Mantoux Test: Procedure and Administration Guidelines for TB Screening
The Mantoux test, a standard method for detecting Mycobacterium tuberculosis infection, involves injecting Tuberculin Purified Protein Derivative (PPD) into the skin. This test is administered to individuals including children and those with TB exposure history. Proper injection technique and site selection are crucial for accurate results. Detailed instructions on how to administer the test are provided in the content.
Download Presentation
Please find below an Image/Link to download the presentation.
The content on the website is provided AS IS for your information and personal use only. It may not be sold, licensed, or shared on other websites without obtaining consent from the author. Download presentation by click this link. If you encounter any issues during the download, it is possible that the publisher has removed the file from their server.
E N D
Presentation Transcript
Community TB Nurse Specialist Julie Campbell North of Tyne TB nurse specialist
PLAN OF TALK MANTOUX TEST/ TUBERCULIN SKIN TEST (PORTFOLIO SIGN OFF!) TB CONTACT TRACING TB SCREENING REPORTING TO PHE: ENHANCED TB SURVEILLANCE (ETS) DOT/VOT QUESTIONS
Mantoux Tests The Mantoux test is the standard method of determining whether a person is infected with Mycobacterium tuberculosis Tuberculin Purified Protein Derivative (PPD) is injected into the skin and used to assess the individual s sensitivity to tuberculin protein, by producing a local skin reaction.
MANTOUX TEST IN THE UK, IT IS GIVEN TO CHILDREN FROM 3 MONTHS TO 16 YEARS OF AGE: WHERE THERE IS A HISTORY OF TB IN THE HOUSEHOLD THOSE WHO HAVE HAD A CLOSE CONTACT WITH A PERSON WITH TB IF THEY HAVE TRAVELLED THROUGH HIGH INCIDENCE COUNTRIES
ADMINISTERING THE MANTOUX TEST TUBERCULIN PPD, 2T.U./0.1ML SOLUTION FOR INJECTION 1 DOSE = 0.1ML CONTAINS 0.04 MICROGRAMS TUBERCULIN PPD 1ML GRADUATED SYRINGE FITTED WITH A SHORT BEVEL 26G NEEDLE INTRADERMAL INJECTION
INJECTION SITE THE TEST IS USUALLY APPLIED ON THE LEFT MIDDLE THIRD OF THE FLEXOR SURFACE OF THE FOREARM/ VOLAR ASPECT. SELECT AN AREA OF HEALTHY SKIN WHICH IS FREE FROM MUSCLE MARGINS/HEAVY HAIR/VEINS/SORES OR SCARS ONLY VISIBLY DIRTY SKIN NEEDS TO BE CLEANED.
PROCEDURE File:Mantoux tuberculin skin test.jpg USE A 1ML SYRINGE TO ASPIRATE OUT 0.1 ML OF PPD INJECT THE PPD INTRADERMALLY ON THE VOLAR SURFACE OF THE FOREARM, POSITION THE SYRINGE AT A 10-15 DEGREES TO THE FOREARM AND INSERT JUST BELOW THE EPIDERMIS (ABOUT 2MM) A 6MM TO 10MM WHEAL, I.E., A RAISED AREA OF SKIN SURFACE, TO FORM AT THE INJECTION SITE. REMOVE THE NEEDLE QUICKLY, DO NOT MASSAGE OR APPLY A DRESSING
INJECTION TECHNIQUE During an intradermal injection, considerable resistance is felt and a raised, blanched bleb showing the tips of the hair follicles is a sign that the injection has been correctly administered. A bleb of 7mm in diameter is approximately equivalent to 0.1ml and is a useful indication of the volume that has been injected. If no resistance is felt, the needle should be removed and reinserted before more vaccine is given
ADVERSE EFFECTS ANAPHYLACTIC REACTION AND FOREIGN BODY REACTION SLIGHT RISK OF HAVING A SEVERE LOCAL REACTION: INCLUDING REDNESS TO THE ARM, PARTICULARLY IN PEOPLE WHO HAVE HAD BCG VACCINE. LOCAL REACTIONS SUCH AS LYMPHADENITIS CONTRAINDICATION SEVERE REACTION EG NECROSIS, BLISTERING, ANAPHYLACTIC SHOCK, TO A PREVIOUS TST
READING THE MANTOUX Forearm should be measured within 72 hours Reaction is the induration around the injection site Induration measured in millimetres Erythema is not measured Positive result is 5mm and above regardless of BCG status
