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Difficulty: Very hardStandard and Transmission-Based Precautions

A unit manager is rounding with the infectious disease team to evaluate clients currently on transmission-based precautions. Based on standard infection control guidelines, which client meets the strict clinical criteria for the safe discontinuation of their current isolation precautions?

  1. A
    A client with pulmonary tuberculosis (TB) who has completed 14 days of multi-drug therapy, is afebrile, and has two consecutive negative early-morning sputum smears for acid-fast bacilli (AFB)
  2. A client with a primary varicella-zoster infection whose temperature is normal and whose entire vesicular rash has completely dried and crusted overAnswer
  3. C
    A client with Clostridioides difficile colitis who is on day 5 of oral vancomycin and has been free of diarrhea with formed stools for exactly 24 hours
  4. D
    A client with Neisseria meningitidis meningitis who has received targeted intravenous antibiotic therapy for the past 12 hours and exhibits resolving nuchal rigidity

Answer

The client with primary varicella-zoster whose entire rash has completely crusted over can safely have their precautions discontinued.
Transmission of the varicella-zoster virus occurs via aerosolized respiratory droplets and direct contact with vesicular fluid. Once all vesicles have dried and formed crusts, the virus is no longer actively shed, and the client is no longer considered contagious. At this precise clinical milestone, both airborne and contact precautions can be safely discontinued.

Step-by-Step Solution

1
Evaluate the discontinuation criteria for pulmonary tuberculosis.
The client has only two negative AFB smears; three are required.
To ensure the client is no longer actively shedding Mycobacterium tuberculosis, guidelines strictly require three consecutive negative smears.
2
Evaluate the discontinuation criteria for primary varicella-zoster virus.
The client's vesicles are completely crusted over.
Crusted lesions indicate the active viral shedding phase has ended, making the client non-infectious.
3
Evaluate the discontinuation criteria for Clostridioides difficile.
The client has been diarrhea-free for only 24 hours; a minimum of 48 hours is required.
C. difficile spores can continue shedding in the immediate period after symptoms resolve, necessitating a longer observation period.
4
Evaluate the discontinuation criteria for Neisseria meningitidis.
The client has received antibiotics for 12 hours; 24 hours of therapy is mandatory.
Nasopharyngeal secretions remain infectious until 24 full hours of effective antibiotics have been administered.

Key Concept

Discontinuation Criteria for Transmission-Based Precautions
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Topics

Standard and Transmission-Based Precautions

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