# A nurse is caring for multiple patients in a medical-surgical unit. Which action by the nurse demonstrates the most appropriate infection control practice?

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> url: https://mymerci.kr/pages/nclex_q.php?qn_id=319490  
> language: ko  
> subject: Next Gen NCLEX

## 문제

A nurse is caring for multiple patients in a medical-surgical unit. Which action by the nurse demonstrates the most appropriate infection control practice?

The nurse is assigned to care for four patients: a patient with MRSA wound infection in contact isolation, a patient recovering from pneumonia, a patient with a urinary tract infection, and a patient admitted for diabetes management.

## 보기

1. Performing hand hygiene before and after each patient contact, even when wearing gloves **✔ 정답**
2. Using the same stethoscope for all patients after wiping it with an alcohol pad between uses
3. Wearing gloves throughout the entire shift to prevent cross-contamination
4. Removing isolation gown outside the patient's room to avoid contaminating the hallway

**정답: 1**

## 해설

Hand hygiene before and after each patient contact is the most critical infection control measure, as it prevents cross-contamination regardless of glove use. Other options involve improper equipment use or inadequate isolation practices.

## 심화 해설

Core Nursing Explanation
**Key Concept Analysis**: This question tests the fundamental principle of Standard Precautions and Transmission-Based Precautions in infection control. The core theme is identifying the single most effective action to prevent the spread of pathogens in a multi-patient care environment. The scenario includes a patient on Contact Isolation for MRSA (Methicillin-resistant Staphylococcus aureus), highlighting the need for strict adherence to protocols to prevent healthcare-associated infections (HAIs).

**Answer Rationale**: Key Point! Hand hygiene is the cornerstone of all infection prevention. Performing it before and after every patient contact, even when gloves are worn, is non-negotiable. Gloves can have microscopic tears and hands can become contaminated during glove removal. Hand hygiene with alcohol-based hand rub or soap and water physically removes or kills transient microorganisms, directly breaking the chain of infection. This practice applies universally to all patients, as outlined in Standard Precautions.

**Distractor Analysis**:
Watch out for confusion! Option ② seems logical but is incorrect. While cleaning equipment like a stethoscope with an alcohol pad between patients is a good practice for non-critical items, using the **same** stethoscope for a patient in contact isolation (MRSA) and other patients is a breach of isolation protocol. For a patient on contact precautions, dedicated patient care equipment (like a stethoscope) should be used. If sharing is unavoidable, it must be cleaned and disinfected according to facility policy **before** use on another patient. The option implies a routine practice that is insufficient for an isolation patient.

Option ③ is a dangerous misconception. Wearing gloves continuously creates a false sense of security and leads to cross-contamination. Gloves are task-specific and must be changed between different tasks on the same patient and **always** between patients. Prolonged glove use can also cause skin maceration and increase the risk of pathogen transmission from the contaminated gloves to multiple surfaces and patients.

Option ④ describes an improper technique for doffing (removing) personal protective equipment (PPE). An isolation gown is considered contaminated on the outside. It should be removed **inside** the patient's room or anteroom, with the inside folded outwards, to prevent contaminating the clean hallway environment. Removing it in the hallway would spread pathogens.

**Related Concepts**: This integrates knowledge of Chain of Infection (breaking it at the portal of exit/entry via hand hygiene), the hierarchy of effectiveness of infection control measures, and the specific steps for Contact Precautions (gown and gloves for contact with patient or environment).

Concept Summary

| Concept | Description | Application |
| --- | --- | --- |
| Standard Precautions | Minimum infection prevention practices for all patient care, regardless of diagnosis. Includes hand hygiene, use of PPE based on risk, safe injection practices. | Apply to all patients, including those with diabetes and UTI in the scenario. |
| Transmission-Based Precautions (Contact) | Used for pathogens spread by direct or indirect contact (e.g., MRSA, C. diff). Requires gown and gloves. | Apply to the patient with MRSA wound infection. Requires dedicated equipment or thorough disinfection. |
| Hand Hygiene | Most effective single measure to prevent HAIs. Required before/after patient contact, after contact with body fluids, and after removing gloves. | The correct answer. It is the foundational action that supports all other precautions. |
| PPE Doffing Sequence | Order of removal to prevent self-contamination: Gloves → Gown → Eye protection → Mask/Respirator. Perform hand hygiene after each step where hands may become contaminated. | Contrasts with incorrect option ④. Gown is removed in the patient's room. |

Side-by-Side Comparison!

| Practice | Correct / Appropriate | Incorrect / Inappropriate |
| --- | --- | --- |
| Glove Use | Change between tasks & patients. Perform hand hygiene before donning and after doffing. | Wearing the same gloves for multiple patients or throughout a shift (Option ③). |
| Equipment Cleaning | Use dedicated equipment for isolation patients. Clean shared non-critical items (stethoscope) with disinfectant between patients. | Using the same stethoscope for an isolation patient and others, even with wiping (Option ②). |
| Isolation Gown Removal | Remove inside patient's room. Untie waist, remove gloves, then remove gown by pulling away from body, folding inside out. | Removing contaminated gown in the hallway (Option ④). |

Anatomy, Physiology & Pharmacology Points
While this question is primarily about procedure, the underlying science involves microbial transmission. MRSA is a bacterium resistant to certain antibiotics, often colonizing skin and wounds. It spreads via hands or equipment that touch the patient or contaminated surfaces. Hand hygiene works by mechanically removing (soap and water) or chemically killing (alcohol-based rub) these pathogens on the healthcare worker's hands, which are the most common vector.

