Thank you all for finding this and responding so quickly!

Lana

Lana Kay Tyer, RN MSN

Tuberculosis Nurse Consultant

Office of Communicable Disease Epidemiology

Division of Disease Control & Health Statistics

Washington State Department of Health

Lana.tyer@doh.wa.gov

206-418-5581 | www.doh.wa.gov

Gender Pronouns: she/her

From: TB nurse communication [mailto:nobody@simplelists.com]
Sent: Friday, November 9, 2018 4:31 PM
To: tbnurses@ntca.simplelists.com
Subject: Daily digest for tbnurses@ntca.simplelists.com

(Previous discussion continued)
Re: Daily digest for tbnurses@ntca.simplelists.com - Goodbody, Angela K V (08 Nov 2018 20:08 EST)
Re: Daily digest for tbnurses@ntca.simplelists.com - Painter, Amy (08 Nov 2018 20:12 EST)
RE: Daily digest for tbnurses@ntca.simplelists.com - Murray, Ellen R (09 Nov 2018 07:05 EST)
RE: Daily digest for tbnurses@ntca.simplelists.com - McDermott, Marjorie (09 Nov 2018 07:21 EST)
Re: Daily digest for tbnurses@ntca.simplelists.com - Denise Wisner (09 Nov 2018 07:39 EST)
RE: Daily digest for tbnurses@ntca.simplelists.com - Patricia Woods (09 Nov 2018 08:27 EST)
RE: Daily digest for tbnurses@ntca.simplelists.com - Morse, Darlene (09 Nov 2018 08:27 EST)
RE: Daily digest for tbnurses@ntca.simplelists.com - Jan Dougan (09 Nov 2018 09:14 EST)
(Previous discussion continued)
RE: Staffing for TB program - Mamtchueng, Willy R. (09 Nov 2018 12:23 EST)

Re: Daily digest for tbnurses@ntca.simplelists.com by Goodbody, Angela K V (08 Nov 2018 20:08 EST)
Reply to list

See CDC publication: Mantoux Tuberculin Skin Test, Facilitator Guide, March 2003, pages 8 and 9

Peace,

Angie

Angela Goodbody, RN

Nursing Supervisor

State of Hawaii, Dept of Health

TB Control Branch

1700 Lanakila Avenue, Ground Floor

Honolulu, HI 96817

Ph (808) 832-5623

Fax (808) 832-3538

“For human beings, the most daunting challenge is to become fully human. For to become fully human is to become fully divine.”
― Thomas Keating

From: TB nurse communication <nobody@simplelists.com>
Sent: Thursday, November 8, 2018 2:34:25 PM
To: tbnurses@ntca.simplelists.com
Subject: Daily digest for tbnurses@ntca.simplelists.com

Alternate TST sites - Tyer, Lana K (DOH) (08 Nov 2018 17:25 EST) Alternate TST sites by Tyer, Lana K (DOH) (08 Nov 2018 17:25 EST)
Reply to list

Hello TB Nurse extraordinaires!

I got a call from a nurse asking for a resource that points out where are “alternate sites” that could be used for TST placement. I remember being told that the upper scapula could be used for patient’s without arms, but I am at a loss to find it. Does anyone have a resource they could share with me?

I have looked at TST manufacturer package insert, CDC Mantoux Manual, and NHANES TST procedure manual.

Thank you for sharing your wisdom!

Lana

Lana Kay Tyer, RN MSN

Tuberculosis Nurse Consultant

Office of Communicable Disease Epidemiology

Division of Disease Control & Health Statistics

Washington State Department of Health

Lana.tyer@doh.wa.gov

206-418-5581 | www.doh.wa.gov

Gender Pronouns: she/her

To reply to a posting, simply reply. To start a new thread, address it to
tbnurses@ntca.simplelists.com and put in a concise subject line.
You are on the daily digest setting for the listserve.The archives for
this list are at http://ntca.simplelists.com/tbnurses.
If you have problems with the listserve, please contact Lorna
Will at lwill@tbcontrollers.org

Re: Daily digest for tbnurses@ntca.simplelists.com by Painter, Amy (08 Nov 2018 20:12 EST)
Reply to list

Lana,

The CDC's DVD on Mantoux Tuberculin Skin Testing states the following in the manual that accompanies it(top of page 9) :

