A nurse is caring for multiple patients with different types of multidrug-resistant infections. Which nursing action demonstrates the highest priority safety measure when transitioning between patient rooms?
1Changing gloves between each patient contact while keeping the same gown
2Using alcohol-based hand sanitizer after removing personal protective equipment
3Removing all personal protective equipment and performing hand hygiene before entering each new patient room✓ 정답
4Wearing the same N95 mask throughout the shift while changing other protective equipment
해설
Complete removal of all PPE and hand hygiene between rooms prevents cross-contamination of multidrug-resistant organisms. Other options are insufficient as they risk contamination via retained PPE or inadequate hand hygiene.
Core Nursing ExplanationKey Concept Analysis: This question tests the fundamental principle of Transmission-Based Precautions and Sequencing of Personal Protective Equipment (PPE) to prevent the spread of multidrug-resistant organisms (MDROs). The core theme is the Key Point! "One Room, One Set of PPE." When caring for patients on Contact Precautions or with MDROs, PPE is considered contaminated after use. The highest priority safety measure is to prevent carrying pathogens from one patient's environment to another.
Answer Rationale: Option ③ is correct because it follows the complete and proper sequence for exiting an isolation room and preparing to enter a new one. The steps are: 1) Remove all PPE (gown and gloves) at the doorway or inside the patient's room, 2) Perform Hand hygiene immediately after glove removal, and 3) Enter the next patient's room with clean hands and don a fresh set of PPE. This breaks the chain of infection by ensuring no contaminated equipment is worn between rooms.
Distractor Analysis:
Watch out for confusion! Option ① is incorrect because changing gloves alone is insufficient. The gown is also contaminated and must be removed. Keeping the same gown risks transferring pathogens via the fabric.
Option ② describes a necessary step but is not the highest priority or complete action. Hand sanitizer is used after removing PPE, but if you enter a new room without first removing all contaminated PPE, you have already breached the protocol. The sequence is critical.
Option ④ is a dangerous practice. An N95 respirator, if worn for a specific airborne pathogen, is typically donned and doffed in a specific sequence. However, wearing the same mask throughout a shift while moving between different isolation rooms risks contaminating the outside of the mask and is not standard practice for contact precautions. For MDROs spread by contact, a surgical mask is often sufficient unless there is also an airborne component; the key error is reusing any PPE between patients.
Related Concepts: This integrates knowledge of Standard Precautions (applied to all patients), Contact Precautions (for MDROs like MRSA, VRE, C. diff), and the specific Doffing (Removal) Sequence for PPE to prevent self-contamination (e.g., gloves first, then gown, then hand hygiene, then mask/eye protection if worn).
Concept Summary
• Chain of Infection: Breaking the mode of transmission (contact) is the goal.
• PPE for Contact Precautions: Gown and gloves. Mask/eye protection if splashes are anticipated.
• Core Principle: PPE is patient-specific. It is donned upon room entry and doffed upon room exit.
• Hand Hygiene: The single most important infection control measure. Must be performed immediately after removing gloves and before touching any clean surface.
Side-by-Side Comparison!
Action
Correct Practice
Incorrect Practice & Risk
Transitioning between isolation rooms
Remove all PPE, perform hand hygiene in the room/anteroom, then enter next room and don clean PPE.
Changing only gloves or keeping the same gown. Risk: Cross-contamination via contaminated gown.
Hand Hygiene Timing
AFTER removing gloves, BEFORE touching door handle or clean surfaces.
Using hand sanitizer over contaminated gloves or delaying hygiene until later. Risk: Contaminating the environment.
N95 Respirator Use
Used for airborne precautions (e.g., TB, measles). Donned before entry, carefully removed after exit to avoid self-contamination. Reused per protocol only if not contaminated.
Wearing the same N95 between different patient rooms for contact precautions. Risk: Unnecessary and risks mask contamination.
Anatomy, Physiology & Pharmacology Points
• While this topic is less about anatomy and more about procedure, understanding Modes of Transmission is key: Contact (direct/indirect), Droplet, Airborne. MDROs are primarily spread by contact (hands, equipment, surfaces).
• For Clostridioides difficile (C. diff), a spore-forming bacterium, hand hygiene with soap and water is required because alcohol-based sanitizers do not kill spores.
Memory Tips
• Mnemonic for PPE Doffing Sequence: "Gloves, Gown, Hands, Mask" (GGHM) or remember: "The dirtiest things (gloves) come off first, clean your hands, then handle your face (mask)."
