National Health and Nutrition Examination Survey TUBERCULOSIS SKIN TEST PROCEDURES MANUAL January 2001 TABLE OF CONTENTS Chapter Page 1 OVERVIEW OF THE NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEY ............................................................................ 1-1 1.1 History of the National Health and Nutrition Examination Programs ............................................................................................. 1-1 1.2 Overview of the Current NHANES .................................................... 1-3 1.2.1 NHANES Pilot and Dress Rehearsal .................................. 1-4 1.2.2 Data Collection for NHANES Main Survey ....................... 1-4 1.3 Sample Selection................................................................................. 1-6 1.4 Field Organization for NHANES ....................................................... 1-7 1.5 Exams and Interviews in the Mobile Examination Center (MEC) ..... 1-10 1.6 Confidentiality and Professional Ethics .............................................. 1-20 2 TUBERCULOSIS SKIN TESTING ................................................................ 2-1 2.1 Overview of TB and TB Skin Testing ................................................ 2-1 2.2 TB Epidemiology ................................................................................ 2-2 2.3 Overview of TB Skin Testing ............................................................. 2-4 2.4 Limitations of Tuberculosis Skin Testing and Implications ............... 2-9 2.5 Skin Test Results ................................................................................ 2-10 3 FIELD OFFICE PROCEDURES .................................................................... 3-1 3.1 Overview............................................................................................. 3-1 3.2 Scheduling Appointments for Reading TB Skin Tests ....................... 3-2 3.2.1 Report of SPs With Scheduled Appointments .................... 3-2 3.2.2 Report of SP Without Scheduled Appointments ................. 3-3 3.3 Refusal Conversion Phone Calls ......................................................... 3-3 3.4 Nonresponse Follow-up of SPs Who Miss a Scheduled TB Reading ............................................................................................... 3-3 4 PROTOCOL FOR PLACING SKIN TEST ANTIGENS ................................ 4-1 4.1 Overview............................................................................................. 4-1 4.2 The Phlebotomy Component .............................................................. 4-1 4.3 Equipment and Supplies ..................................................................... 4-2 4.3.1 General Principles for Handling and Storing the PPD Antigens .............................................................................. 4-2 TABLE OF CONTENTS (continued) Chapter Page 4.4 Procedures Preceding Skin Testing .................................................... 4-6 4.4.1 Screening SPs for Skin Test Eligibility ............................... 4-6 4.4.2 Examination for Bacille Calmette-Guerin (BCG) Vaccine Scar........................................................................ 4-6 4.5 PPD Antigen Skin Testing .................................................................. 4-9 4.5.1 Background: How PPD Antigen Skin Tests Work ............. 4-9 4.5.2 Skin Test Preparation Steps: Filling Syringes (May be done before venipuncture) ................................................... 4-9 4.5.3 Skin Test Administration Steps........................................... 4-12 4.6 Appointments for Measurement of Skin Reactions ............................ 4-18 4.7 Entering Results in ISIS ...................................................................... 4-20 4.8 Conducting the TB Exam in Spanish .................................................. 4-39 4.9 Severe Adverse Reactions during Antigen Administration ................ 4-41 5 APPOINTMENT MANAGER GUIDE FOR TB READERS ......................... 5-1 APPOINTMENT MANAGER OVERVIEW .................................................. 1 Opening the Program .......................................................................... 1 Logon ............................................................................................... 1 Toolbar and Menu Options ................................................................. 2 Important Navigational Keystrokes .................................................... 6 Colors.................................................................................................. 7 The Stand List ..................................................................................... 9 APPOINTMENTS CALENDAR .................................................................... 10 Calendar.............................................................................................. 10 Session Appointment Detail ............................................................... 11 Person Summary ................................................................................. 13 APPOINTMENT DETAIL WINDOW ........................................................... 14 Button Bar – Appointment Detail ....................................................... 15 General Information – Appointment Detail Window ......................... 16 Transportation Tab – Appointment Detail Window ........................... 17 Important Transportation Considerations ........................................... 20 Interpreter Tab – Appointment Detail Window .................................. 21 Considerations/Incentives Tab – Appointment Detail Window ......... 22 History Tab – Appointment Detail Window ....................................... 23 TABLE OF CONTENTS (continued) Chapter Page SP Address Tab – Appointment Detail Window ................................ 24 Comments Tab – Appointment Detail Window ................................. 25 SP Info Tab – Appointment Detail Window ....................................... 25 Consents Tab – Appointment Detail Window .................................... 27 Change or Cancel Appointment Status ............................................... 27 SEARCH.......................................................................................................... 29 Search for All Persons Given Antigens or with a TB and/or VOC Appointment ....................................................................................... 29 Search by Last Name .......................................................................... 30 Search with Multiple Criteria ............................................................. 31 Scheduling Appointments from Search Results ................................. 32 Current Session Appointments Status (Check-in Window) ................ 33 Session Status Changes....................................................................... 33 Edit Session Comments ...................................................................... 34 Stand Calendar View .......................................................................... 35 Call Log .............................................................................................. 37 REPORTS ........................................................................................................ 40 TB Appt Schedule with Time Constraints .......................................... 40 Appt Schedule ..................................................................................... 41 SP's Needing TB Appt ........................................................................ 42 Sort a Report ....................................................................................... 43 Zoom................................................................................................... 44 Page Setup .......................................................................................... 44 Printing a Report ................................................................................. 45 6 PROTOCOL FOR MEASUREMENT OF SKIN REACTIONS .................... 6-1 6.1 Overview............................................................................................. 6-1 6.2 Equipment and Supplies ..................................................................... 6-2 6.3 Procedures for Measurement of Skin Reaction .................................. 6-3 6.3.1 Overview............................................................................. 6-3 6.3.2 Procedures for Measuring the Skin Reaction...................... 6-12 6.4 Quality Control Measurement of Skin Reactions: (BIDRs) ............... 6-15 6.4.1 BIDR by a Third Reader ..................................................... 6-16 6.5 Adverse Reaction Form ...................................................................... 6-16 6.6 Report of Findings (ROF) ................................................................... 6-18 TABLE OF CONTENTS (continued) Chapter Page 6.7 Remuneration ...................................................................................... 6-36 6.7.1 Petty Cash ........................................................................... 6-37 6.8 Measurement of the Skin Reactions after the Stand Closes ................ 6-37 6.8.1 End of Stand Procedures ..................................................... 6-38 6.8.2 Measurement of Skin Reaction after the Field Office Closes ....................................................................... 6-38 6.8.3 Tasks Completed before