A nurse is caring for a patient with methicillin-resistant Staphylococcus aureus (MRSA) pneumonia in the intensive care unit. Which intervention should the nurse prioritize to prevent transmission of MRSA to other patients?
1Wear a surgical mask when entering the patient's room
2Place the patient in a private room with standard precautions
3Implement contact precautions with gown and gloves for all patient interactions✓ 정답
4Use alcohol-based hand sanitizer only after direct patient contact
해설
Contact precautions with gown and gloves are prioritized for MRSA to prevent transmission via direct contact or contaminated surfaces. Other options are insufficient: surgical masks don't prevent contact spread, standard precautions alone are inadequate, and hand hygiene must be performed before and after contact.
Clinical Judgment
The core of this question is to identify the appropriate isolation precautions to apply for a patient with a multidrug-resistant organism (MRSA) infection. MRSA is primarily transmitted through direct contact (patient skin, secretions, contaminated environmental surfaces). Therefore, in addition to Standard Precautions, Contact Precautions are essential. Contact Precautions include wearing a gown and gloves for all interactions with the patient (including respiratory therapy and wound care). This is to prevent healthcare workers' clothing and hands from becoming a primary vector of transmission.
Memory Tip: MRSA requires Contact Precautions! Remember MRSA is Mainly Contact.
KR vs US: In Korea, Contact Precautions are applied for MRSA patients, but the level of compliance and the environment (e.g., difficulty securing a private room) in actual clinical practice can vary by facility. The US CDC guidelines very clearly require Contact Precautions, and failure to follow them can be considered an infection control violation.
Clinical Practice GuideContact precaution protocol for managing MRSA infected/colonized patients:1. A private room is ideal, and cohorting with a patient who has the same pathogen can also be considered.2. Wear a clean gown and gloves for all patient contact and contact with the patient's surrounding environment.3. Remove personal protective equipment (PPE) outside the patient's room and perform thorough hand hygiene.4. If possible, use dedicated equipment such as stethoscopes and blood pressure cuffs, and disinfect shared equipment after use.
Caution: MRSA pneumonia does not require Airborne Precautions. The primary route of transmission for MRSA is contact, not airborne. Be careful not to fall into the trap of choosing airborne precautions just because of the word 'pneumonia'.
Contact Precautions (접촉주의) — Contact precautions are applied when multidrug-resistant organisms (such as MRSA, VRE) or significant infectious agents can be transmitted through direct or indirect contact. Wearing a gown and gloves is mandatory.
MRSA (Methicillin-resistant Staphylococcus aureus) — Staphylococcus aureus resistant to beta-lactam antibiotics, including methicillin. It primarily causes skin and soft tissue infections, and can also lead to invasive infections such as pneumonia or bacteremia.
Standard Precautions (표준주의) — A basic infection prevention measure that treats all patients' blood, body fluids, secretions, and mucous membranes (except intact skin) as potentially infectious. This includes hand hygiene and the use of appropriate personal protective equipment based on the situation.
Transmission-Based Precautions (전파기반주의) — In addition to standard precautions, isolation precautions are applied based on the known or suspected transmission route of the pathogen (contact, droplet, airborne). Contact precautions are one of these.
Hand Hygiene (손 위생) — The most basic and important step in infection prevention, including using alcohol-based hand sanitizer or washing hands with soap and water. This must be performed before and after all patient care activities.