Follow-up of Positive Tuberculin Skin Test

Policy

Category: Control of Infectious Diseases
Subject: Follow-up of Positive Tuberculin Skin Test
Division: Health Protection
Policy Number: CA.82.01.205
Effective Date: February 26, 2016

POLICY STATEMENT

It is the policy of Wellington-Dufferin-Guelph Public Health (WDGPH) to ensure all persons identified as having a positive tuberculin skin test (TST) have appropriate follow-up to rule out active tuberculosis (TB) disease. Follow-up would also include education and referral for treatment of latent tuberculosis infection (LTBI) if indicated.

SCOPE

This policy applies to all Control of Infectious Diseases (CID) team members or nursing students who may be required to follow-up an individual with a positive TST.

DEFINITIONS

Positive TST is defined by three criteria; size, positive predictive value (the probability that a positive test result represents the true presence of TB infection), and risk of disease.

REFERENCES AND RELATED FORMS, POLICIES AND PROCEDURES

Corresponding Procedure:  CA.82.02.205 Follow-up of Positive Tuberculin Skin Test
Health Protection and Promotion Act, 1990
Ontario Public Health Standards, 2008
Infectious Diseases Protocol, 2009
Tuberculosis Prevention & Control Guidance Document, 2011
Canadian Tuberculosis Standards (as current online) 

CONTACT FOR INQUIRIES

Manager, Control of Infectious Diseases

APPROVED BY

Director, Health Protection


Procedure

Category: Control of Infectious Diseases
Subject: Follow-up of Positive Tuberculin Skin Test
Division: Health Protection
Procedure Number: CA.82.02.205
Effective Date: February 26, 2016

PROCEDURE

  1. When a Public Health Nurse (PHN) reads the result of a tuberculin skin test (TST) as positive (in mm), or is notified by a physician of a positive TST result, the PHN will complete the Positive Tuberculin Skin Test form (CHDPTB(F)5)  with all pertinent data.
  2. The PHN will notify the client’s family physician by telephone if not already aware of the client’s positive results.  This will be followed up by completing and faxing the physician the Positive Tuberculin Skin Test form (CHDPTB(F)5). The PHN will advise the physician to complete a chest x-ray and medical exam for the client to rule out active tuberculosis. The Positive Skin Test form must be completed, including physician recommendations, and returned with chest x-ray report to Wellington-Dufferin-Guelph Public Health (WDGPH).  If this is a recent conversion, prophylactic medication may be ordered by the physician.
  3. If the client has no family physician, the PHN will fill out the Chest X-ray Requisition (HPDTB(F)11) and request the chest x-ray be completed in accordance with Medical Directive CA.40.01.107 Ordering Laboratory Testing.

When the chest x-ray report is received, a copy is sent to the Medical Officer of Health (MOH) along with completed Positive Tuberculin Skin Test Reporting for Clients Without Physicians (HPDTB(F)19). When the above forms are returned, the PHN will implement MOH recommendations.

If the client is referred to TB Clinic, the PHN will complete the form Request for Consultation (HPDTB(F)12)  and fax the completed form along with the appointment date to the TB Clinic physician’s office.  The PHN will notify the client of the appointment by phone and/or mail.

  1. If the PHN is notified of a positive TST result from a physician, the PHN will direct the physician to complete the Positive Tuberculin Skin Test form (CHDPTB(F)5)  with all pertinent data.  The PHN will advise the physician to return the completed form, including physician recommendations and chest x-ray report to PHN.  If the physician prescribes prophylactic medication, this will be dispensed to the client as outlined in CA.82.01.202 Dispensing of Tuberculosis Medication.
  2. The PHN will report all positive TST results to the Ministry of Health and Long-Term Care by submitting required information through iPHIS.
  3. A chart will be created in Excelicare for all clients with positive skin tests.

RESPONSIBILITIES

Management will:
  • Ensure employees/students adhere to this policy and procedure;
  • Ensure new employees are trained to plant and read TSTs; and
  • Monitor policy compliance on a regular basis.
Employees will:
  • Adhere to this policy and procedure; and
  • Follow procedures to manage follow-up of individuals with a new report of a positive TST.

REFERENCES AND RELATED FORMS, POLICIES AND PROCEDURES

Corresponding Policy CA.82.01.205 Follow-up of Positive Tuberculin Skin Test
CA.40.01.107 Ordering Laboratory Testing
CA.82.01.202 Dispensing of Tuberculosis Medication
CHDPTB(F)5 Positive Tuberculin Skin Test form
HPDTB(F)11 Chest X-ray Requisition
HPDTB(F)19 Positive Tuberculin Skin Test Reporting for Clients Without Physicians
HPDTB(F)12 Request for Consultation
CHDPTB(F)5 Positive Tuberculin Skin Test form
Health Protection and Promotion Act, 1990
Ontario Public Health Standards, 2008
Infectious Diseases Protocol, 2009
Tuberculosis Prevention & Control Guidance Document, 2011
Canadian Tuberculosis Standards, (as current online)

CONTACT FOR INQUIRIES

Manager, Control of Infectious Diseases

APPROVED BY

Director, Health Protection