Tuberculosis Education for School Nurses

One-to-One Training

Training of individual nurses may be initiated by the health department or school nurse supervisor. The circumstances under which this type of training will most likely be conducted is for learning Mantoux tuberculin skin testing or for initiating school-based DOT.

Mantoux Tuberculin Skin Testing

New nursing school graduates or nurses who have come from school districts which have not required skin testing, may come into a district needing to know how to perform Mantoux tuberculin skin testing. It is important not only to learn how to administer the skin test, but how to read and interpret the skin test. A local health department’s TB clinic has nurses who are proficient in tuberculin skin testing. You can refer an individual nurse to the health department to learn skin testing. However, there are some aspects of training that can be done ahead of time, to prepare the school nurse for training at the health department.

Review the skin testing procedure with the nurse, by using the guidelines on pages 6-11 in the Tuberculosis School Nurse Handbook
Use the Documentation Form for Tuberculin Skin Testing using the Mantoux Method in Appendix B, page 26 of the Handbook to demonstrate the importance of accurate record keeping for skin test results. There may also be similar school-district forms which can be used as well
Schedule the school nurse for health department training, on a day when there are several skin tests to be read in the clinic, so a practical learning experience can take place

School Based Directly Observed Therapy (DOT)

At times, a school nurse may need to administer anti-TB medications in school either by order of a private physician or a health department. The medication may be for treatment of latent TB infection or active TB disease. The standard for treating both types of conditions, is by directly observed therapy (DOT). DOT requires that a trained healthcare professional observe the ingestion of TB medications in order to ensure adherence. Since TB is a communicable disease, treating active TB or TB infection is very important. The Tuberculosis School Nurse Handbook provides the information needed to administer medications. You should supplement this resource by providing some additional information to the nurse on a one-to-one basis, such as the following:

School district’s medication administration policy
Handling medication administration in the nurse’s absence (page 16)
Permission forms from parents to administer medications in school (see "Request for Medication to be Administered by a School Nurse" in Appendix E, page 29)
Record of medication ingestion (see "Directly Observed Therapy Log" in Appendix D, page 28)
Arrangements for medication administration in case the child is absent (page 16)
Balancing time for other students’ medical needs (page 17)

Many of the above issues are addressed in the Handbook, but it is important to have a plan ahead of time. The nurse may also have a number of questions on TB itself. If you have the knowledge to respond to these questions you may do so, but feel free to contact the child’s clinician for answers as well.