A nurse is caring for a 68-year-old patient with a confirmed MRSA wound infection on the lower leg, requiring daily dressing changes and irrigation. Which nursing action demonstrates the highest priority for preventing transmission of MRSA to other patients?
A 68-year-old patient has been admitted with a large, draining wound on the lower leg that has tested positive for MRSA. The wound requires daily dressing changes and irrigation.
1Wearing sterile gloves when performing wound care procedures
2Implementing contact precautions and ensuring proper hand hygiene before and after patient contact✓ 정답
3Administering prescribed antibiotics on schedule to reduce bacterial load
4Educating the patient about proper wound care techniques for home management
해설
Contact precautions with proper hand hygiene are the highest priority to prevent MRSA transmission via direct contact. Other options are important but secondary for immediate infection control.
Core Nursing ExplanationKey Concept Analysis: This question tests the priority of infection control measures for a patient with Methicillin-resistant Staphylococcus aureus (MRSA). MRSA is a multi-drug resistant organism (MDRO) primarily transmitted through direct contact with the patient or contaminated surfaces/equipment. The highest priority in infection control is always to Key Point! prevent the spread of the pathogen to other patients, which is a core principle of Standard and Transmission-Based Precautions.
Answer Rationale: Option ② is correct because it directly addresses the primary mode of MRSA transmission. Contact Precautions involve placing the patient in a private room or cohorting with another MRSA patient, using gown and gloves for all interactions that may involve contact, and dedicating equipment. Key Point!Hand hygiene (using soap and water or alcohol-based hand rub) is the single most effective measure to prevent transmission and is the cornerstone of all precautions. This action is the immediate, highest-priority intervention to protect other patients.
Distractor Analysis:
Option ① (Wearing sterile gloves): While sterile technique is crucial for wound care itself to prevent introducing new pathogens into the wound, it does not primarily prevent transmission from the patient. Sterile gloves protect the wound, not other patients from MRSA. Contact Precautions typically use clean (non-sterile) gloves to protect the healthcare worker and prevent environmental contamination.
Option ③ (Administering antibiotics): Treating the infection is important for the patient's own health and may eventually reduce shedding of bacteria. However, it is not an immediate infection control measure for preventing transmission to others. The bacterial load may remain high for some time even with appropriate antibiotics.
Option ④ (Patient education): Education is vital for long-term management and preventing recurrence, especially for home care. However, it is not the highest priority for preventing in-hospital transmission to other patients during this admission.
Related Concepts: This scenario integrates principles from fundamentals of nursing (infection control), medical-surgical nursing (wound care), and public health. Understanding the hierarchy of interventions—where breaking the chain of transmission takes precedence over treatment and education in the acute setting—is critical for NCLEX and safe practice.
Concept Summary
Concept
Description
Application in this Scenario
Transmission-Based Precautions
Additional measures beyond Standard Precautions used for patients with known/suspected infections. Include Contact, Droplet, and Airborne.
Contact Precautions are required for MRSA due to direct/indirect contact transmission.
Contact Precautions
Use of gown and gloves for patient/environment contact. Private room or cohorting.
Must be implemented immediately upon confirmation of MRSA.
Hand Hygiene
Washing with soap/water or using alcohol-based rub. The #1 method to prevent HAI (Healthcare-Associated Infections).
Required before and after patient contact, after removing gloves, and upon leaving the room.
MDRO (Multi-Drug Resistant Organism)
Bacteria resistant to one or more classes of antibiotics (e.g., MRSA, VRE, CRE).
Requires strict adherence to precautions to prevent outbreaks in healthcare settings.
Side-by-Side Comparison!
Precaution Type
Key Pathogens/Indications
Required PPE (Personal Protective Equipment)
Room Requirement
Contact
MRSA, VRE (Vancomycin-resistant Enterococcus), C. difficile*, RSV (Respiratory Syncytial Virus)
Gown & Gloves
Private room or cohort
Droplet
Influenza, Pertussis, Meningitis (Neisseria meningitidis), COVID-19 (per some guidelines)
Surgical Mask, Eye Protection (if within 3 feet), Gown/Gloves as needed
Fit-tested N95 respirator or PAPR (Powered Air-Purifying Respirator)
Negative pressure room; door closed
*Note: For C. difficile, soap and water handwashing is preferred over alcohol-based rub due to spore resistance.
