SER- MAN- 207 TUBERCULIN SKIN TESTING (MANTOUX) Page 1 of 3

PURPOSE

This procedure outlines the process for the Tuberculin Skin Testing (Mantoux) testing

BACKGROUND

TUBERSOL [Tuberculin Purified Protein Derivative (Mantoux)] is indicated to aid diagnosis of

tuberculosis infection (TB) in persons at increased risk of developing active disease. There are
two general situations where risk of disease is increased:

1. Recent infection – most commonly contacts of a recently diagnosed patient with active
contagious pulmonary TB, or immigrants within five years of their arrival in Canada
from countries where TB is still common,
2. Increased risk of reactivation due to impaired immunity. This includes HIV infection,
diabetes, renal failure, corticosteroids or other immunosuppressant medication and
pulmonary silicosis

The tuberculin skin test is useful in epidemiologic surveys to define the prevalence of infection
in population groups or to estimate prevalence or risk of infection in certain population groups.
Previous BCG vaccination is not a contraindication to tuberculin testing. TUBERSOL may be
used as an aid in the diagnosis of tuberculosis infection in persons with a history of BCG
vaccination. The repeated testing of uninfected persons does not sensitize them to tuberculin.

Five (5) tuberculin units (TU) per test dose of 0.1ml is the standard strength used for intradermal
(Mantoux) testing.

MATERIALS

1. Tuberculin syringes with blunt fill filter needle,

2. Alcohol swabs,
3. Mantoux reagent (tuberculin PPD),
4. Sharps container,
5. Small, plastic, flexible transparent ruler (in millimeters (mm)), ball point pen
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PROCEDURE

1. Verify patient’s information on laboratory requisition form.

2. Explain procedure to the patient to put him/her at ease.
3. Wash hands.
4. Wipe rubber stopper of vial with alcohol wipe (70%). Allow to dry.
5. Using a tuberculin syringe, draw up (using the blunt fill filter needle) more than 0.1mls of
mantoux solution (5 TU per test dose). Change needle.
6. Date mantoux solution vial. Discard after 1 month
7. Inspect the arm in good light and on a firm surface.
8. Select site for test(flexor surface of the mid forearm)
- For the first time use the left forearm;
- For the second test use right forearm.
9. Clean the site with alcohol wipes (70%). Allow to dry.
10. Prime needle with solution until only 0.1ml is in syringe
11. Insert the point of the needle into the most superficial layers of the skin with the bevel of
the needle facing upwards until bevel is just covered by the skin.
12. Inject the solution slowly.
If the intradermal injection is performed correctly, a definite white wheal will rise at the
needle point. This will disappear within minutes. No dressing is required.
Refer to figure 2.
13. Dispose of the syringe used appropriately into a biohazard container.
14. Wash hands.
15. Explain to the patient by giving them a date - 72 hours after administration of the test- to
return and have the test read off
16. Inform the patient not to scratch or wet the injected site within that 72 hours period since
results can be greatly affected.
17. Place requisition form onto clipboard in the phlebotomy area and be sure to indicate the
date and time for the results to be read off.
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INTERPRETATION

The mantoux reaction should be read at 48 – 72 hours with the forearm slightly flexed at the
elbow. If possible, read at 72 hours as it may take some time for significant reactions to
develop.

A positive reaction indicates that the client has been exposed to Mycobacterium tuberculosis.
The basis of reading is the presence or absence of induration determined by either visible
inspection or palpation (see appendix 3 page 106 for palpation with fingertips
procedure); redness should not be considered.

If palpation method is used, mark the area lightly with a fine dot with a ball point pen at the
widest edge (margin) of the induration on both sides of the patient’s forearm.

Measure diameter of palpable induration (not entire area of redness) transversely (elbow to
wrist) using transparent ruler (in mm). Refer to figure 3 page 106

Record results along with any presence or absence of blistering and ulceration.

REFERENCES

1. Tuberculosis Act (1948)

2. WHO guidelines

3. Tuberculin reagent package insert