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Zorluk: Çok zorInfection Control and Hospital-Acquired Conditions

A 45-year-old man is admitted to the medical ward with a 3-week history of fever, weight loss, and hemoptysis. He emigrated from Vietnam 2 years ago. A sputum smear is positive for acid-fast bacilli. He is appropriately placed in an airborne infection isolation room.

On hospital day 4, he develops frequent, foul-smelling, watery stools and abdominal pain. An enzyme immunoassay for Clostridioides difficile toxin A and B is positive. He is started on oral vancomycin, and Contact Precautions are added to his care protocol.

On hospital day 5, the patient develops sudden, severe, focal left lower quadrant pain with localized rebound tenderness and guarding, accompanied by worsening tachycardia. The surgical team requests an urgent computed tomography (CT) scan of the abdomen with IV contrast to evaluate for localized bowel perforation or abscess.

Which of the following describes the most appropriate infection control protocol for transporting this patient to the radiology department?

  1. The patient wears a standard surgical mask and a clean hospital gown; transport personnel push the stretcher without wearing any personal protective equipment.Cevap
  2. B
    The patient wears a standard surgical mask and a clean hospital gown; transport personnel push the stretcher while wearing a gown and gloves.
  3. C
    The patient wears an N95 respirator and a clean hospital gown; transport personnel push the stretcher without wearing any personal protective equipment.
  4. D
    The patient wears an N95 respirator and a clean hospital gown; transport personnel push the stretcher while wearing a gown, gloves, and an N95 respirator.
  5. E
    The transport is deferred in favor of a portable abdominal ultrasound to prevent environmental contamination outside the isolation room.

Cevap

The patient should wear a standard surgical mask and a clean hospital gown, and transport personnel should push the stretcher without wearing any personal protective equipment.
The correct protocol for transporting a patient on combined Airborne and Contact Precautions involves maximizing patient source control while minimizing environmental contamination by staff. For Airborne Precautions (pulmonary tuberculosis), the patient must wear a standard surgical mask to contain expelled infectious droplets. N95 respirators are inappropriate for patients as they require fit-testing and are designed for wearer inhalation protection, not source control. For Contact Precautions (C. difficile), the patient's infectious areas must be contained by wearing a clean hospital gown and being wrapped in a clean sheet. Transport personnel must remove their in-room PPE (gown, gloves, N95) and perform hand hygiene before leaving the isolation room. They must push the stretcher through public hallways without wearing PPE to avoid contaminating clean environmental surfaces (e.g., elevator buttons, door handles). Clean PPE should only be donned at the destination if direct patient handling is required.

Adım Adım Çözüm

1
Identify the required isolation precautions based on the patient's active infections.
The patient requires Airborne Precautions for active pulmonary tuberculosis and Contact Precautions for Clostridioides difficile.
Correctly identifying the transmission routes dictates the necessary barriers during transport.
2
Determine the appropriate patient source control measures for transport.
The patient must wear a standard surgical mask to contain airborne droplets and a clean hospital gown to contain contact contamination.
Source control is the primary mechanism for preventing transmission when an isolated patient leaves their room.
3
Determine the correct PPE requirements for healthcare workers during the transport process.
Transport personnel must remove in-room PPE, perform hand hygiene, and navigate public corridors without wearing gowns or gloves.
Wearing contaminated or even clean PPE in public hallways violates infection control policy by risking the contamination of shared environmental surfaces (e.g., elevator buttons, doors).

Anahtar Kavram

During transport of patients on Airborne and Contact Precautions, the patient acts as the primary barrier (surgical mask and clean gown), while transport staff should not wear PPE in public corridors to prevent environmental contamination.
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Infection Control and Hospital-Acquired Conditions

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