Memory Tips

- **Hand Hygiene First and Last**: Think "Clean hands are the bookends of care" – before you start and after you finish any patient interaction.

- **Gloves are NOT Magic Shields**: Mnemonic: "**G**loves **G**et **G**erms Too." They must be changed.

- **PPE Doffing Order**: Remember the acronym "**G**et **G**erms **O**ff" (Gloves, Gown, Other [eye/face], Mask). Hand hygiene between steps if contaminated.

High-Frequency NCLEX Topics
Infection control is a **High Yield** topic on the NCLEX. Expect questions on:
1. Prioritizing actions (Hand hygiene is almost always the first or most important step).
2. Identifying breaches in technique (like the distractor options here).
3. Specifics of Transmission-Based Precautions (Airborne, Droplet, Contact).
4. Proper sequence for donning and doffing PPE.

Watch Out for Question Variations!
The same concept can be tested differently:

- **Priority Action**: "What is the nurse's *first* action after removing gloves soiled with a patient's blood?" (Answer: Perform hand hygiene).

- **Patient Education**: "Which statement by a patient's family member indicates understanding of contact precautions for MRSA?" (Answer: "I will put on the gown and gloves before entering the room and wash my hands after taking them off.").

- **Equipment**: "A nurse uses a blood pressure cuff on a patient with Clostridioides difficile. What should the nurse do with the cuff?" (Answer: Dedicate it to that patient's room or ensure it is cleaned with a sporicidal agent before use elsewhere).

## 임상 시나리오

Nursing Clinical Practice Guide
**Clinical Scenario**: You are starting your morning rounds. Your first patient is Mr. Jones in Room 312, who has a MRSA-infected surgical wound and is on Contact Precautions. Your next patient, Ms. Smith in Room 314, is recovering from pneumonia and is on standard oxygen therapy.

**Nursing Intervention Strategy**:
1.  **Assessment & Planning**: Before entering any room, review the patient's chart and the signage on the door. For Room 312, note the Contact Isolation sign.
2.  **Implementation**:

- **Before Room 312**: Perform hand hygiene at the station or with the wall-mounted sanitizer outside the room. Don (put on) a clean gown and gloves from the supply outside the room.

- **Inside Room 312**: Perform your assessment (vitals, wound check). Use the dedicated stethoscope and blood pressure cuff left in the room. Provide care.

- **Exiting Room 312**: Remove gloves first (peel off inside out), then untie the gown and remove it by pulling it away from your body, folding it inside out. Discard both in the room's trash. **Perform hand hygiene immediately after removing gloves and again after removing the gown** before exiting the room.

- **Before Room 314**: Perform hand hygiene again in the hallway. You do not need PPE for routine assessment unless you anticipate contact with respiratory secretions.

3.  **Evaluation & Patient Safety**: Self-check: Did my hands touch any potentially contaminated surface after my final hand hygiene? Are my clothes clean? This systematic approach creates a "clean zone" (hallway, nursing station) and contains contamination within the "dirty zone" (isolation room).

**Patient Safety and Precautions**:

- **Contraindications**: Never skip hand hygiene under the assumption that gloves are enough. Never use alcohol-based hand rub if hands are visibly soiled (use soap and water).

- **Key Monitoring**: Monitor for signs of breach in technique, such as a colleague entering an isolation room without appropriate PPE, and address it professionally.

Nursing Procedure & Medication Flow
While not directly about medication, the principle applies: **Hand hygiene is the first and last step of any procedure**. For example, when administering IV medication:
1. Hand hygiene.
2. Prepare medication in a clean area.
3. Hand hygiene.
4. Don gloves if there is risk of blood/body fluid exposure (e.g., accessing a central line).
5. Administer medication.
6. Remove gloves and perform hand hygiene.
This protects you, the patient, and the medication port from contamination.

A Word from Your Senior Nurse
"In the hustle of a busy shift, it's easy to think 'I just have gloves on, I'm fine.' But I've seen outbreaks traced back to a single lapse in hand hygiene. Your hands are your most important tool and your biggest liability. Protecting your patients from infection is a sacred trust. On the NCLEX, they are testing your commitment to this fundamental safety principle. In practice, make hand hygiene so automatic that you feel naked without having done it. That habit will save lives, starting with your first day on the floor."

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