# A nurse is caring for multiple patients on 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=319492  
> language: ko  
> subject: Next Gen NCLEX

## 문제

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

## 보기

1. Wearing the same pair of gloves while taking vital signs for three patients in the same room
2. Using alcohol-based hand sanitizer after removing gloves that were worn while caring for a patient with an infection
3. Placing a patient with active tuberculosis in a private room with the door closed
4. Performing hand hygiene before and after each patient contact, even when gloves are worn **✔ 정답**

**정답: 4**

## 해설

Hand hygiene before and after each patient contact, even with gloves, is the most appropriate practice as it prevents cross-contamination and is a cornerstone of standard precautions. Other options either reuse gloves, use hand sanitizer inappropriately, or are condition-specific measures.

## 심화 해설

Core Nursing Explanation
**Key Concept Analysis**: This question tests the fundamental principle of Standard Precautions in infection control. Standard precautions are the foundation for preventing the transmission of infectious agents in healthcare settings and apply to **all patients**, regardless of their diagnosis. The core concept is that hand hygiene is the single most important measure to prevent healthcare-associated infections (HAIs).

**Answer Rationale**: Key Point! Option ④ is correct because it embodies the principle that hand hygiene is required before and after every patient contact. This is non-negotiable, even when gloves are worn. Gloves are not a substitute for hand hygiene. Hand hygiene before contact protects the patient from organisms on the nurse's hands. Hand hygiene after contact (and after glove removal) protects the nurse and the environment from patient organisms, breaking the chain of infection.

**Distractor Analysis**:

• Watch out for confusion! Option ①: Wearing the same gloves between patients is a **major violation** of standard precautions. Gloves are *single-use, patient-specific* items. Reusing them transfers microorganisms from one patient to another, causing cross-contamination.

• Option ②: Using alcohol-based hand sanitizer (ABHR) *after* removing gloves is correct, but the option is incomplete and not the "most appropriate" overall practice. ABHR is effective for routine hand hygiene when hands are not visibly soiled. However, this option does not mention hand hygiene *before* patient contact or address the comprehensive practice shown in option ④.

• Option ③: Placing a patient with active Tuberculosis (TB) in a private, negative-pressure room with the door closed is correct, but it is a Transmission-Based Precaution (specifically, Airborne Precautions). It is a disease-specific intervention, not the universal, foundational practice that applies to **all** patients, which is what the question is asking for.

**Related Concepts**: This integrates the nursing process of **Implementation** for safety. Understanding the hierarchy of infection control—Standard Precautions first, then add Transmission-Based Precautions as needed—is crucial. The question assesses the nurse's ability to prioritize the most fundamental, universally applicable action.

Concept Summary: **Standard Precautions** (apply to all patients): Hand hygiene, use of personal protective equipment (PPE) like gloves/gowns, safe injection practices. **Transmission-Based Precautions** (added for specific diseases): Contact, Droplet, Airborne.

Side-by-Side Comparison!:

| Precaution Type | When to Use | Key Components | Example Conditions |
| --- | --- | --- | --- |
| Standard Precautions | For ALL patient contact | Hand hygiene, Gloves for potential contact with body fluids, Mask/eye protection for splashes | Every patient, every time |
| Airborne Precautions | Diseases transmitted via small airborne particles | Private negative-pressure room, N95 respirator or higher, Keep door closed | Tuberculosis, Measles, Varicella |

Anatomy, Physiology & Pharmacology Points: The chain of infection (Infectious Agent → Reservoir → Portal of Exit → Mode of Transmission → Portal of Entry → Susceptible Host). Hand hygiene is the primary intervention to break the chain at the "Mode of Transmission" and "Portal of Entry" links.

Memory Tips: Remember "**My 5 Moments for Hand Hygiene**" by WHO: 1) Before touching a patient, 2) Before clean/aseptic procedure, 3) After body fluid exposure risk, 4) After touching a patient, 5) After touching patient surroundings. Also: "**Gloves are not a substitute for hand washing!**"

High-Frequency NCLEX Topics: Infection control is a **High Yield** topic. NCLEX constantly tests the priority of hand hygiene, the difference between standard and transmission-based precautions, and the correct sequence of donning/doffing PPE.

Watch Out for Question Variations!: The same concept can be tested by: 1) Asking for the **first** action a nurse should take (answer is often hand hygiene). 2) Presenting a scenario with a patient on Contact Precautions and asking which action is correct (e.g., wearing gloves and gown for contact). 3) Asking about the order for removing PPE (gloves first, then gown, then mask, then perform hand hygiene).

## 임상 시나리오

Nursing Clinical Practice Guide
**Clinical Scenario**: You are assigned to a 6-patient med-surg pod. Your patients include Mr. A (post-op appendectomy), Ms. B (Cellulitis with MRSA history), and Mr. C (Pneumonia). You need to administer medications, check dressings, and assess vital signs.

**Nursing Intervention Strategy**:

1. **Assessment & Planning**: Review charts for any isolation precautions. Gather supplies for all patients to minimize exits/entries. Plan your route.

2. **Implementation**:

• Enter Mr. A's room. Perform **hand hygiene** at the door.

• Assess incision, administer meds. Remove gloves, perform **hand hygiene**.

• Exit room. Enter Ms. B's room (Contact Precautions). Perform **hand hygiene**, then don gown and gloves.

• Provide care. In room, remove gloves and gown, perform **hand hygiene**, then exit.

• Enter Mr. C's room. Perform **hand hygiene** before touching him.

This flow ensures you never carry organisms from one patient to the next.

**Patient Safety and Precautions**: Never "cluster" care by seeing multiple patients in the same room without performing hand hygiene between each one. Alcohol-based hand rub is preferred unless hands are visibly soiled (use soap and water). If gloves are torn or heavily soiled, remove them, perform hand hygiene, and don new gloves.

Nursing Procedure & Medication Flow: Hand hygiene is step 0 for every procedure. Before preparing medications, after handling a medication cart used by others, and before entering any patient's room—clean your hands. This prevents contaminating medications or supplies.

A Word from Your Senior Nurse: "In the real world, it's easy to get rushed and think 'my gloves are clean' or 'I'm just going to the next bed.' Fight that impulse! Your hands are your most important tool and your biggest liability in spreading infection. Making hand hygiene an unbreakable ritual is what protects your patients from harm and defines you as a safe, professional nurse. On the NCLEX, they love to test if you know that this basic action is always a priority."

## 핵심 개념

- **Standard Precautions** — A set of infection prevention practices that apply to all patient care, regardless of suspected or confirmed infection status. The foundation includes hand hygiene and use of PPE.
- **Hand Hygiene** — A general term that applies to handwashing with soap and water, use of an antiseptic hand rub, or surgical hand antisepsis. It is the most effective measure to prevent HAIs.
- **Transmission-Based Precautions** — Precautions (Contact, Droplet, Airborne) used in addition to Standard Precautions for patients with known or suspected infections transmitted by specific routes.
- **Cross-Contamination** — The transfer of harmful microorganisms from one person, object, or place to another. In healthcare, it often refers to spreading pathogens between patients via healthcare workers' hands or equipment.
- **Healthcare-Associated Infection** — An infection patients acquire during the course of receiving healthcare treatment for other conditions. Hand hygiene is the primary strategy for HAI prevention.

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