A nurse is caring for a 45-year-old client admitted with acute hepatitis B, reporting jaundice, dark urine, and loss of appetite. Laboratory results show elevated bilirubin and ALT levels, and the client tests positive for HBsAg. Which intervention should the nurse prioritize to prevent transmission of the virus to others?

Nursing Clinical Practice Guide Clinical Scenario: You are the nurse on a medical-surgical unit. Mr. Jones, a 45-year-old construction worker, is admitted with fatigue, jaundice, and abdominal pain. He is diagnosed with acute Hepatitis B. His lab shows HBsAg+, ALT 850 U/L (high), Total Bilirubin 5.2 mg/dL (high). He is anxious and asks, "Am I contagious? Can my wife visit?"

Nursing Intervention Strategy:
1. Assessment: Perform a thorough assessment focusing on liver function: monitor for worsening jaundice, clay-colored stools, dark urine, pruritus (itching), and signs of bleeding tendency (bruising, petechiae) due to possible coagulopathy. Assess nutritional intake (loss of appetite).
2. Infection Control Implementation:
• Upon receiving the diagnosis, immediately initiate Contact Precautions in addition to Standard Precautions.
• Place a "Contact Precautions" sign on the door.
• Ensure a private room is available. If not, cohort with another patient with the same infection.
• Don gloves and a gown upon entry into the room for any activity involving potential contact with the patient or his environment (e.g., taking vital signs, assisting with ADLs).
• Use dedicated patient care equipment (e.g., blood pressure cuff, stethoscope) that remains in the room.
3. Patient & Family Education: This is critical to alleviate fear and prevent transmission.
• Explain to Mr. Jones and his wife that HBV is spread through blood and body fluids, not by casual contact like hugging, talking, or sharing a meal.
• Educate on home precautions: No sharing of razors, toothbrushes, or nail clippers. Cover any open wounds. Practice safe sex (condom use).
• Emphasize the importance of hand hygiene for everyone.
• Encourage household members and sexual contacts to get tested and vaccinated against Hepatitis B.

Patient Safety and Precautions:
• Needlestick Safety: Use extreme caution with any sharps. Activate safety devices immediately after use. Dispose of all sharps in a puncture-resistant container at the point of use.
• Environmental Cleaning: Ensure daily and terminal cleaning of the patient's room with an EPA-approved disinfectant, paying special attention to high-touch surfaces.
• Lab Specimens: Label all specimens with a "Biohazard" warning. Place them in a sealed, leak-proof bag for transport.

Nursing Procedure & Medication Flow Procedure: Applying Contact Precautions
1. Perform hand hygiene before donning PPE.
2. Don a clean gown, tying securely at neck and waist.
3. Don clean gloves, extending cuffs over gown sleeves.
4. Provide patient care.
5. Remove PPE in this order: Gloves first (grasp outside of glove with opposite gloved hand; peel off), then gown (unfasten ties, pull gown away from neck/shoulders, turning it inside out as you remove it), then perform hand hygiene immediately.
6. Exit the room.
7. Perform hand hygiene again.

Medication: Post-Exposure Prophylaxis (PEP) - HBIG & Vaccine
• HBIG: Given via IM injection. Provides temporary, passive immunity. Most effective when given within 24 hours of exposure (can be given up to 7 days).
• Hepatitis B Vaccine: Given as a series of 3 IM injections (0, 1, and 6 months schedule). Provides active, long-term immunity. For PEP, the first dose is given concurrently with HBIG at a separate injection site.

A Word from Your Senior Nurse "In the real world, a patient with Hepatitis B isn't just a diagnosis on a chart—they're often scared and stigmatized. Your nursing care balances two equally important roles: being a compassionate caregiver who alleviates fear and educates, and being a vigilant infection control practitioner who protects everyone else on the unit. Never let precautions become a barrier to human connection. Explain what you're doing and why. That moment you put on gloves, say, 'I'm just putting these on as a safety step for both of us while I check your IV.' It builds trust. On the NCLEX, they're testing that you know the right precaution to use. In practice, you're applying that knowledge with empathy and skill."