Anatomy, Physiology & Pharmacology Points
Microbiology: Staphylococcus aureus is a Gram-positive coccus commonly found on skin/nasal passages. MRSA has acquired the mecA gene, making it resistant to all beta-lactam antibiotics (penicillins, cephalosporins).
Transmission Physiology: MRSA spreads via direct contact (touching the patient) or indirect contact (touching contaminated surfaces like bed rails, equipment). Draining wounds are a major source of environmental contamination.
Pharmacology: Treatment antibiotics for MRSA often include vancomycin (IV), linezolid, daptomycin, or trimethoprim-sulfamethoxazole (for some community-acquired strains). Timely administration (option ③) is important for treatment but secondary to containment.
Memory Tips
MRSA Priority Acronym: "Contain it First!" = Contact Precautions & Frequent Hand Hygiene are the first priorities.
Hand Hygiene Rule: Remember the 5 Moments for Hand Hygiene from WHO: 1) Before patient contact, 2) Before aseptic task, 3) After body fluid exposure risk, 4) After patient contact, 5) After contact with patient surroundings.
PPE Donning/Doffing Order: Don (put on): Gown → Mask → Goggles → Gloves. Doff (take off): Gloves → Goggles → Gown → Mask. Perform hand hygiene after each step and at the end.
High-Frequency NCLEX Topics
NCLEX heavily tests infection control and safety. You must know:
The differences between Standard, Contact, Droplet, and Airborne Precautions.
That hand hygiene is always the priority in preventing transmission.
Specific organisms and their required precautions (MRSA=Contact, Tuberculosis=Airborne, etc.).
How to answer "priority" or "first" action questions—often, the answer involves safety and containment before specific treatment or education.
Watch Out for Question Variations!
The same concept can be tested in different ways:
Variation 1 (Priority Intervention): "The nurse is assigned to a patient with a new diagnosis of MRSA pneumonia. What is the nurse's first action?" (Answer: Initiate Contact Precautions/place patient in isolation).
Variation 2 (Equipment/Discharge Planning): "Which item in the MRSA patient's room should be dedicated for single-patient use?" (Answer: Blood pressure cuff, stethoscope, etc.). Or "What is the priority teaching point for a patient with MRSA being discharged home?" (Answer: Emphasize hand hygiene and not sharing personal items like towels).
Variation 3 (Breaking the Chain): "A nurse removes gloves after wound care on an MRSA patient. What should the nurse do next?" (Answer: Perform hand hygiene).
Nursing Clinical Practice GuideClinical Scenario: You are a nurse on a medical-surgical unit. Mr. Johnson, 68, is admitted with a chronic, purulent wound on his left lower leg. The culture results just returned: Positive for MRSA. The wound is draining moderate serosanguinous fluid. You need to perform his daily wound irrigation and dressing change.
Nursing Intervention Strategy:
Assessment & Planning: Confirm the MRSA result in the chart. Assess the wound for size, drainage (color, odor, amount), and surrounding skin. Plan to gather all supplies before entering the room to minimize exits/entries.
Implementation - Infection Control FIRST:
Place a Contact Precautions sign on the door.
Ensure a dedicated blood pressure cuff and stethoscope are in the room.
Before entering: Perform hand hygiene. Don (put on) a gown and clean gloves.
Perform wound care using sterile technique (sterile gloves, sterile irrigation solution) for the procedure itself to protect the wound.
After procedure: Dispose of soiled dressings in a biohazard bag. Remove PPE properly (gloves first, then gown), perform hand hygiene immediately upon exiting the room.
Document wound characteristics and patient response.
Patient Education & Psychosocial Care: Explain Contact Precautions to reduce fear of isolation ("This is to protect others, not because you are dirty"). Teach signs of wound infection. Encourage questions.
Evaluation: Monitor for no new MRSA infections in other patients on the unit. Evaluate wound for improved healing. Assess patient's understanding of precautions.
