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Difficulty: HardStandard and Transmission-Based Precautions

During interdisciplinary rounds, the healthcare team is discussing the care of a client with a confirmed diagnosis of active pulmonary tuberculosis who recently developed frequent, watery diarrhea that tested positive for Clostridioides difficile toxin. Which interventions should the registered nurse implement to ensure appropriate infection control? Select all that apply.

  1. Don a fit-tested N95 respirator, a disposable gown, and clean gloves before entering the client's room.Answer
  2. B
    Perform hand hygiene using an alcohol-based hand rub immediately after removing personal protective equipment.
  3. Clean and disinfect dedicated reusable medical equipment with an EPA-registered sporicidal disinfectant.Answer
  4. Place the client in a negative-pressure infection isolation room and keep the door continuously closed.Answer
  5. E
    Place a standard surgical mask on the client whenever healthcare providers enter the room to provide care.
  6. F
    Delegate the initial instruction on personal protective equipment use for visiting family members to the unlicensed assistive personnel (UAP).

Answer

The correct interventions are: donning an N95 respirator, a disposable gown, and clean gloves before entering; cleaning dedicated equipment with an EPA-registered sporicidal disinfectant; and placing the client in a negative-pressure infection isolation room with the door closed.
The client requires concurrent airborne precautions for active pulmonary tuberculosis and contact precautions for Clostridioides difficile. To prevent transmission, the client must be placed in a negative-pressure Airborne Infection Isolation Room (AIIR) with the door closed. Healthcare personnel must wear an N95 respirator or powered air-purifying respirator (PAPR) to protect against airborne droplet nuclei, as well as a gown and gloves to protect against contact with C. difficile spores. Because C. difficile forms resilient spores, any dedicated reusable medical equipment kept in the room must be cleaned with an EPA-registered sporicidal disinfectant, such as a bleach solution.

Step-by-Step Solution

1
Analyze the client's diagnoses to determine the required transmission-based precautions.
Pulmonary tuberculosis requires airborne precautions, and Clostridioides difficile requires contact precautions with enteric variations.
Identifying the specific pathogens and their modes of transmission dictates the appropriate infection control tier.
2
Evaluate the room placement and environmental requirements based on the highest level of transmission risk.
The client must be placed in a negative-pressure Airborne Infection Isolation Room (AIIR) with the door kept closed.
Negative pressure is necessary to prevent airborne tuberculosis droplet nuclei from escaping into the facility's general airflow.
3
Determine the correct personal protective equipment (PPE) for healthcare staff and the specific requirements for hand hygiene.
Staff must don an N95 respirator, gown, and gloves prior to entry. Hand hygiene must be performed with soap and water upon exiting.
The N95 protects against airborne pathogens, while the gown and gloves protect against contact transmission. Soap and water are required because alcohol-based sanitizers do not kill bacterial spores.
4
Assess the remaining interventions regarding equipment disinfection, client masking, and task delegation.
Dedicated equipment requires sporicidal disinfection. The client does not need a mask inside the room. Initial teaching cannot be delegated to UAP.
Spores require sporicidal agents to be eradicated. Clients only wear masks during transport outside the AIIR. The RN retains the responsibility for all initial client and family education.

Key Concept

Concurrent management of airborne and enteric contact precautions requires comprehensive PPE (N95, gown, gloves), specialized hand hygiene (soap and water for spores), and appropriate room assignment (negative-pressure).
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Topics

Standard and Transmission-Based Precautions

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