THE TUBERCULIN SKIN TESTS (TST) HAS THE ADVANTAGE OF BEING CHEAP AND RELATIVELY EASY TO PERFORM, BUT CAN SUFFER FROM A NUMBER OF PROBLEMS. THE TEST RESULTS HAVE TO BE INTERPRETED WITHIN A CERTAIN TIMESCALE, AND PATIENTS WHO DO NOT RETURN, OR DELAY RETURNING, WILL HAVE EITHER NO RESULT OR A POSSIBLY INACCURATE ONE. FALSE POSITIVE RESULTS CAN OCCUR BECAUSE OF THE SENSITISING EFFECT ON THE IMMUNE SYSTEM OF EITHER PRIOR BCG VACCINATION OR OPPORTUNISTIC ENVIRONMENTAL MYCOBACTERIA. FALSE NEGATIVE RESULTS CAN OCCUR DUE TO ANYTHING REDUCING IMMUNITY, PARTICULARLY CO-INFECTION WITH HIV, BUT ALSO TREATMENTS SUCH AS CYTOTOXICS, OR IMMUNOSUPPRESSION. EXTENSIVE TUBERCULOSIS (PULMONARY OR MILIARY) CAN ITSELF ALSO TEMPORARILY DEPRESS IMMUNITY, AND CAN LEAD TO A PARADOXICALLY NEGATIVE TST
CONTACT TRACING FIRST STEP IS TO GATHER BACKGROUND INFORMATION FROM THE ACTIVE TB PATIENT/ FROM MEDICAL RECORDS. INFORMATION IS USED TO DETERMINE THE CONTACT PERIOD WITH THE INFECTIOUS PATIENT GATHER INFORMATION ABOUT PLACES WHERE DISEASE TRANSMISSION COULD HAVE OCCURRED EG. PATIENT S HOME/CONGREGATE SETTINGS /EDUCATION & SOCIAL SETTINGS SEE HOW MANY PEOPLE SLEEP IN SAME ROOM, HOW MUCH VENTILATION, WHETHER PEOPLE EAT TOGETHER IN A COMMON AREA GATHER NAMES, PHONE NUMBERS, ADDRESSES OF PEOPLE WHO MAY HAVE BEEN EXPOSED LENGTH OF TIME IN THE UK / BCG STATUS
CONTACT TRACING CONFIDENTIALITY IMPORTANT, ONLY INFORM THE CONTACTS THAT THEY HAVE BEEN EXPOSED TO A PERSON SOMEWHERE THAT HAS ACTIVE TB THIS IS BECAUSE IT CAN BE VERY SENSITIVE AND CAUSE STIGMA IN THE COMMUNITY IF THE INDEX CASE IS A CHILD, THE SOURCE OF THE DISEASE MAY BE A PERSON WITH PULMONARY TB, UNKNOWN AT THE TIME OF CONTACT (DISTANT RELATIVE ETC)
TB SCREENING PULMONARY TB: ALL KNOWN CONTACTS SHOULD BE SCREENED IF CONTACTS ARE CHILDREN OF PULMONARY TB THEY WOULD NEED TO BE SCREENED AT 2/52 AND THEN 6/52 AFTER POTENTIAL EXPOSURE CHILDREN OF NON-PULMONARY TB NEED TO WAIT 6/52 BEFORE SCREENING AS PER NICE GUIDELINE, UNLESS SYMPTOMATIC ADULTS OF ALL OTHER ACTIVE TB, SCREENING WOULD JUST BE OF HOUSEHOLD CONTACTS ADULTS : QUANTIFERON, CXR PAEDIATRICS: MANTOUX/QUANTIFERON/ CXR IF PULMONARY/ BBV SCREENING
ETS PHE ENHANCED TB SURVEILLANCE -IS THE PUBLIC HEALTH ENGLAND RISK ASSESSMENT, TO WHICH ALL FORMS OF ACTIVE TB ARE STATUTORILY NOTIFIABLE ALL NEW TUBERCULOSIS CASES THAT ARE CULTURE CONFIRMED CASES DUE TO M. TUBERCULOSIS COMPLEX (INCLUDING M. TUBERCULOSIS, M. BOVIS, M. AFRICANUM OR M. MICROTI) NOT: NON-TUBERCULOUS MYCOBACTERIUM CASES / LATENT TB INFECTION /CASES RECEIVING ANTI TB CHEMOPROPHYLAXIS WHEN TO NOTIFY /TB CASES SHOULD BE NOTIFIED WITHIN 3 WORKING DAYS OF MAKING OR SUSPECTING THE DIAGNOSIS. PHE WILL RING TO DISCUSS
ETS QUESTIONS 1. PREVIOUS TB? 2. BCG VACCINE? 3. HISTORY OF DRUG USE? 4. IS THE PATIENT'S ABILITY TO SELF-ADMINISTER TREATMENT AFFECTED BY ALCOHOL MISUSE OR ABUSE? 5. IS THE PATIENT CURRENTLY HOMELESS OR HAS (S)HE EVER BEEN HOMELESS? 6. HAS THE PATIENT EVER BEEN IN PRISON? 7. HAS THE PATIENT TRAVELLED OUTSIDE THE UK FOR MORE THAN A MONTH IN THE TWO YEARS PRIOR TO DIAGNOSIS? 8. IE DETERMINE WHETHER THE PATIENT WOULD NEED DOT/VOT
Directly Observed Therapy (DOT) STANDARD THRICE WEEKLY DOSING MON/WED/FRIDAY AM. OBSERVE THE PATIENT DISPENSING AND TAKING THEIR MEDICATIONS IN THEIR PLACE OF RESIDENCE. DEPENDING ON CASE LOAD, PATIENTS ARE SHARED BETWEEN TWO TB NURSE SPECIALISTS WE HAVE TO CARRY OUT OUR OWN RISK ASSESSMENT OF THE PROPERTY AND PEOPLE LIVING THERE MAY REQUIRE TWO NURSES FOR SAFETY
VIDEO OBSERVED THERAPY (VOT) AS WE COVER NEWCASTLE/NORTH TYNESIDE/NORTHUMBRIA/CUMBRIA THEN WE ARE SOMETIMES REQUIRED TO USE VOT EG RECENT MDR PATIENT FROM CUMBRIA: RISK FACTOR WAS DUE TO THE DRUGS HE IS TAKING IE BEDAQUILINE, WHICH IS A STANDARD SECOND-LINE DRUG REGIMEN COST OF THE COMPLETE SIX MONTHS COURSE OF BEDAQUILINE IN ENGLAND IS 18,700 GOVERNANCE ARRANGEMENTS: ADMINISTERED BY DIRECT OBSERVATION (DOT/VOT) TO ADULTS AGED 18 YEARS
