A nurse is caring for a 6-year-old child diagnosed with impetigo. Which nursing intervention should be the priority?
1Apply warm compresses to the affected areas three times daily
2Encourage the child to wear loose-fitting cotton clothing
3Administer oral antibiotics as prescribed by the physician
4Implement strict contact precautions to prevent transmission✓ 정답
해설
Contact precautions are the priority for impetigo due to its high contagiousness via direct contact. Other interventions like warm compresses, loose clothing, and antibiotics are supportive but do not address transmission prevention as directly.
Understanding Impetigo Transmission and Infection Control
Impetigo is a highly contagious, superficial bacterial skin infection most commonly caused by Staphylococcus aureus or Group A Streptococcus (GAS, Streptococcus pyogenes). The provided research underscores that these infections proliferate in conditions of overcrowding and poor hygiene, with intrafamilial transmission being a significant concern [1][2]. The bacteria typically enter through breaks in the skin, such as cuts, insect bites, or scratches, leading to the formation of the characteristic honey-colored crusts.
The pathophysiological basis for prioritizing infection control lies in the virulence of the causative organisms. GAS, for instance, is a highly virulent gram-positive bacterium that produces enzymes and toxins, enabling it to cause not only localized skin infections but also severe invasive disease and immunologically mediated sequelae like post-streptococcal glomerulonephritis [3]. Similarly, specific strains of Staphylococcus aureus can produce exfoliative toxins and Panton-Valentine leukocidin, leading to recurrent and difficult-to-eradicate infections within families [2]. This high transmissibility and potential for serious complications make breaking the chain of infection the absolute priority.
Analysis of Nursing Interventions
* Option 1 (Incorrect): Applying warm compresses can be a supportive measure to gently soak and remove crusts, but it is not the priority. The mechanical action of a compress does not address the primary risk of spreading the infection to the child or to others.
* Option 2 (Incorrect): Encouraging scratching, even gently, is contraindicated. Scratching disrupts the skin barrier, creating new portals of entry for bacteria. This action promotes autoinoculation, spreading the infection to other parts of the child's body, and increases the risk of secondary infection.
* Option 3 (Incorrect): Keeping fingernails long is dangerous. Long fingernails harbor bacteria and increase the risk of skin damage from scratching, which directly facilitates the spread of impetigo. The correct intervention is to keep the child's fingernails short and clean.
* Option 4 (Correct): Implementing strict contact precautions and teaching proper hand hygiene is the priority intervention. Impetigo is spread through direct contact with the lesions or contaminated items. A study on recurrent staphylococcal skin infections demonstrated that intrafamilial transmission is strongly suspected and that decolonization procedures are often challenging [2]. Furthermore, research in conflict settings confirms that unhygienic conditions are a primary determinant for the proliferation of these highly contagious infections [1]. Therefore, isolating the infectious drainage and rigorously practicing hand hygiene are the most effective immediate measures to prevent transmission to other children, family members, and healthcare staff. This directly addresses the "highly contagious" nature of the disease described in the evidence [1][3].
References (research sources)
[1]
A cross-sectional study of the burden and risk factors of impetigo and scabies among children during conflict in the middle area of the Gaza strip.Research articleHassan ASM, Barakat AHH, Abudayya DMH, Abulkhair LMS, Abu Amra MAARS, Abdullateif NNE, Owais TA, Sabboh M, Suliman J, Warasna HJM, Awad MYH, Abu Serriya RAA. (2026) · DOI: 10.1038/s41598-026-38441-7
[2]
Skin Infections Caused by Panton-Valentine Leukocidin and Methicillin-Susceptible Staphylococcus aureus in Child, Japan.Research articleShoji K, Yoshida K, Takenouchi M, Hisatsune J, Kutsuno S, Arai C, Masuda K, Sugai M, Ishikawa T, Kawai T, Uda K, Miyairi I. (2025) · DOI: 10.3201/eid3106.241955
[3]
Invasive group A Streptococcus infection (Streptococcus pyogenes): Current situation in Spain.Research articleMartín-Delgado MC, De Lucas Ramos P, García-Botella A, Cantón R, García-Lledó A, Hernández-Sampelayo T, Gómez-Pavón J, González Del Castillo J, Martín Sánchez FJ, Martínez-Sellés M, Molero García JM, Moreno Guillén S, Rodríguez-Artalejo FJ, Ruiz-Galiana J, Burillo A, Muñoz P, Calvo Rey C, Catalán-González M, Cendejas-Bueno E, Halperin-Benito V, Recio R, Viñuela-Benítez C, Bouza E. (2024) · DOI: 10.37201/req/067.2024
Clinical Practice Guide
When nursing impetigo, Contact Precautions include wearing gloves and gowns, using dedicated equipment, and placing the patient in a single room if possible. The patient remains contagious until 24 hours after starting antibiotic treatment and before the lesions crust over. Keep the child's nails short, teach handwashing, and manage and wash towels, bedding, and clothing separately.
Caution
In SATA (Select All That Apply) questions asking for the "most important" or "priority" intervention, interventions related to Safety and Prevention may take higher priority than therapeutic interventions (e.g., administering antibiotics). The keyword "highly contagious" should immediately prompt infection control interventions.
Impetigo (농가진) — A highly contagious superficial bacterial skin infection caused by Staphylococcus aureus or Group A beta-hemolytic streptococcus. Characterized by blisters and honey-colored crusts.
Contact Precautions (접촉주의) — A type of Transmission-Based Precautions, these are measures to protect others from microorganisms spread through direct contact (skin-to-skin) or indirect contact (contaminated object surfaces). Includes wearing gloves and gowns, and placement in a private room.
Staphylococcus aureus (황색포도알균) — One of the main causative bacteria for various skin and soft tissue infections, including impetigo. It is particularly associated with bullous impetigo.
Transmission-Based Precautions (전염병 격리) — Infection control measures implemented in addition to Standard Precautions. They are classified into Contact Precautions, Droplet Precautions, and Airborne Precautions based on the route of transmission (contact, droplet, airborne).
Infection Control (감염관리) — Policies and procedures to prevent and control the spread of Healthcare-Associated Infections (HAIs). This includes hand hygiene, isolation precautions, and environmental management.