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Difficulty: MediumStandard and Transmission-Based Precautions

During a morning shift, a nurse is assigned to care for a client who has a confirmed diagnosis of active pulmonary tuberculosis alongside a large, draining sacral pressure injury infected with methicillin-resistant Staphylococcus aureus (MRSA). Which of the following infection control interventions should the nurse implement? Select all that apply.

  1. Place the client in a single-occupancy, negative-pressure room and ensure the door remains closed.Answer
  2. Don an N95 respirator, an isolation gown, and clean gloves before entering the client's room.Answer
  3. Ensure the client wears a standard surgical mask when transport outside of the room is necessary.Answer
  4. D
    Remove all personal protective equipment, including the N95 respirator, inside the client's room before exiting.
  5. E
    Require the client to wear an N95 respirator while healthcare personnel are inside the room providing care.
  6. F
    Delegate the task of explaining the isolation room rules to the client's family to the unlicensed assistive personnel (UAP).

Answer

The correct interventions are to place the client in a negative-pressure room, don an N95 respirator, gown, and gloves prior to entry, and ensure the client wears a surgical mask during transport.
The client is suffering from two separate infections requiring concurrent transmission-based precautions. Active pulmonary tuberculosis requires airborne precautions, while a draining MRSA wound requires contact precautions. The client must be placed in a negative-pressure isolation room with the door closed to prevent the spread of airborne droplets. Anyone entering the room must don an N95 respirator (or PAPR) for the tuberculosis, along with an isolation gown and gloves to prevent contact transmission from the MRSA wound. If the client must leave the negative-pressure room for essential testing, they must wear a standard surgical mask to contain their respiratory secretions and act as source control.

Step-by-Step Solution

1
Identify the modes of transmission for the pathogens mentioned in the client's diagnoses.
Tuberculosis requires airborne precautions. The draining MRSA wound requires contact precautions.
Accurate identification of transmission modes determines the required environmental controls and personal protective equipment.
2
Determine the appropriate room assignment based on the identified precautions.
The client must be placed in a single-occupancy, negative-pressure room (Airborne Infection Isolation Room) with the door closed.
Negative pressure prevents airborne pathogens from escaping into the hallway or other client areas.
3
Select the correct personal protective equipment (PPE) for entering the room.
An N95 respirator is required for the airborne pathogen, and a gown and gloves are required for the contact pathogen.
Simultaneous application of airborne and contact precautions mandates comprehensive PPE to protect the respiratory tract and clothing/skin.
4
Evaluate transport and doffing protocols.
The client wears a surgical mask for transport. The nurse removes the gown and gloves inside the room, but keeps the N95 respirator on until outside the room with the door closed.
Surgical masks on clients act as source control. Removing the N95 inside the room exposes the nurse to suspended infectious particles.
5
Assess the appropriateness of delegated tasks regarding isolation precautions.
Explaining isolation rules to the family is recognized as a teaching responsibility and must be performed by the registered nurse.
Teaching cannot be delegated to unlicensed assistive personnel (UAP) according to nursing scope of practice guidelines.

Key Concept

Airborne and Contact Transmission-Based Precautions
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Topics

Standard and Transmission-Based Precautions

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