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Difficulty: MediumStandard and Transmission-Based Precautions

A medical-surgical unit is at maximum capacity, requiring some clients on transmission-based precautions to be cohorted in semi-private rooms. When reviewing the bed assignment board, which client pairing should the practical nurse (PN) recognize as a safe and appropriate cohorting strategy?

  1. A client with a vancomycin-resistant Enterococcus (VRE) infected surgical wound sharing a room with a client who has a VRE urinary tract infection.Answer
  2. B
    A client with Clostridioides difficile colitis sharing a room with a client experiencing severe diarrhea caused by a rotavirus infection.
  3. C
    A client with active pulmonary tuberculosis sharing a room with a client requiring airborne precautions for rubeola (measles).
  4. D
    A client with chemotherapy-induced neutropenia sharing a room with a client recovering from viral pneumonia.

Answer

The safe and appropriate cohorting strategy is to pair the client with the VRE infected wound with the client who has a VRE urinary tract infection.
Cohorting is the practice of grouping clients with the same specific active infection. Because both clients in this pairing are infected with vancomycin-resistant Enterococcus (VRE), they can safely share a room without the risk of cross-infecting each other with a new, different pathogen. Both require contact precautions, and standard infection control measures must still be maintained between the clients.

Step-by-Step Solution

1
Identify the core principles of cohorting clients with infectious diseases in a shared room.
Clients should ideally be placed in private rooms. If unavailable, they may share a room only if they are confirmed to be infected with the exact same microorganism.
This prevents cross-contamination and the introduction of new, harmful pathogens to already vulnerable clients.
2
Evaluate each pairing to determine if the pathogens match or if a vulnerable client is placed at risk.
Only the pairing with VRE involves the exact same pathogen. The C. diff/rotavirus pairing and the TB/measles pairing involve different pathogens. The neutropenia/pneumonia pairing places an immunocompromised client in danger.
Matching the isolation category or symptom profile is insufficient; the specific causative organism must be identical for safe cohorting.

Key Concept

Cohorting in Infection Control
Estimated Time:1m 15s
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Topics

Standard and Transmission-Based Precautions

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