Tuberculosis Skin Test (TST)
Mantoux Technique
Administering the TST
1. Locate the site of injection
 Place the forearm palm
side up
 Select an area 5 to 10 cm
(2 to 4 inches) below the
elbow that is free of
tattoos, scars, blood
vessels and broken skin
 Clean site using an alcohol
swab; allow to dry
 Do not use local
anesthetic cream
2. Prepare the Tuberculin (purified
protein derivative [PPD])
 Check the expiration date
of the tuberculin
 Use a 1 mL tuberculin
safety engineered syringe
with 26 or 27 gauge
needle
 Do not inject air into vial
 Withdraw 0.1 mL (5-TU
[tuberculin units])
 Administer immediately
once drawn
3. Injecting the Tuberculin (PPD)
 Insert the needle with the
bevel up just below the
skin’s surface at a 5° to
15° angle
 Inject the tuberculin and a
wheal/bleb will form
4. Check the injection site
 Ensure a 6-10 mm
wheal/bleb appears
 Repeat test 5 to 10 cm (2
to 4 inches) from original
site of wheal if not more
than 5 mm
 Do not cover with Band-
Aid
5. Document the test, including:
 Location (left or right
forearm)
 Lot number
 Expiry date
 Date and time test
administered, by whom,
and designation
6. Stability and storage
 Store at 2° to 8° Celsius
 Tuberculin is light sensitive
 Tuberculin must be used
within 30 days once
opened. Mark date opened
on vial and box
Precautions: Acute allergic reactions,
including anaphylaxis, have been very
rarely reported following skin testing with
tuberculin. Epinephrine hydrochloride
solution (1:1000) and other appropriate
agents should be available for immediate
use in the case of anaphylactic or other
acute hypersensitivity reactions.
 Reading the TST
The skin test must be read 48 to 72 hours after administration. If this window is
missed, the TB skin test may have to be re-administered.

1. Inspect the site

 Inspect the skin test site under good lighting

 Note the induration (hard, dense, raised formation)

2. Palpate

 Use your fingertips to determine if any induration is present

3. Mark

 Mark the edges of induration (not redness) across the forearm with a pen

4. Measure

 Using a caliper ruler, measure the distance between the pen marks
 Measure induration – NOT erythema/redness

5. Record induration in millimetres (mm)

 Do not record simply as positive or negative

 If there is no induration, record as 0 mm

Tuberculin
Reaction Size (in Setting in which reaction considered positive
mm induration)

0-4 HIV infection with immune suppression AND expected risk of TB infection is
high (i.e. patient is an immigrant from a country where TB is endemic, is a
household contact, or has an abnormal radiograph). This reaction size is not
normally considered significant, but in the presence of immune suppression
may be important.
5-9  HIV infection
 Close contact of an active case
 Abnormal chest radiograph with fibronodular disease
 Children suspected of having active TB disease
 Other immune suppression: TNF-alpha inhibitors, chemotherapy
≥10 All others

Reporting a positive TST

Under the Health Protection and Promotion Act, sec. 26, all positive TSTs are reportable to Public Health. Please call
Halton Region by dialing 311 and ask for the Communicable Disease reporting line.

January 2016