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Difficulty: Very hardStandard and Transmission-Based Precautions

A hospital's rapid response team is summoned to a general medical floor for a client experiencing acute respiratory failure. The client is currently undergoing treatment for crusted (Norwegian) scabies and was diagnosed earlier in the day with Mycoplasma pneumoniae. The responding personnel must immediately initiate bag-valve-mask (BVM) ventilation. Which infection control measures must the team implement during this emergency? Select all that apply.

  1. Don an N95 filtering facepiece respirator or higher-level respiratory protection before initiating airway management.Answer
  2. B
    Place a standard medical face mask over the client's airway while delivering manual ventilations.
  3. Ensure all responding personnel wear a fluid-resistant isolation gown and clean examination gloves.Answer
  4. D
    Perform hand hygiene exclusively with antimicrobial soap and water after removing personal protective equipment.
  5. Utilize protective eyewear, such as tightly fitting goggles or a full face shield, during the procedure.Answer
  6. F
    Delegate an unlicensed assistive personnel (UAP) to remain inside the room to disinfect surfaces concurrently during the resuscitation.

Answer

The team must don an N95 respirator or higher, wear a fluid-resistant isolation gown with clean gloves, and utilize protective eyewear during the procedure.
Mycoplasma pneumoniae typically requires droplet precautions. However, bag-valve-mask (BVM) ventilation is an aerosol-generating procedure (AGP). When an AGP is performed on a client with a droplet-transmitted respiratory infection, precautions must be escalated to airborne-level respiratory protection, requiring an N95 respirator or PAPR, along with eye protection. Additionally, crusted (Norwegian) scabies is highly contagious and necessitates strict contact precautions; therefore, a fluid-resistant gown and gloves must be worn by anyone entering the client's room.

Step-by-Step Solution

1
Identify the baseline transmission-based precautions for the client's current infections.
Crusted scabies requires Contact precautions; Mycoplasma pneumoniae requires Droplet precautions.
To determine the minimum baseline personal protective equipment (PPE) required for room entry.
2
Evaluate the impact of the planned emergency intervention (BVM ventilation) on infection control requirements.
BVM ventilation is classified as an aerosol-generating procedure (AGP).
AGPs aerosolize respiratory secretions, significantly increasing the risk of airborne transmission.
3
Determine the necessary escalation of respiratory PPE based on the AGP.
Personnel must escalate from Droplet to Airborne precautions, requiring an N95 respirator and eye protection.
Standard surgical masks do not adequately protect against fine aerosolized particles generated during an AGP.
4
Integrate the required precautions for all conditions present.
The team needs Contact precautions (gown, gloves) for scabies, plus Airborne/AGP precautions (N95, eye protection) for the respiratory pathogen.
To ensure comprehensive protection against all active transmission routes.
5
Evaluate each option against these synthesized requirements and clinical safety principles.
Select options that include N95, gown, gloves, and eye protection, while rejecting contraindicated actions like masking the client during ventilation or exposing non-essential staff.
To identify the correct evidence-based interventions for this complex scenario.

Key Concept

Escalation of Droplet Precautions to Airborne Precautions during Aerosol-Generating Procedures (AGPs) combined with strict Contact Precautions.
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Topics

Standard and Transmission-Based Precautions

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