A nurse is caring for a 45-year-old patient with a confirmed MRSA skin infection on the lower leg. Which nursing intervention should be the highest priority to prevent transmission to other patients and healthcare workers?

Contact precautions are the highest priority to prevent MRSA transmission in healthcare settings. Other interventions are important but secondary to infection control.

Understanding the Priority: Breaking the Chain of Infection

In the NCLEX-RN framework, questions about infection control require you to prioritize interventions based on the "Chain of Infection." For a patient with a confirmed multidrug-resistant organism (MDRO) like MRSA, the immediate safety goal is preventing transmission to others. While all the listed options are important components of the patient's care plan, the nurse must first establish a physical barrier to contain the infectious agent at its source. The patient's ambulatory status and frequent room exits make this an urgent safety concern, as the pathogen can easily contaminate the environment and be transferred to other patients and healthcare workers.

Why Contact Precautions Are the Highest Priority

The correct intervention is implementing contact precautions with dedicated equipment and proper hand hygiene protocols. Contact precautions are a core, evidence-based strategy specifically designed to interrupt the primary mode of transmission for organisms like MRSA (Methicillin-resistant Staphylococcus aureus), which is direct and indirect contact.

A 2025 systematic review on preventing the transmission of MDROs reaffirms that a bundle of interventions, with contact precautions as a central element, is critical for patient safety ^[1]. The rationale is twofold:
1. Physical Barrier: Donning a gown and gloves upon room entry creates a physical barrier that prevents the nurse's clothing and hands from becoming contaminated vectors that carry the organism to the next patient or surface.
2. Source Containment: Dedicated equipment (e.g., a stethoscope, blood pressure cuff, and thermometer that remain in the patient's room) prevents the organism from being shared via fomites. This is particularly crucial for an ambulatory patient who may touch surfaces in the hallway, making the immediate environment outside the room a potential contamination zone.

A patient-centered framework for isolation emphasizes that these precautions must be applied immediately and systematically upon identification of the pathogen to optimize safety without delay ^[2]. The priority is to physically contain the biological hazard before focusing on pharmacological treatment or patient education.

Analyzing the Other Options

The other options, while clinically important, are secondary to the immediate safety need of preventing an outbreak.

- Option 2: Administering prescribed vancomycin intravenously. This addresses the portal of exit by treating the infection and eventually reducing the bioburden of the pathogen. However, antibiotic therapy takes time to become effective. Transmission can occur for hours or days before the antibiotic concentration in the wound is sufficient to kill the bacteria. Physical source containment via contact precautions provides an immediate barrier, which is the higher priority for a nurse implementing a care plan.
- Option 3: Performing wound irrigation with normal saline twice daily. This is a supportive care measure that aids in wound healing by removing purulent drainage and debris. While it helps clean the wound, the very act of performing wound care without proper barrier precautions is a high-risk moment for contaminating the environment and the nurse's attire. The contact precautions must be in place before this procedure is performed to make it safe.
- Option 4: Educating the patient about completing antibiotic therapy. Patient education is a vital nursing intervention to prevent recurrence and further development of antimicrobial resistance. However, education is a long-term strategy for the individual patient's health outcome. It does not provide an immediate, physical barrier to prevent the direct and indirect contact transmission of MRSA to other vulnerable patients in the hallway right now. The nurse's first duty is to protect all patients on the unit from a known safety hazard.

Connecting to Core Infection Control Principles

Current evidence-based prevention strategies for MDROs consistently rank hand hygiene and targeted contact precautions as the foundational interventions . The systematic review on MDRO transmission prevention highlights that these practices are standard-of-care safety practices with broad acceptance because they physically interrupt the chain of infection at its most vulnerable link: the mode of transmission ^[1]. For an ambulatory patient with a purulent MRSA wound, the risk of environmental contamination is exceptionally high. The nurse's immediate action of instituting contact precautions and using dedicated equipment directly mitigates this risk, making it the unequivocal highest priority nursing intervention.