MDH Releases New Tuberculin Protocol

The Minnesota Department of Health (MDH) has created new tools related to tuberculin skin testing:

• "Tuberculin Skin Testing (TST): Storage of Tuberculin and Need for Orders to Administer" is a one-page fact sheet that provides an overview of appropriate storage of tuberculin (including the temperature range, temperature monitoring, and type of refrigerator to use) and the need for a legal prescription to administer TSTs.
• "Tuberculin Skin Testing (TST) Protocol for Screening Health Care Workers" is a three-page template protocol for health care facilities to adapt for their own use. The protocol includes guidance for administration, reading, interpreting, and documenting TSTs.

You can find the fact sheet and template protocol here

These MDH tools create significant changes to the TST protocols currently in use by many nursing homes and home health providers:

This clarification may require some home health care agencies to modify how they purchase, store, and administer TSTs for new employees.

All providers should verify that their nurses have a legal prescription to administer a TST. This can be done with a patient-specific order or a condition-specific protocol signed by a licensed prescriber. Nurses administering TSTs without signed protocols (signed by an authorized prescriber) or prescriber’s orders are working outside of their legal scope of practice.

All providers should review how they store tuberculin, as the MDH document is very specific in terms of proper storage:

• Store tuberculin at 35º to 46º F (2º to 8º C) and protect it from light (keep in original packaging). Monitor refrigerator temperature using a digital thermometer with the probe inserted in a vial of biosafe glycol or a vial of glass beads. Tuberculin that has been exposed to freezing temperatures (32º F or lower) or has been stored above 46º F should be discarded.
• Use a stand-alone or medical-grade refrigerator appropriate for storing tuberculin, vaccines, and medications. Do not use a dorm-style refrigerator (combination refrigerator and freezer with a single door). Do not place tuberculin in the door of the refrigerator. Date the tuberculin vial when opening and discard it after 30 days. Do not store tuberculin vial with other vials, such as Tdap, that could be mistaken for tuberculin.

Questions about these documents can be directed to Beth Kingdon at 651-201-5529.