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Difficulty: MediumStandard and Transmission-Based Precautions

While providing care during the day shift, the interdisciplinary healthcare team encounters clients with various infectious diseases. Which of the following staff actions demonstrate the correct application of transmission-based precautions? Select all that apply.

  1. Donning a standard surgical mask prior to entering the room of a client diagnosed with seasonal influenza.Answer
  2. B
    Using an alcohol-based hand rub for hand hygiene after assisting a client with Clostridioides difficile to the bathroom.
  3. C
    Removing an N95 respirator inside the room of a client with active pulmonary tuberculosis after completing a respiratory treatment.
  4. Wearing a disposable gown and clean gloves while changing the bed linens of a client infected with vancomycin-resistant enterococci (VRE).Answer
  5. E
    Placing a client with suspected meningococcal meningitis into an airborne infection isolation room with negative air pressure.

Answer

The correct actions are donning a standard surgical mask prior to entering the room of a client with seasonal influenza, and wearing a disposable gown and clean gloves while changing the linens of a client with vancomycin-resistant enterococci (VRE).
Appropriate transmission-based precautions depend on the pathogen's mode of spread. Seasonal influenza is transmitted via large respiratory droplets, so droplet precautions (requiring a standard surgical mask upon room entry) are indicated. Vancomycin-resistant enterococci (VRE) are transmitted by direct or indirect contact, meaning contact precautions (requiring a gown and gloves for all interactions with the client and their immediate environment, such as handling bed linens) are the correct standard of care.

Step-by-Step Solution

1
Evaluate the action regarding the client with seasonal influenza.
Influenza requires droplet precautions, which mandate the use of a surgical mask when entering the room.
This prevents transmission of large-particle infectious droplets generated when the client coughs or sneezes.
2
Evaluate the action regarding the client with Clostridioides difficile.
Alcohol-based hand rubs are ineffective against spore-forming bacteria like C. difficile. Soap and water must be used.
Physical friction and rinsing with water are required to mechanically remove spores from the hands.
3
Evaluate the action regarding the client with pulmonary tuberculosis.
Tuberculosis requires airborne precautions. The N95 respirator must remain on until after the staff member has exited the room and closed the door.
Removing the respirator inside the room exposes the healthcare worker to airborne droplet nuclei that remain suspended in the air.
4
Evaluate the action regarding the client with vancomycin-resistant enterococci (VRE).
VRE requires contact precautions, meaning a gown and gloves must be worn when interacting with the client or their environment.
This prevents the transfer of multidrug-resistant organisms to the healthcare worker's clothing and hands.
5
Evaluate the action regarding the client with meningococcal meningitis.
Meningococcal meningitis requires droplet precautions. A standard private room is sufficient.
Meningococcal bacteria are transmitted via large droplets that do not remain suspended in the air, so expensive and specialized negative-pressure airflow rooms are unnecessary.

Key Concept

Transmission-based precautions require specific personal protective equipment (PPE), room assignments, and hand hygiene protocols based on the mode of transmission (airborne, droplet, or contact) of the infectious agent.
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Topics

Standard and Transmission-Based Precautions

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