"The DVD demonstrates consistent placement on the left arm. Typically, the other arm is used as the alternate site; however, in some situations other alternatives need to be considered (the shoulder is demonstrated as an alternative site, as it is often selected in patients who have less skin turgor)."

https://www.cdc.gov/tb/education/Mantoux/images/mantoux.pdf

Amy R. Painter, RN, BSN
TB Division Director
S.C. Dept. of Health & Environmental Control
Mobile: (803) 722-0179

Office: (803) 898-0644

Fax: (803) 898-0685
Connect: www.scdhec.gov Facebook Twitter

This e-mail and any included attachments are intended only for the addressee(s). The information contained herein may include privileged or otherwise confidential information. Unauthorized review, forwarding, printing, copying, distributing, or using such information is strictly prohibited and may be unlawful. If you received this e-mail in error, or have reason to believe you are not authorized to receive it, please delete this message and notify the sender by e-mail.

From: TB nurse communication <nobody@simplelists.com>
Sent: Thursday, November 8, 2018 7:34:25 PM
To: tbnurses@ntca.simplelists.com
Subject: Daily digest for tbnurses@ntca.simplelists.com

Alternate TST sites - Tyer, Lana K (DOH) (08 Nov 2018 17:25 EST) Alternate TST sites by Tyer, Lana K (DOH) (08 Nov 2018 17:25 EST)
Reply to list

Hello TB Nurse extraordinaires!

I have looked at TST manufacturer package insert, CDC Mantoux Manual, and NHANES TST procedure manual.

Thank you for sharing your wisdom!

Lana

Lana Kay Tyer, RN MSN

Tuberculosis Nurse Consultant

Office of Communicable Disease Epidemiology

Division of Disease Control & Health Statistics

Washington State Department of Health

Lana.tyer@doh.wa.gov

206-418-5581 | www.doh.wa.gov

Gender Pronouns: she/her

RE: Daily digest for tbnurses@ntca.simplelists.com by Murray, Ellen R (09 Nov 2018 07:05 EST)
Reply to list

Hi Everyone,

You can find alternate sites in the MMWR “Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005.” In Appendix F, under the table there is additional information that states “the back of the shoulder is a good alternate TST administration site.” The source is the NTCA/NTNC book “Tuberculosis Nursing: A Comprehensive Guide to Patient Care, 1997.” I hope that helps.

Ellen R. Murray, PhD, BSN, RN | Nurse Consultant/Corrections Training Specialist

College of Medicine | Department of Medicine | Division of infectious Diseases and Global Medicine

Southeastern National Tuberculosis Center

Office 352.273.7682 | Direct 352.273.9385 | Fax 352.273.9275

UF|UNIVERSITY of FLORIDA

“We may never stop TB from entering our correctional facilities, but we can halt the transmission through education and training!” Murray, 2013

From: TB nurse communication <nobody@simplelists.com>
Sent: Thursday, November 08, 2018 7:34 PM
To: tbnurses@ntca.simplelists.com
Subject: Daily digest for tbnurses@ntca.simplelists.com

Alternate TST sites - Tyer, Lana K (DOH) (08 Nov 2018 17:25 EST)

Alternate TST sites by Tyer, Lana K (DOH) (08 Nov 2018 17:25 EST)
Reply to list

Hello TB Nurse extraordinaires!

I have looked at TST manufacturer package insert, CDC Mantoux Manual, and NHANES TST procedure manual.

Thank you for sharing your wisdom!

Lana

Lana Kay Tyer, RN MSN

Tuberculosis Nurse Consultant

Office of Communicable Disease Epidemiology

Division of Disease Control & Health Statistics

Washington State Department of Health

Lana.tyer@doh.wa.gov

206-418-5581 | www.doh.wa.gov

Gender Pronouns: she/her

RE: Daily digest for tbnurses@ntca.simplelists.com by McDermott, Marjorie (09 Nov 2018 07:21 EST)
Reply to list

Hi Lana,

It is actually shown on the Mantoux TST podcast on the CDC website.

Marjorie

From: TB nurse communication [mailto:nobody@simplelists.com]
Sent: Thursday, November 8, 2018 7:34 PM
To: tbnurses@ntca.simplelists.com
Subject: Daily digest for tbnurses@ntca.simplelists.com

CAUTION: This email originated from outside of the organization. Do not click links or open attachments unless you recognize the sender and know the content is safe.

