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Question

Difficulty: HardStandard and Transmission-Based Precautions

A practical nurse is reviewing the upcoming room assignments on a medical-surgical unit. Only one semi-private room (two beds) remains available. According to infection control guidelines, which pair of clients should the nurse recognize as safe to cohort in the same room?

  1. A client with a methicillin-resistant Staphylococcus aureus (MRSA) infected abdominal wound and a client with a urinary tract infection caused by MRSAAnswer
  2. B
    A client with severe diarrhea caused by Clostridioides difficile and a client with gastroenteritis caused by rotavirus
  3. C
    A client with suspected active pulmonary tuberculosis and a client who has a documented latent tuberculosis infection
  4. D
    A client with localized, crusted herpes zoster and a client who is severely immunocompromised due to chemotherapy

Answer

The safest pair to cohort consists of the two clients who are both infected with MRSA.
According to standard infection control protocols, if private rooms are not available, it is acceptable to cohort (group together) clients who have confirmed infections caused by the exact same microorganism. Because both clients in the correct pairing are infected with methicillin-resistant Staphylococcus aureus (MRSA), there is no risk of cross-transmitting a new, different pathogen between them.

Step-by-Step Solution

1
Evaluate the transmission risk for the clients with MRSA.
Both clients are infected with the exact same pathogen (MRSA).
When private rooms are unavailable, clients with the same active bacterial or viral infection can be safely cohorted without risking cross-contamination of a new disease.
2
Evaluate the cohorting risk for the clients with diarrhea.
C. diff and rotavirus are different pathogens.
Cohorting clients with different infectious organisms exposes each client to a secondary infection.
3
Evaluate the requirements for pulmonary tuberculosis.
Active TB requires a negative-pressure private room.
A client with suspected active TB poses a severe airborne transmission risk and cannot be placed in a standard semi-private room, especially not with a client who only has latent (non-contagious, non-active) TB.
4
Evaluate the risk to the immunocompromised client.
The immunocompromised client is highly vulnerable to opportunistic or viral infections.
Clients with weakened immune systems should never be cohorted with clients who have an infectious disease history like herpes zoster, even if the lesions are localized and crusted.

Key Concept

Cohorting Principles for Transmission-Based Precautions
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Topics

Standard and Transmission-Based Precautions

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