Correct Answer: 1
The patient with pulmonary tuberculosis who has been on anti-tuberculosis therapy for only
10 days requires airborne precautions.
Rationale
The core of this question lies in understanding the duration of infectivity for
pulmonary tuberculosis (TB) and the specific criteria for discontinuing
airborne precautions. The updated AORN guideline emphasizes that transmission-based precautions, including airborne, are implemented based on the suspected or confirmed pathogen and its mode of transmission
[1].
Why Airborne Precautions Are Still Required
Mycobacterium tuberculosis is transmitted via tiny droplet nuclei (≤
5 microns) that can remain suspended in the air for hours. Airborne precautions, which include placing the patient in a negative-pressure airborne infection isolation room (AIIR) and using N95 respirators, are mandatory for patients with active pulmonary TB
[1]. A patient who has been on effective anti-tuberculosis therapy for only
10 days is still considered infectious. Clinical guidelines typically require a patient to be on effective treatment for at least
2 to 3 weeks, show clinical improvement (e.g., decreased cough, reduced fever), and have three consecutive negative acid-fast bacilli (AFB) sputum smears before airborne precautions can be safely discontinued. The
10-day mark is insufficient to render the patient non-infectious.
Analysis of Incorrect Options
-
Option 2: A patient with methicillin-resistant Staphylococcus aureus (MRSA) wound infection
MRSA is primarily transmitted through direct or indirect contact with the wound, drainage, or contaminated surfaces. The correct precaution for this patient is
contact precautions, which include the use of gloves and a gown, not airborne precautions
[1].
-
Option 3: A patient with Clostridium difficile-associated diarrhea
C. difficile spores are transmitted via the fecal-oral route through contact with contaminated surfaces. This patient requires
contact precautions, with a strong emphasis on hand hygiene using soap and water (as alcohol-based hand rubs are not sporicidal) and the use of gloves and a gown
[1].
-
Option 4: A patient with influenza A who is receiving antiviral medication
Influenza is transmitted via large respiratory droplets generated when a patient coughs, sneezes, or talks. These droplets travel a short distance (typically
3 to 6 feet) before falling to the ground. The appropriate precaution for this patient is
droplet precautions, which require a surgical mask for anyone entering the room
[1]. Airborne precautions are not indicated for routine seasonal influenza.
Clinical Application and Risk Assessment
The decision to initiate and discontinue precautions is a critical safety measure that protects healthcare workers (HCWs) and other patients. The risk of transmission is directly linked to the nature of the pathogen and the task being performed
[1]. For TB, the risk is significant enough that HCWs in high-risk groups undergo routine screening for latent tuberculosis infection (LTBI) due to potential occupational exposure . Failing to maintain airborne precautions for a patient with active TB who has not completed a sufficient course of therapy could lead to a dangerous exposure event, requiring a post-exposure risk assessment and follow-up for all exposed individuals
[1]. The patient's current treatment duration of
10 days is the key clinical indicator that the infectious period is still ongoing, making airborne precautions the only correct choice.
References (research sources)