Patient Safety and Precautions:
Environmental Cleaning: High-touch surfaces (bed rails, over-bed table, call button) must be cleaned daily and upon discharge with a disinfectant effective against MRSA.
Visitors: Instruct visitors to see the nurse before entering for guidance on PPE and hand hygiene.
Transport: If the patient must leave the room (e.g., for X-ray), cover the wound with a clean, dry dressing and notify the receiving department so they can maintain precautions.
Nursing Procedure & Medication FlowWound Care with Contact Precautions - Step-by-Step:
Prepare Outside Room: Gather sterile dressing kit, irrigation solution, biohazard bag, and clean PPE (gown, gloves).
Hand Hygiene & Don PPE: Perform hand hygiene at the door. Put on gown, then clean gloves. Enter room.
Patient Preparation: Explain procedure. Position patient. Place waterproof pad under leg.
Remove Old Dressing: With clean gloves on, carefully remove soiled dressing and place directly into biohazard bag.
Hand Hygiene & Don Sterile Gloves: Remove soiled clean gloves, perform hand hygiene (alcohol rub is acceptable here if hands not visibly soiled). Open sterile kit. Don sterile gloves.
Irrigate & Assess Wound: Using sterile technique, irrigate wound with prescribed solution (e.g., normal saline). Assess wound bed.
Apply New Dressing: Apply sterile dressing as ordered (e.g., gauze with antimicrobial ointment if prescribed). Secure.
Doff PPE & Exit: Place all used materials in biohazard bag. Remove sterile gloves, then gown. Perform hand hygiene. Exit room and dispose of bag in appropriate container.
Final Hand Hygiene & Document: Perform hand hygiene again at the nursing station. Document procedure, wound appearance, drainage, and patient tolerance.
Medication Administration Note: If administering IV vancomycin for MRSA:
Infuse slowly (over at least 60 minutes) to prevent Red Man Syndrome (flushing, pruritus, hypotension).
Monitor trough levels (drawn just before the 4th dose) to ensure therapeutic level and avoid toxicity (target trough typically 10-20 mcg/mL).
Assess for ototoxicity (hearing loss, tinnitus) and nephrotoxicity (monitor BUN, creatinine).
A Word from Your Senior Nurse
"In the real world, infection prevention is a team sport and everyone's responsibility. When you see that Contact Precautions sign, it's not a suggestion—it's a requirement to protect your other vulnerable patients. I've seen MRSA outbreaks shut down entire hospital wings. The simple act of consistent, proper hand hygiene is the most powerful tool in your nursing arsenal. When you're studying, don't just memorize 'MRSA = Contact Precautions.' Understand why—because it lives on skin and surfaces, and we are the vectors if we're not careful. That mindset transforms you from a student memorizing for the NCLEX into a vigilant nurse who truly keeps patients safe."
Contact Precautions — A type of Transmission-Based Precautions used for patients known or suspected to be infected with epidemiologically important pathogens that can be transmitted by direct or indirect contact. Requires use of gown and gloves and a private room or cohorting.
Hand Hygiene — The act of cleaning one's hands with soap and water or an alcohol-based hand rub to remove pathogens and prevent their transmission. It is the single most important measure to prevent healthcare-associated infections (HAIs).
MRSA (Methicillin-resistant Staphylococcus aureus) — A strain of Staphylococcus aureus bacteria that is resistant to several common antibiotics, including methicillin, oxacillin, penicillin, and amoxicillin. It is a common cause of healthcare-associated and community-acquired infections.
Standard Precautions — The minimum infection prevention practices that apply to all patient care, regardless of suspected or confirmed infection status. They are based on the principle that all blood, body fluids, secretions, excretions (except sweat), non-intact skin, and mucous membranes may contain transmissible infectious agents.
Multi-Drug Resistant Organism — Microorganisms, predominantly bacteria, that are resistant to one or more classes of antimicrobial agents. Examples include MRSA, VRE (Vancomycin-resistant Enterococcus), and CRE (Carbapenem-resistant Enterobacteriaceae). They require strict infection control measures.