# A nurse is caring for a patient with methicillin-resistant Staphylococcus aureus (MRSA) pneumonia in the intensive care unit. Which nursing intervention is the highest priority to prevent transmission of infection to other patients? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=319486 > language: ko > subject: Next Gen NCLEX ## 문제 A nurse is caring for a patient with methicillin-resistant Staphylococcus aureus (MRSA) pneumonia in the intensive care unit. Which nursing intervention is the highest priority to prevent transmission of infection to other patients? ## 보기 1. Perform hand hygiene before and after all patient contact using alcohol-based hand sanitizer or soap **✔ 정답** 2. Place the patient in a private room with negative air pressure ventilation 3. Wear a N95 respirator mask when entering the patient's room 4. Ensure all visitors wear sterile gloves and gowns before entering the room **정답: 1** ## 해설 Hand hygiene is the highest priority intervention to prevent MRSA transmission, as it directly breaks the chain of infection through contaminated hands. Other options like isolation or PPE are secondary to hand hygiene in preventing cross-contamination. ## 심화 해설 Core Nursing Explanation **Key Concept Analysis**: This question tests the priority of infection control measures for a patient with Methicillin-resistant Staphylococcus aureus (MRSA) pneumonia. The core principle is the Chain of Infection and the most effective, fundamental action to break it. While MRSA is a multi-drug resistant organism (MDRO) requiring Contact Precautions, and pneumonia suggests a respiratory component, the single most critical action to prevent transmission to other patients is consistent, proper hand hygiene. **Answer Rationale**: Key Point! Hand hygiene is the cornerstone of all infection prevention. It is the **highest priority** because it is the simplest, most effective, and most universally applicable intervention to break the chain of infection via the mode of transmission (contaminated hands of healthcare workers). The CDC and WHO consistently emphasize that hand hygiene is the primary measure to reduce healthcare-associated infections (HAIs). For MRSA, which is primarily spread via direct and indirect contact, hand hygiene before and after every patient contact is non-negotiable. **Distractor Analysis**: Watch out for confusion! Option ②: Placing the patient in a private room with negative air pressure is a key component of Airborne Precautions (e.g., for tuberculosis, measles, varicella). MRSA is spread primarily by Contact Precautions, not by the airborne route over long distances. A private room is required for Contact Precautions, but negative pressure is not. This intervention is important but not the universal, highest priority. Option ③: Wearing an N95 respirator is also a requirement for Airborne Precautions. For MRSA pneumonia, standard droplet/contact precautions are typically sufficient unless an aerosol-generating procedure (e.g., bronchoscopy, open suctioning) is being performed. This is a more specific intervention, not the broadest, highest priority. Option ④: Ensuring all visitors wear sterile gloves and gowns is incorrect. For Contact Precautions, visitors should wear **clean, non-sterile** gowns and gloves. "Sterile" attire is reserved for surgical or other sterile procedures. Furthermore, educating and managing visitors is important, but it is secondary to the nurse's own consistent hand hygiene practice. **Related Concepts**: This integrates knowledge of Transmission-Based Precautions (Contact, Droplet, Airborne), the hierarchy of infection control measures (standard precautions first), and the specific epidemiology of MRSA. Remember: Key Point! Hand hygiene is a **Standard Precautions** measure that applies to *all* patients, all the time, and is the foundation upon which additional Transmission-Based Precautions are built. Concept Summary | Concept | Key Takeaway | | --- | --- | | Standard Precautions | Foundation for all patient care. Includes hand hygiene, PPE based on anticipated exposure. | | Contact Precautions (for MRSA) | Private room or cohorting. Wear gown & gloves for direct contact. Dedicated equipment if possible. | | Droplet Precautions | Private room, surgical mask for close contact. For influenza, pertussis, meningococcal meningitis. | | Airborne Precautions | Negative pressure room, N95 respirator. For tuberculosis, measles, chickenpox. | | Chain of Infection | Infectious agent > Reservoir > Portal of exit > Mode of transmission > Portal of entry > Susceptible host. Hand hygiene breaks the transmission link. | Side-by-Side Comparison! | Precaution Type | Key PPE / Room Requirement | Typical Diseases/Conditions | MRSA Application | | --- | --- | --- | --- | | Contact | Gown & Gloves. Private room. | MRSA, VRE, C. diff, RSV, wound infections. | YES - Primary mode of transmission. | | Droplet | Surgical Mask. Private room. | Influenza, pertussis, bacterial meningitis, COVID-19 (per some guidelines). | Not typically. MRSA pneumonia does not require droplet precautions alone. | | Airborne | N95 Respirator. Negative Pressure room. | Tuberculosis, measles, varicella (chickenpox), disseminated herpes zoster. | NO. MRSA is not transmitted via the airborne route under normal circumstances. | Anatomy, Physiology & Pharmacology Points • **MRSA**: A strain of *Staphylococcus aureus* resistant to beta-lactam antibiotics (methicillin, oxacillin). It produces an altered penicillin-binding protein (PBP2a). • **Pneumonia**: Infection causing inflammation of the lung alveoli. MRSA pneumonia is often hospital-acquired (HAP) or ventilator-associated (VAP) and can be severe. • **Infection Control Physiology**: Hand hygiene with soap and water mechanically removes spores (e.g., *C. diff*) and debris. Alcohol-based hand rub (ABHR) kills most vegetative bacteria and viruses by denaturing proteins. Memory Tips • **Priority Acronym**: "**H**and **H**ygiene **H**elps **H**alt **H**AIs" (Healthcare-Associated Infections). • **Precaution Mnemonic**: "**M**y **R**espiratory **S**ystem **A**voids **A**irborne?" NO! MRSA = **M**ainly **R**equires **C**ontact **A**ttention. • Think of hand hygiene as the "seatbelt" of healthcare – it's the first and most basic thing you do for safety, every single time. High-Frequency NCLEX Topics NCLEX loves to test **priority-setting** in infection control. They will often present a scenario with a patient on specific precautions and ask, "Which action by the nurse is the *priority*?" or "Which action should the nurse take *first*?" The answer is almost always related to **standard precautions** (hand hygiene, assessing the situation) before implementing disease-specific interventions. Be prepared to distinguish between Contact, Droplet, and Airborne Precautions. Watch Out for Question Variations! • Variation 1: "The nurse is preparing to suction a patient with MRSA pneumonia. Which action is most important?" (Answer would involve performing hand hygiene AND now donning appropriate PPE for the procedure, which may include a mask/eye protection due to aerosol generation). • Variation 2: "A patient with pulmonary tuberculosis is admitted. Which nursing intervention has the highest priority?" (Answer shifts to **placing the patient in an airborne infection isolation room (AIIR)** with negative pressure, as this is the specific, primary intervention for airborne diseases). • Variation 3: "Which instruction is most important to give a family member visiting a patient with MRSA?" (Answer focuses on **hand hygiene before leaving the room**, not necessarily full PPE). ## 임상 시나리오 Nursing Clinical Practice Guide **Clinical Scenario**: You are the primary nurse for Mr. Johnson, a 68-year-old man in the ICU with ventilator-associated pneumonia (VAP) confirmed to be caused by MRSA. The respiratory therapist is coming to perform a bronchoscopy, and two new nursing students are assigned to assist you. **Nursing Intervention Strategy**: 1. **Assessment & Planning**: Confirm the patient's isolation status in the chart and on the door (Contact Precautions). Assess what procedures are planned that day (bronchoscopy is an aerosol-generating procedure). 