Alternate TST sites - Tyer, Lana K (DOH) (08 Nov 2018 17:25 EST)

Alternate TST sites by Tyer, Lana K (DOH) (08 Nov 2018 17:25 EST)
Reply to list

Hello TB Nurse extraordinaires!

I have looked at TST manufacturer package insert, CDC Mantoux Manual, and NHANES TST procedure manual.

Thank you for sharing your wisdom!

Lana

Lana Kay Tyer, RN MSN

Tuberculosis Nurse Consultant

Office of Communicable Disease Epidemiology

Division of Disease Control & Health Statistics

Washington State Department of Health

Lana.tyer@doh.wa.gov

206-418-5581 | www.doh.wa.gov

Gender Pronouns: she/her

Re: Daily digest for tbnurses@ntca.simplelists.com by Denise Wisner (09 Nov 2018 07:39 EST)
Reply to list

I cannot give you a direct resource but I teach TST certifications in southeast Michigan and in our training video provided by the state they give the scapular regions as an alternate site if arms are not available or if there is excessive scaring or tattoos...Denny

On Thu, Nov 8, 2018 at 7:34 PM TB nurse communication <nobody@simplelists.com> wrote:

Alternate TST sites - Tyer, Lana K (DOH) (08 Nov 2018 17:25 EST) Alternate TST sites by Tyer, Lana K (DOH) (08 Nov 2018 17:25 EST)
Reply to list

Hello TB Nurse extraordinaires!

I have looked at TST manufacturer package insert, CDC Mantoux Manual, and NHANES TST procedure manual.

Thank you for sharing your wisdom!

Lana

Lana Kay Tyer, RN MSN

Tuberculosis Nurse Consultant

Office of Communicable Disease Epidemiology

Division of Disease Control & Health Statistics

Washington State Department of Health

Lana.tyer@doh.wa.gov

206-418-5581 | www.doh.wa.gov

Gender Pronouns: she/her

Denise Wisner PHN III

Macomb County Health Department

TB Control

586-469-6857

denise.wisner@macombgov.org

E-Mail Confidentiality Notice: This message, including any attachments is intended solely for the use of the name recipient(s) and may contain confidential and/or privileged information. Any unauthorized review, use, disclosure, or distribution of any confidential and/or privileged information contained in this e-mail is expressly prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy any and all copies of the original message.

RE: Daily digest for tbnurses@ntca.simplelists.com by Patricia Woods (09 Nov 2018 08:27 EST)
Reply to list

Lana,

The CDC facilitators guide mentions it on page 7. See below for the link.

The DVD demonstrates consistent

placement on the left arm. Typically, the

other arm is used as the alternate site;

however, in some situations other

alternatives need to be considered (the

shoulder is demonstrated as an alternative

site, as it is often selected in patients who

have less skin turgor). Describe the skin

test placement site selection standards for

your facility.

· What is the standard arm used for

placement?

· What is the standard alternative site if

there are barriers to placing on that

arm?

· Are there any other alternative sites?

https://www.cdc.gov/tb/education/mantoux/pdf/mantoux.pdf

Have a great weekend,

Patty

Patricia Woods, RN, MSN

Nurse Manager

NJMS Global Tuberculosis Institute, ICP, 1st Floor, East Wing

Lattimore Clinic

Rutgers, State University of New Jersey

225 Warren St, Newark, NJ 07103

p. 973-972-3830 f. 973-972-3832

patty.woods@rutgers.edu

Website: globaltb.njms.rutgers.edu

From: TB nurse communication [mailto:nobody@simplelists.com]
Sent: Thursday, November 08, 2018 7:34 PM
To: tbnurses@ntca.simplelists.com
Subject: Daily digest for tbnurses@ntca.simplelists.com

Alternate TST sites - Tyer, Lana K (DOH) (08 Nov 2018 17:25 EST)

Alternate TST sites by Tyer, Lana K (DOH) (08 Nov 2018 17:25 EST)
Reply to list

Hello TB Nurse extraordinaires!

I have looked at TST manufacturer package insert, CDC Mantoux Manual, and NHANES TST procedure manual.

Thank you for sharing your wisdom!

