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No. 1, 2012

TB EDUCATION AND TRAINING NETWORK UPDATES


Minnesota Addresses TST Training Needs with Model Kits


Although use of the tuberculin skin test (TST) is becoming less common in Minnesota due to increased use of interferon-gamma release assays (IGRAs), the TST remains an important tool in TB prevention and control efforts. Learning to perform TSTs can be difficult, and as use of the TST becomes less common, fewer healthcare workers may be available to teach and mentor these skills.

In 2006, the Minnesota Department of Health (MDH) TB Prevention and Control Program created five “Tuberculin Skin Testing Models Kits” to address TST training needs in Minnesota (Image).  Each kit includes: two soft rubber arm models (6 inches long, 3 inches wide, and 1½ inches high) with multiple indurations and an answer key (1); baby powder (to put on the arms); two red wet-erase markers; five small rulers; instructions for cleaning the arms; Candidates for Treatment of Latent TB Infection (LTBI) (an MDH document for categorizing a TST result as positive or negative) (2); a quiz to practice interpretation skills (including answer key); the Latent Tuberculosis Infection: A Guide for Primary Health Care Providers booklet (3); and the Centers for Disease Control and Prevention’s 30-minute video titled “Mantoux Tuberculin Skin Test” with facilitator guide (4). The kit contents are enclosed in a plastic container with a handle (13 inches wide, 7½ inches deep, and 7 inches high). The only direct costs are the two arms (sold as a set) and the plastic container; together, these items cost less than $100.

Kits are available by loan for use by all health care and public health settings in Minnesota. They are delivered by mail. Each person who requests the kit is asked to complete a one-page paper and pencil survey and return it to MDH with the kit. The survey includes several opinion questions including “This kit is a useful training tool,” “I would recommend this training tool to others,” “Those who used this kit increased their ability to place, read, and interpret Mantoux tuberculin skin tests,” and several open-ended questions.

Between August 2006 and July 2012, MDH filled 105 requests for the kit; the kits were used to train over 1,600 people. Of the 86 people (82%) who returned the survey, 100% strongly agreed or agreed that “This kit is a useful training tool,” 100% strongly agreed or agreed that “I would recommend this training tool to others,” and 95% strongly agreed or agreed that “Those who used this kit increased their ability to place, read, and interpret Mantoux tuberculin skin tests” (Table).

Many of those who responded to the open-ended questions reported that the arms were a valuable part of the kit and that the learners appreciated the opportunity for a hands-on experience.

Few people reported that there was anything that they didn’t like about the kit. Among those who did, the most common complaint was that it was difficult to remove the marks made by the red marker during the process of reading the test.

tools for support teaching TST
The survey did not ask how it was determined that the learners increased their ability to place, read, and interpret TSTs or how the learners themselves felt about their skill level after the training. Although the kit reached over 1,600 learners, this likely represents only a fraction of healthcare workers who require training in TST.

This kit is an effective, inexpensive, and easily reproducible tool for teaching TST. The kit was well received by those who used it in Minnesota. Although TST is becoming less commonly used in Minnesota, the need continues for tools for support teaching TST.

If you have any questions about this kit, you may contact the author by e-mail at Elisabeth.Kingdon@state.mn.us or by telephone at 651-201-5529.


Table. Usefulness of Tuberculin Skin Testing Models Kit (N=86)

Question

Strongly agree

Agree

Unsure

Disagree

Strongly disagree

This kit is a useful training tool

81%

19%

0%

0%

0%

I would recommend this training tool to others

80%

20%

0%

0%

0%

Those who used this kit increased their ability to place, read, and interpret Mantoux tuberculin skin tests (N=85)

73%

24%

4%

0%

0%

References
1. Health Edco (www.healthedco.com) Palpable TB Testing Arms – item number 26001, cost $84.30 for set of two arms
2. Source: www.health.state.mn.us/divs/idepc/diseases/tb/candidates.pdf
3. CDC publication: www.cdc.gov/tb/publications/LTBI/ default.htm
4. CDC video: http://wwwn.cdc.gov/pubs/CDCInfoOnDemand.aspx

—Submitted by Beth Kingdon, MPH
TB Education Coordinator/Planner
TB Prevention and Control Program
Minnesota Department of Health

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