• Think: "One Patient, One Gown". The gown is like a patient's jacket—you wouldn't wear one patient's jacket to see another.
High-Frequency NCLEX Topics
Infection control is a High Yield NCLEX category. Expect questions on:
1. Priority Action: What is the first or most important step? (Hand hygiene is almost always a component).
2. Sequencing: Proper order for donning/doffing PPE.
3. Precautions Specifics: Matching the type of precaution (Contact, Droplet, Airborne) to the disease and required PPE.
4. Patient Education: Teaching visitors or family about isolation precautions.
Watch Out for Question Variations!
• Variation 1: "A nurse is preparing to enter the room of a patient with tuberculosis. Which action should the nurse take first?" (Answer: Don an N95 respirator before entering the room—Airborne Precautions).
• Variation 2: "A nurse has just completed a dressing change for a patient with MRSA. Which action should the nurse take immediately after removing gloves?" (Answer: Perform hand hygiene).
• Variation 3: "Which patient should the nurse place in a private room first?" (Tests prioritization of airborne over contact precautions).
Nursing Clinical Practice GuideClinical Scenario: You are assigned to two patients on the medical-surgical unit. Patient A has a wound infection with Methicillin-resistant Staphylococcus aureus (MRSA). Patient B has Vancomycin-resistant Enterococci (VRE) in their urine. Both are on Contact Precautions.
Nursing Intervention Strategy:
1Assessment & PlanningBefore starting care, gather all supplies needed for both patients to minimize exits and re-entries. Plan your route to avoid crossing from one contaminated room to a clean area without doffing.
2Implementation - The Correct Sequence• Enter Patient A's room: Don gown and gloves.
• Provide care.
• Exit Patient A's room: Remove gloves first, then gown. Perform hand hygiene with alcohol-based sanitizer (unless hands are visibly soiled) immediately at the point of exit.
• Discard used PPE in the room's trash.
• With clean hands, proceed to Patient B's room.
• Enter Patient B's room: Don a new, clean gown and gloves.
• Provide care.
3Patient Safety and PrecautionsDedicate equipment (e.g., stethoscope, blood pressure cuff) to each room if possible. If equipment must be shared, it must be cleaned and disinfected with an EPA-approved disinfectant between uses. Educate the patient and family on the purpose of precautions to reduce stigma.
Nursing Procedure & Medication Flow
• PPE Donning Sequence: 1) Perform hand hygiene. 2) Gown. 3) Mask/respirator. 4) Eye protection. 5) Gloves.
• PPE Doffing Sequence: 1) Gloves. 2) Gown (untie waist, then neck, pull away from body). 3) Perform hand hygiene. 4) Eye protection. 5) Mask/respirator (by straps only). 6) Perform hand hygiene again.
• Special Case: C. diff: Use soap and water for hand hygiene instead of alcohol-based sanitizer, as soap physically removes spores.
A Word from Your Senior Nurse
"In the real world, it's hectic. You might be tempted to 'gown swap' in the hallway or just change your gloves to save time. Don't. I've seen outbreaks traced back to these shortcuts. Your role as a nurse is to protect every patient, especially the most vulnerable. That gown you wore in Mr. Smith's room is covered in his bacteria. Walking into Ms. Jones' room with it on is like bringing his germs to her bedside. Mastering this sequence isn't just for the NCLEX; it's a non-negotiable standard of safe care. Be the nurse who always takes the extra 30 seconds to do it right. Your patients are counting on you."
Contact Precautions — Precautions used for patients known or suspected to be infected with epidemiologically important pathogens spread by direct or indirect contact. Requires gown and gloves.
Hand Hygiene — A general term that applies to handwashing with plain soap and water, antiseptic handwash, or using an alcohol-based hand rub. The most effective measure to prevent healthcare-associated infections.
Multidrug-Resistant Organism — Bacteria and other microorganisms that have developed resistance to multiple antimicrobial drugs. Examples include MRSA, VRE, and ESBL-producing bacteria.
Personal Protective Equipment — Specialized clothing or equipment worn by healthcare personnel for protection against infectious materials. Includes gloves, gowns, masks, respirators, and eye protection.
Cross-Contamination — The transfer of harmful microorganisms from one person, object, or place to another. In healthcare, it often refers to spreading pathogens between patients via hands, equipment, or contaminated PPE.