Skip directly to search Skip directly to A to Z list Skip directly to navigation Skip directly to site content Skip directly to page options
CDC Home

Latent Tuberculosis Infection: A Guide for Primary Health Care Providers

Return to Table of Contents

Appendix C

Administration and Measurement of the TST*

Administration

The Mantoux test is the recommended TST. It is administered by injecting 0.1 ml of 5 TU of purified protein derivative (PPD) solution intradermally into the volar surface of the forearm using a 27-gauge needle with a tuberculin syringe.

  • Obtain results of all previous TST. Ask patient to describe what the test area looked like 2–3 days after administration. Written documentation must be obtained for history to be applicable.
  • Avoid areas of skin with veins, rashes, or excess hair.
  • Cleanse the area with alcohol swab, allow area to dry, and inject all antigen just below the surface of the skin on the volar surface of the forearm, forming a 6–10 mm wheal (a pale, raised area with distinct edges; has orange-peel appearance and does not disappear immediately).
  • If no wheal forms, or if a wheal forms that is less than 6 mm of induration, the test should be repeated immediately, approximately 2 inches from original site or on the other arm.
  • If minor bleeding occurs, dab the injection site with a cotton swab.
  • Avoid covering the area with a bandage or applying pressure to the injection site.
  • Record the date, time, and location of TST administration.
  • Instruct patient not to scratch the site, but to use cool compress to relieve any itching or swelling.
  • Inform patient of the importance of returning for a reading of the TST within 48–72 hours (2–3 days).
  • Give written appointment card for TST reading.
  • Provide written information about TST (pamphlet or brochure).

Measurement

  • Measure the induration (hard bump) rather than erythema.
  • Palpate area with fingertips, measuring the diameter of induration perpendicular to the long axis of the arm.
  • Use ballpoint pen to mark edges of induration.
  • Use a tuberculin skin testing ruler or ruler with millimeters to measure the distance between the 2 points.

Recording and Documentation

  • Record date TST was administered.
  • Record the brand name of the PPD solution, lot number, manufacturer, and expiration date on the patient record.
  • Record results in millimeters of induration (0 mm if there is no induration) rather than as positive or negative.
  • Record date and time of reading and name of person reading TST.
  • Provide written documentation to patient and ordering health care provider.

Storage and Handling

  • PPD solution must be kept refrigerated at 36°– 46° F.
  • Avoid fluctuations in temperature; do not store on the refrigerator door.
  • Syringes must be filled immediately prior to administration.
  • Store and transport the tuberculin in the dark as much as possible; avoid exposure to light.
  • Tuberculin testing solution should not be stored with other vials, such as Tdap, that could be mistaken for PPD.

* Contact the local health department TB program for training on the Mantoux tuberculin skin test.

 
Contact Us:
  • Centers for Disease Control and Prevention
    Division of Tuberculosis Elimination (DTBE)
    1600 Clifton Rd., NE
    MS E10
    Atlanta, GA 30333
  • 800-CDC-INFO
    (800-232-4636)
    TTY: (888) 232-6348
  • Contact CDC–INFO
USA.gov: The U.S. Government's Official Web PortalDepartment of Health and Human Services
Centers for Disease Control and Prevention   1600 Clifton Road Atlanta, GA 30329-4027, USA
800-CDC-INFO (800-232-4636) TTY: (888) 232-6348 - Contact CDC–INFO
A-Z Index
  1. A
  2. B
  3. C
  4. D
  5. E
  6. F
  7. G
  8. H
  9. I
  10. J
  11. K
  12. L
  13. M
  14. N
  15. O
  16. P
  17. Q
  18. R
  19. S
  20. T
  21. U
  22. V
  23. W
  24. X
  25. Y
  26. Z
  27. #