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Difficulty: Very hardStandard and Transmission-Based Precautions

During a period of high census, a healthcare facility has utilized all available private isolation rooms. A practical nurse is verifying the safety of the current room assignments. Which pairing of clients in a semi-private room demonstrates correct application of infection control principles?

  1. A client with localized herpes zoster whose lesions are fully crusted, sharing with a client receiving treatment for an acute asthma exacerbationAnswer
  2. B
    A client with meningococcal meningitis who received their first dose of intravenous antibiotics 12 hours ago, sharing with a client admitted for a sickle cell crisis
  3. C
    A client with confirmed seasonal influenza A, sharing with a client exhibiting a persistent cough and high fever who is awaiting respiratory viral panel results
  4. D
    A client with a heavily draining methicillin-resistant Staphylococcus aureus (MRSA) wound that saturates dressings, sharing with a client who is a known carrier of MRSA in the nares

Answer

The pairing of the client with fully crusted localized herpes zoster and the client with an acute asthma exacerbation represents a safe cohorting arrangement.
The correct arrangement pairs a client whose localized herpes zoster lesions have completely crusted over with a client experiencing an asthma exacerbation. According to infection control guidelines, localized herpes zoster is no longer contagious once all lesions are dry and crusted. Therefore, transmission-based precautions can be discontinued. Because the client with asthma is also non-infectious, both clients only require standard precautions and can safely share a semi-private room.

Step-by-Step Solution

1
Evaluate the transmission risk and isolation requirements for the first client in each proposed pair.
Identified that crusted zoster requires standard precautions; meningitis (at 12 hours) requires droplet; confirmed influenza requires droplet; uncontained MRSA requires a private room.
Accurate identification of a client's infectious state is the prerequisite for determining room placement.
2
Assess the clinical status and susceptibility of the second client in each proposed pair.
Identified that asthma, sickle cell crisis, and MRSA colonization are distinct conditions, while the suspected influenza client has an unknown pathogen.
Roommates must not be placed at risk of acquiring healthcare-associated infections.
3
Apply facility cohorting criteria to each pair.
Pairings with active infections mixed with non-infectious or unconfirmed clients violate isolation protocols.
Cohorting is only safe when clients share the exact same active pathogen or when both require only standard precautions.
4
Select the only pairing that adheres to infection control standards.
The client with crusted zoster and the client with asthma both require only standard precautions, making them a safe match.
Once shingles lesions crust over, viral shedding stops, eliminating the transmission risk.

Key Concept

Infection control cohorting and discontinuation of transmission-based precautions
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Topics

Standard and Transmission-Based Precautions

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