A 7-year-old child is admitted to the pediatric unit with a confirmed diagnosis of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) skin and soft tissue infection. Which nursing intervention should be the priority?

Contact precautions are the immediate priority to prevent transmission of CA-MRSA to other patients and healthcare workers. Administering antibiotics, obtaining cultures, and patient education are important but secondary to infection control.

Priority Nursing Intervention for CA-MRSA Infection

The correct answer is implement contact precautions immediately and ensure proper hand hygiene protocols.

Rationale

When a child is admitted with a confirmed diagnosis of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) skin and soft tissue infection, the immediate priority is to prevent transmission of this multidrug-resistant organism to other patients, healthcare workers, and the environment. MRSA is primarily spread via direct contact with an infected wound or contaminated hands, making infection control the most urgent nursing action upon admission.

The provided evidence underscores the critical importance of contact precautions and hygiene as foundational elements in MRSA management. The study by Wong et al. (2026) evaluated a comprehensive MRSA decolonization protocol, which relied on a bundle of interventions. Central to this bundle were strict infection control measures, including the application of topical antiseptics and a rigorous bathing regimen with chlorhexidine gluconate (CHG) ^[1]. While the study focused on a specific decolonization protocol, its design highlights a key principle: systemic decolonization efforts are built upon the assumption that baseline transmission has been halted through contact isolation and meticulous hand hygiene. Without this first step, any subsequent treatment or decolonization attempt would be undermined by the risk of ongoing cross-contamination within the pediatric unit.

From a pathophysiological and safety perspective, a patient with an active, draining CA-MRSA wound serves as a reservoir for the bacteria. The organism can survive on surfaces like bed rails, stethoscopes, and blood pressure cuffs, creating opportunities for indirect contact transmission. Implementing contact precautions—which include placing the child in a private room or cohorting with another MRSA-positive patient, using gloves and a gown for all interactions that may involve contact with the patient or their immediate environment, and dedicating non-critical patient-care equipment—creates a barrier that physically interrupts this chain of infection. This aligns with the standard and transmission-based precautions that are a cornerstone of the NCLEX-RN Safe and Effective Care Environment client need category.

The other options represent important but secondary steps in the care sequence. Administering prescribed antibiotics (option 2) is a critical treatment component, but a 30-minute window, while a best practice for certain conditions like sepsis, is not the immediate safety priority over preventing an outbreak. Obtaining additional wound cultures (option 3) is redundant and delays treatment, as the diagnosis is already confirmed; the priority shifts from diagnosis to containment and therapy. Finally, educating the family about completing the full antibiotic course (option 4) is essential for preventing the development of further resistance and ensuring the child’s recovery, but this teaching is most effective when initiated after the immediate safety concern of infection transmission is addressed and the family is settled. The physical act of instituting isolation takes precedence over the educational intervention.