Tuberculosis Screening & Documents: PPD, TST, Chest X-rays, Titers

picture of test tubes for TB screening
Written by
Miranda Kay, RN
December 4, 2023

Everything You Need to Know About Tuberculosis Screening & Documents

Tuberculosis testing and blood draws (titers) are recommended by the CDC for anyone working in the following healthcare settings:

  • inpatient settings,
  • outpatient settings,
  • laboratories,
  • emergency medical services,
  • medical settings in correctional facilities,
  • home-based health care and outreach settings,
  • long-term care facilities, and
  • clinics in homeless shelters.

The PPD Test 

The PPD test is a skin test that will require two separate visits to your physician's office. The test is usually administered to the underside skin of your forearm. Due to the serious and highly contagious nature of tuberculosis, this test will need to be performed periodically over your career.

  • For your first visit, you will receive a shot of the PPD. A bump will form at the injection site but usually dissipates within a few hours after.
  • Your second visit should occur 48 to 72 hours following the injection. Your physician will assess your reaction to the test.


The Tuberculin Skin Test (TST) is a two-step skin test recommended for healthcare workers because they need to be routinely re-tested throughout their career and it eliminates what is called the "booster phenomenon" where a skin test conversion could occur.

  1. Step one of the TST: The first step of the TST is comprised of the two visits required for the PPD test. Remember, the second visit needs to occur within 48-72 hours of the PPD injection.
  2. Step two of the TST: This step of the TST should take place between seven and 21 days following the second visit of step one. For this step, a third office visit will occur where another injection of PPD is administered. 48-72 hours after the third visit (second injection of PPD) your physician will assess your reaction.

Chest X-Ray

If you test positive after the second test of the TST it could mean a TB infection in your past. A chest x-ray may be needed with proof of either a past positive TB test or a TB blood draw.

Tuberculosis Titers

There are three forms of tuberculosis titers:

  •  IGRA - Interferon Gamma Release Assay tests to see if you have TB germs in your body
  • Tspot.TB - A diagnostic test that checks your T cells
  • QuantiFERON-TB - This whole blood test measures your immune reactivity

Not all facilities will require titers, and some may require one or another.

Documentation and Resources

Take care of your documentation and lab work and upload them to your Nursa profile. When you're browsing PRN jobs near you, be sure to take a look at each facility's requirements when you prepare to apply. If you think you may be missing something, go to our Nursing Resources Parent page to guide you.

We're excited to have you become part of our PRN community. We're committed to helping healthcare communities have better patient outcomes because they have appropriate state to patient ratios in their facilities. They can do that, only because of your hard work as a PRN nurse. Learn more about compliance and nursing documentation here.

Miranda Kay, RN
Blog published on:
December 4, 2023

Miranda is a Registered Nurse, Medical Fact Checker, and Publishing Editor at Nursa. Her work has been featured in publications including the American Nurses Association (ANA), Healthcare IT Outcomes, International Living, and more.

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