2. **Implementation**: • **Your First Action**: Perform hand hygiene with alcohol-based rub upon entering the unit and before approaching the patient's bedside. • **Room & Signage**: Ensure the patient is in a private room. The door should have a clear Contact Precautions sign listing required PPE (gown and gloves). • **PPE for Routine Care**: Don a clean gown and gloves upon room entry if you will have direct contact with the patient or his environment (bed rails, ventilator). • **PPE for Aerosol-Generating Procedure**: For the bronchoscopy, you and all personnel in the room must upgrade protection. This includes an N95 respirator (or equivalent), eye protection (goggles or face shield), gown, and gloves. This is due to the high risk of generating infectious aerosols. • **Equipment**: Use dedicated patient equipment (e.g., stethoscope, blood pressure cuff) if possible. If not, clean and disinfect with an EPA-approved disinfectant between uses. 3. **Patient & Family Education**: Educate the patient (if alert) and family on the reason for precautions. Teach visitors to perform hand hygiene and to wear gown/gloves if they will have contact. Reassure them that these measures protect everyone. 4. **Evaluation**: Monitor for any breaches in technique. Ensure all staff and visitors comply. Observe for no new MRSA infections in other patients in the unit. **Patient Safety and Precautions**: • **Contraindications**: Do not use alcohol-based hand rub if hands are visibly soiled or after caring for a patient with *C. difficile* (soap and water are preferred for *C. diff*). • **PPE Doffing Sequence**: To prevent self-contamination, remove PPE in this order: 1) Gloves, 2) Gown, 3) Perform hand hygiene, 4) Eye protection, 5) Mask/N95, 6) Perform hand hygiene again. • **Environmental Cleaning**: High-touch surfaces (bed rails, IV pumps, door handles) must be cleaned and disinfected frequently with a disinfectant effective against MRSA. Nursing Procedure & Medication Flow **Procedure: Donning and Doffing PPE for Contact Precautions** 1. Perform hand hygiene. 2. Don gown: Tie at neck and waist. 3. Don gloves: Extend gloves over gown cuffs. 4. Provide patient care. 5. Remove gloves: Grasp outside of one glove with other gloved hand; peel off. Hold removed glove in gloved hand. Slide fingers of ungloved hand under remaining glove at the wrist; peel off over first glove. Discard. 6. Remove gown: Unfasten ties. Pull gown away from neck and shoulders, touching inside of gown only. Roll gown inside out into a bundle. Discard. 7. **Perform hand hygiene immediately after removing gown and gloves.** 8. Exit room. 9. Perform hand hygiene again if indicated. **Medication Note**: When administering IV antibiotics for MRSA (e.g., Vancomycin, Linezolid), perform hand hygiene and don gloves before handling the IV line or accessing the port. This prevents contaminating the line and protects you from exposure. A Word from Your Senior Nurse "In the fast-paced world of the ICU, it's easy to see the ventilator, the monitors, and the complex meds as the 'real' nursing work. But never, ever underestimate the power of the 20-second hand hygiene ritual. I've seen outbreaks stopped in their tracks by a unit with a 95%+ hand hygiene compliance rate. When you're studying, remember: the NCLEX is testing if you have the judgment to know what matters most. In infection control, the foundation is always your own clean hands. Build your practice on that solid foundation, and you'll protect your patients, your colleagues, and yourself every single day." ## 핵심 개념 - **Standard Precautions** — The foundation for preventing transmission of infectious agents in healthcare settings. Applies to all patients and includes hand hygiene, use of PPE based on risk, safe injection practices, and environmental controls. - **Contact Precautions** — A type of Transmission-Based Precautions used for patients known or suspected to be infected with epidemiologically important microorganisms transmitted by direct or indirect contact (e.g., MRSA, VRE, C. difficile). - **Airborne Precautions** — A type of Transmission-Based Precautions used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nuclei (small particles) that remain infectious over long distances (e.g., TB, measles, varicella). Requires a negative pressure room and N95 respirator. - **Hand Hygiene** — A general term referring to any action of hand cleansing. This includes washing hands with soap and water or using an alcohol-based hand rub to reduce transient microbial flora. It is the single most important measure to prevent healthcare-associated infections. - **Methicillin-resistant Staphylococcus aureus** — A strain of the bacterium Staphylococcus aureus that has developed resistance to beta-lactam antibiotics, including methicillin, oxacillin, penicillin, and amoxicillin. 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