||
5-9 mm |
Negative |
Indeterminate, and must retest the patient in 2 weeks using a different injection site. Results of retest:
Consider: Cross-reaction from other mycobacterium infection | ||||
Less than 5 mm |
Positive or negative |
Negative |
UTHCPC requires any patient suspected of having tuberculosis to wear a mask at all times.
UTHCPC considers the following patients to be at high risk for contracting tuberculosis:
 | HIV positive |
| Homeless |
| History of jail or prison |
| IV drug users |
| Immigrants |
| Debilitated alcoholics |
| History of recent exposure |
This table describes the process for testing patients who are coughing and moving sputum in their lungs:
Stage |
Description | |||||||||||||||||
1 |
Nursing staff requires the patient to wear a mask. | |||||||||||||||||
2 |
Physician orders one or all of the following tests:
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3 |
This table describes what happens next:
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4 |
Physician orders sputum collection for fast bacilli smear and culture. | |||||||||||||||||
5 |
Physician consults with Internal Medicine to diagnose and treat the patient. | |||||||||||||||||
6 |
Physician transfers patient diagnosed with active tuberculosis to a medical facility for isolation, diagnosis, and treatment. | |||||||||||||||||
This table describes the process for testing and diagnosing tuberculosis:
Stage |
Description | |||||||||||||||||||
1 |
The physician orders 0.1 ml of purified protein derivative (PPD) administered intradermally using the Mantoux method. | |||||||||||||||||||
2 |
The patient's nurse administers the test. | |||||||||||||||||||
3 |
The patient's nurse interprets the results 48 to 72-hours after administration. | |||||||||||||||||||
4 |
This table describes what happens next:
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5 |
The nurse interprets the results. | |||||||||||||||||||
6 |
This table describes what happens next:
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7 |
This table describes what happens next:
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8 |
The nurse and/or physician document all results and treatment in the patient's chart. | |||||||||||||||||||
The Joint Commission : Surveillance, Prevention, and Control of Infection
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