Incorrect administration (not administered intradermally).Improper PPD vaccine storage (prolonged exposure to light or heat).Delayed administration after drawing up purified protein derivative (PPD).Nurse knowledge of the following causes can help prevent care delays and ensure adequate treatment: Many sources of false-negative tuberculosis (TB) skin tests are correctable. False-negative tests can result from improper PPD vaccine storage, improper administration, and improper interpretation of results due to lack of knowledge or inexperience. This decline is believed to be impacted by COVID-19 in many ways, including underdiagnosis and a true reduction in the disease.Īlthough we can’t prevent some TB infections, many cases occur because patients go undiagnosed as a result of false-negative skin tests and then unknowingly spread TB to others. The 2020 data reveal a significant decrease in the number of reported TB cases compared to previous years.In 2020, 43 states reported incidences at or below the national average of 2.2 cases per 100,000 persons, six states reported incidences that exceeded the national average, and only one state reported no TB cases.The incidence of TB in the United States decreased from 9,105 in 2017 to 7,860 in 2021.Worldwide, in 2020, an estimated 10 million cases of TB were diagnosed and 1.5 million people died from the disease.(See About TB.)Īccording to the World Health Organization, tuberculosis (TB) is the 13th leading cause of death worldwide and the second leading infectious killer after COVID-19. Inaccurate readings may increase the number of TB cases worldwide. Nurses must be accurate when interpreting TB skin test results to identify those patients who may need further diagnostic testing and follow up. This protocol reduces the likelihood of a boosted reaction to subsequent TB skin tests in patients with no previous history of TB. In the two-step protocol, a negative result after 48 to 72 hours requires a repeat test within 1 to 4 weeks. If the results aren’t read within that timeframe, the result becomes invalid and the test must be repeated. In the one-step protocol, the nurse administers the PPD vaccine intradermally to the patients’ forearm and interprets the result within 48 to 72 hours. The test can be given as a one- or two-step screening. Everyone Monica has encountered (at the hospital where she volunteers, at the clinic, and in her home and community) must be tested and receive ongoing follow-up and care.Ĭould this situation have been avoided when Monica received her TB skin test? Did the nurse make an error when he interpreted the 7-mm induration as negative? Does a magic number exist that nurses can rely on as the minimum induration for a positive result? Nurses’ role in TB testingĪll nurses learn how to administer and interpret TB skin tests and that a result of ≥10 mm induration is positive. A chest X-ray ordered by the provider indicates that Monica may have TB. The patient has hypertension, diabetes, and is HIV positive. He documents the results as negative.Ībout 3 months later Monica returns to the clinic with a cough and night sweats, which she says have worsened over the past 2 months. When the patient returns 2 days later, the nurse notes a 7-mm induration and no redness. The nurse administers the purified protein derivative (PPD) vaccine to the patient’s left forearm and advises her to return in 48 to 72 hours to read the results. When the nurse asks Monica if she’s ever had a positive TB test, she says that she hasn’t. Measure the induration only, not the redness of the tuberculin skin test reaction.Īs required for volunteer work at a local hospital, Monica, a 28-year-old woman, arrives as a new patient at a small community clinic to request a tuberculosis (TB) skin test.Accurate interpretation depends on various risk factors no single measurement is always indicative of TB.Follow your organization’s policies and procedures for interpreting TB skin test results and stay up-to-date on the most recent guidelines and recommendations.Author Guidelines and Manuscript Submission.
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