A nurse is caring for a patient with a confirmed MRSA wound infection. Which nursing action demonstrates the most appropriate infection control practice to prevent transmission to other patients?

Contact precautions with gown and gloves for all patient contact are essential for MRSA to prevent transmission via direct contact or contaminated surfaces. Other options provide insufficient protection.

Understanding the Rationale for Contact Precautions in MRSA

The correct action is implementing contact precautions with gown and gloves for all patient contact and proper hand hygiene. This approach directly aligns with the foundational principles of infection control for multidrug-resistant organisms (MDROs) like Methicillin-Resistant Staphylococcus aureus (MRSA). MRSA is a high-burden healthcare-associated pathogen primarily transmitted via the contaminated hands of healthcare workers and contact with contaminated environmental surfaces or patient care equipment ^[3]. The presence of a large, draining wound significantly amplifies the risk of environmental contamination and subsequent transmission.

Why Other Options are Incorrect

- Option 1 (Wearing gloves only when directly touching the wound) is insufficient because it fails to account for the widespread contamination of the patient's immediate environment. Healthcare workers' hands and clothing can become contaminated by touching surfaces like bed rails, overbed tables, or linens, even without direct wound contact, facilitating transmission to other patients ^[2].
- Option 3 (Using standard precautions and changing gloves between body sites) is inadequate for a known MDRO with a significant transmission risk. Standard precautions, which include hand hygiene and glove use for potential contact with body fluids, do not provide the enhanced barrier of a gown to protect clothing from contamination during extensive patient care activities.
- Option 4 (Isolating the patient without additional protective equipment for routine care) places other patients and staff at risk. While a private room is a critical component, it must be combined with the consistent use of personal protective equipment (PPE)—specifically gown and gloves—upon room entry for all interactions, a key element of transmission-based precautions ^[1].

Clinical Application of Evidence-Based Practice

The implementation of contact precautions is a cornerstone of the Centers for Disease Control and Prevention (CDC) guidelines for preventing MDRO transmission ^[2]. A systematic review confirms that MRSA infections are associated with increased mortality, prolonged hospital stays, and substantial healthcare costs, making rigorous prevention a clinical priority ^[3]. The strategy involves a two-tiered approach: the administrative measure of placing the patient in a private room and the practice measure of donning a gown and gloves for all patient contact.

The evidence supporting routine contact isolation is being re-evaluated in the context of resource constraints, with some literature exploring risk-based strategies ^[1]. However, for a symptomatic patient with a copiously draining wound, the transmission risk is high, and the application of full contact precautions remains the most appropriate, evidence-supported nursing action to ensure patient safety. Proper hand hygiene immediately after removing PPE is the final, non-negotiable step to break the chain of infection ^[1].