Policy Manual sample

MDT Home Health Care Agency, Inc. 134 TUBERCULOSIS TESTING PURPOSE: TB skin testing may be performed on clinical staff or patient’s (with physician’s order). A questionnaire must be completed by person receiving the testing and the nurse administering the skin test. RESPONSIBLE PERSONNEL: RN, LPN EQUIPMENT : Alcohol prep pads, TB syringe and needle (1cc, 25 gauge, 5/8” needle); antigen, needle box, ruler in millimeter increments. PROCEDURE: 1. Explain procedure to patient. 2. Wash hands. 3. Remove vial of PPD antigen from refrigerator. 4. Inspect vial for expiration date. NOTE: Do not put unused antigen back into a vial. Do not mix antigen from separate vials to administer skin tests. 5. Cleanse top of vial with alcohol prep. 6. Withdraw, aseptically, 0.1cc of antigen into a TB syringe. 7. Cleanse site with alcohol prep and allow to dry. 8. Grasp under part of the forearm and exert pressure downward to tighten skin. 9. Administer injection into flexor surface of forearm by holding the syringe, bevel up, horizontal to the injection site and inserting tip of the needle between the layers of the skin, approximately 2-1/2 inches below the bend of the elbow. NOTE: The injection should produce a discreet, pale elevation of the skin or wheal, 6 – 10 mm in diameter, and resembling a mosquito bite. 10. Dispose of syringe and needle into needle disposal container. 11. Inform employee to return in 48 to 72 hours for PPD reading during office hours or schedule patient visit to read results. 12. Document date of test, site, amount and type of antigen administered on Permission Form for employee or in Clinical Note for patients. To Read Test: 1. Wash hands. 2. Place arm in a good light with forearm slightly flexed. 3. Determine the presence or absence of the induration (swelling). NOTE: If the erythema is 10 mm or more, and no induration is apparent, it is possible that the test was given too deeply. Do not assume test was positive.