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Difficulty: HardStandard and Transmission-Based Precautions

A client is placed on concurrent airborne and contact precautions due to active pulmonary tuberculosis and a methicillin-resistant Staphylococcus aureus (MRSA) wound infection. Which action by the practical nurse demonstrates adherence to safe infection control and scope of practice standards?

  1. Completes the prescribed wound care, removes the gown and gloves inside the client's room, and removes the N95 respirator in the hallway.Answer
  2. B
    Removes the N95 respirator, isolation gown, and gloves in that specific sequence while still inside the client's room.
  3. C
    Exits the client's room wearing all personal protective equipment (PPE) and removes the gown and gloves in the hallway.
  4. D
    Delegates the MRSA wound dressing change to unlicensed assistive personnel (UAP) to limit licensed staff exposure.

Answer

The nurse should complete the wound care, remove the gown and gloves inside the client's room, and remove the N95 respirator after stepping into the hallway.
For a client on concurrent contact and airborne precautions, the gown and gloves must be removed inside the room to prevent environmental contamination with MRSA. The N95 respirator must remain in place until the nurse has exited the negative-pressure room and the door is closed to protect against airborne tuberculosis transmission.

Step-by-Step Solution

1
Analyze the transmission-based precautions required for the client's diagnoses.
Tuberculosis requires airborne precautions (N95 respirator), and MRSA requires contact precautions (gown and gloves).
Identifying the specific precautions dictates the necessary personal protective equipment (PPE) and the correct sequence for removal.
2
Determine the appropriate location for removing each piece of PPE.
Contact PPE (gown and gloves) must be removed inside the room. Airborne PPE (N95 respirator) must be removed outside the room.
Removing contact PPE inside prevents the spread of pathogens to the hallway. Keeping the N95 on until outside the room protects the nurse from inhaling aerosolized droplet nuclei.
3
Evaluate the appropriateness of delegating the wound care task.
The nurse must perform the dressing change rather than delegating it.
An infected MRSA wound requires sterile or modified-sterile technique and ongoing assessment of the wound bed, which cannot be delegated to unlicensed assistive personnel (UAP).

Key Concept

Personal Protective Equipment (PPE) Doffing Sequence and Delegation Scope
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Topics

Standard and Transmission-Based Precautions

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