Lana

Lana Kay Tyer, RN MSN

Tuberculosis Nurse Consultant

Office of Communicable Disease Epidemiology

Division of Disease Control & Health Statistics

Washington State Department of Health

Lana.tyer@doh.wa.gov

206-418-5581 | www.doh.wa.gov

Gender Pronouns: she/her

RE: Daily digest for tbnurses@ntca.simplelists.com by Morse, Darlene (09 Nov 2018 08:27 EST)
Reply to list

Lana,

It is actually in the TST training video from the CDC. They have written instructions there as well.

Darlene

From: TB nurse communication [mailto:nobody@simplelists.com]
Sent: Thursday, November 08, 2018 7:34 PM
To: tbnurses@ntca.simplelists.com
Subject: Daily digest for tbnurses@ntca.simplelists.com

Alternate TST sites - Tyer, Lana K (DOH) (08 Nov 2018 17:25 EST)

Alternate TST sites by Tyer, Lana K (DOH) (08 Nov 2018 17:25 EST)
Reply to list

Hello TB Nurse extraordinaires!

I have looked at TST manufacturer package insert, CDC Mantoux Manual, and NHANES TST procedure manual.

Thank you for sharing your wisdom!

Lana

Lana Kay Tyer, RN MSN

Tuberculosis Nurse Consultant

Office of Communicable Disease Epidemiology

Division of Disease Control & Health Statistics

Washington State Department of Health

Lana.tyer@doh.wa.gov

206-418-5581 | www.doh.wa.gov

Gender Pronouns: she/her

RE: Daily digest for tbnurses@ntca.simplelists.com by Jan Dougan (09 Nov 2018 09:14 EST)
Reply to list

I found it in the CDC’s Facilitator Guide from March 2003: Mantoux Tuberculin skin test. This is the guide that comes with the video. Pg. 9 The DVD demonstrates consistent placement on the left arm. Typically, the other arm is used as the alternate site; however, in some situations other alternatives need to be considered (the shoulder is demonstrated as an alternative site, as it is often selected in patients who have less skin turgor).

Jan Dougan, RN TB Outreach CM – ADH

Office: Miller County Health Dept.

Phone: 870-773-2108 ext 119

Cell: 870-703-5751

CONFIDENTIALITY NOTICE:

The information contained in this e-mail message and any attachment is the property of the State of Arkansas and may be protected by state and federal laws governing disclosure of private information. It may contain information that is privileged, confidential, or otherwise protected from disclosure. It is intended solely for the use of the addressee. If you are not the intended recipient, you are hereby notified that reading, copying or distributing this e-mail or the information herein by anyone other than the intended recipient is STRICTLY PROHIBITED. The sender has not waived any applicable privilege by sending the accompanying transmission. If you have received this transmission in error, please notify the sender by reply e-mail immediately, and delete this message and attachments from your computer.

From: TB nurse communication [mailto:nobody@simplelists.com]
Sent: Thursday, November 8, 2018 6:34 PM
To: tbnurses@ntca.simplelists.com
Subject: Daily digest for tbnurses@ntca.simplelists.com

Alternate TST sites - Tyer, Lana K (DOH) (08 Nov 2018 17:25 EST)

Alternate TST sites by Tyer, Lana K (DOH) (08 Nov 2018 17:25 EST)
Reply to list

Hello TB Nurse extraordinaires!

I have looked at TST manufacturer package insert, CDC Mantoux Manual, and NHANES TST procedure manual.

Thank you for sharing your wisdom!

Lana

Lana Kay Tyer, RN MSN

Tuberculosis Nurse Consultant

Office of Communicable Disease Epidemiology

Division of Disease Control & Health Statistics

Washington State Department of Health

Lana.tyer@doh.wa.gov

206-418-5581 | www.doh.wa.gov

Gender Pronouns: she/her

RE: Staffing for TB program by Mamtchueng, Willy R. (09 Nov 2018 12:23 EST)
Reply to list

Good morning,

I am working on updating job description for our staff in our TB program. I am trying to add minimum requirement and certification for some staff. So, I am looking to see what is out there. Here are my few questions:

- What is your TB program Staffing like? How many case mangers? How do they share their caseload?

- Do RNs case manage your LTBI?

- Also, are your DOT aide CNAs? CMAs?

Any help with this is welcomed.

Thank you all

Willy MAMTCHUENG, BSN, RN
Disease Prevention and Control Supervisor

Clinical Services

Municipality of Anchorage
Department of Health & Human Services
825 L Street, Anchorage, AK 99501
Office: (907) 343-4709| Fax: (907 249-7992