A charge nurse on an oncology unit is reviewing infection control practices for a client who is 14 days post-allogeneic hematopoietic stem cell transplant and has newly developed a localized dermatomal rash confirmed as herpes zoster (shingles). Which of the following actions by the healthcare team are appropriate? Select all that apply.
- Assigning a registered nurse with documented varicella-zoster immunity to provide direct care for the clientAnswer
- BImplementing standard and contact precautions only, as the client's lesions are limited to a single dermatome
- Ensuring the client is placed in a single-patient room with monitored negative air pressureAnswer
- DHaving the client wear a fit-tested N95 particulate respirator when being transported to the radiology department
- Keeping the door to the client's room tightly closed at all times, except when personnel must enter or exitAnswer
- FInstructing the unlicensed assistive personnel (UAP) to explain the purpose of the personal protective equipment to the client's visitors
Answer
The appropriate actions are assigning immune staff to the client, placing the client in a monitored negative-pressure room, and keeping the door to the room tightly closed.
Immunocompromised clients with localized herpes zoster must be managed with both airborne and contact precautions. This requires placing the client in a negative-pressure Airborne Infection Isolation Room (AIIR) and keeping the door closed to maintain the pressure gradient. Additionally, assigning staff with documented immunity to the varicella-zoster virus minimizes occupational exposure risks.
Step-by-Step Solution
Key Concept
Localized herpes zoster requires both airborne and contact precautions when occurring in an immunocompromised client, in contrast to the contact precautions sufficient for an immunocompetent client.