# A nurse is caring for a 68-year-old patient with a confirmed MRSA wound infection on the lower leg, requiring daily dressing changes and irrigation. Which nursing action demonstrates the highest priority for preventing transmission of MRSA to other patients?

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## 문제

A nurse is caring for a 68-year-old patient with a confirmed MRSA wound infection on the lower leg, requiring daily dressing changes and irrigation. Which nursing action demonstrates the highest priority for preventing transmission of MRSA to other patients?

A 68-year-old patient has been admitted with a large, draining wound on the lower leg that has tested positive for MRSA. The wound requires daily dressing changes and irrigation.

## 보기

1. Wearing sterile gloves when performing wound care procedures
2. Implementing contact precautions and ensuring proper hand hygiene before and after patient contact **✔ 정답**
3. Administering prescribed antibiotics on schedule to reduce bacterial load
4. Educating the patient about proper wound care techniques for home management

**정답: 2**

## 해설

Contact precautions with proper hand hygiene are the highest priority to prevent MRSA transmission via direct contact. Other options are important but secondary for immediate infection control.

## 심화 해설

Understanding the Priority: Breaking the Chain of Infection

For a patient with a confirmed MRSA wound infection, the nurse's highest priority is always to interrupt the transmission pathway. MRSA (Methicillin-resistant Staphylococcus aureus) is primarily spread via direct or indirect contact, often on the hands of healthcare workers or through contaminated equipment and surfaces. While all the listed actions are components of comprehensive care, only one directly addresses the immediate mechanism of pathogen spread from the source (the draining wound) to a susceptible host (another patient).

Analysis of the Correct Answer: Option 2

Implementing contact precautions and ensuring proper hand hygiene before and after patient contact is the cornerstone of infection prevention for MDROs like MRSA. This action creates a barrier at the most critical point of transmission. A high-fidelity simulation study using surrogate markers demonstrated that healthcare worker workflows and practices during high-contact care are primary contributors to environmental contamination and subsequent transmission [4]. The study specifically showed how organisms spread from the patient to the nurse's hands and then to multiple environmental surfaces during routine care. Contact precautions, including the use of gowns and gloves, combined with meticulous hand hygiene, are designed to contain the organism at the source and prevent this very sequence of events. Hand hygiene before and after patient contact, even when gloves are worn, is the single most effective measure to prevent cross-contamination.

Why the Other Options Are Not the Highest Priority

- Option 1: Wearing sterile gloves when performing wound care procedures. While sterile gloves are essential for protecting the patient's open wound from new pathogens (preventing surgical site infection), they do not, on their own, prevent the spread of the patient's existing MRSA to others. The external surface of a sterile glove becomes contaminated the moment it touches the infected wound. If the nurse then touches a bed rail or door handle without performing hand hygiene, the organism is transferred. Contact precautions require clean, non-sterile gloves that are donned upon room entry and discarded before exiting, a practice specifically aimed at containment [4].

- Option 3: Administering prescribed antibiotics on schedule to reduce bacterial load. This is an important medical intervention for treating the patient's infection, but it is not the most immediate nursing action for preventing transmission. The patient remains a transmission risk until the bacterial burden is significantly reduced and the wound is contained. Relying on antibiotics as a primary prevention strategy ignores the immediate risk posed by a heavily draining wound during every care interaction.

- Option 4: Educating the patient about proper wound care techniques for home management. Patient education is a vital nursing function for long-term management and preventing recurrence or spread in the community. However, in the acute care setting, the immediate and highest-stakes risk is the transmission of a virulent MDRO to other vulnerable hospitalized patients. This systemic risk takes precedence over an individual patient's discharge planning need. A scoping review on isolation policies reinforces that the primary goal of such measures is to protect the broader patient population from pathogens originating from an identified source .

Clinical Application of the Evidence

The findings from the simulation study are directly applicable here. It showed that during a bed bath, a high-contact activity analogous to wound irrigation and dressing changes, pathogens spread from the resident to the nursing assistant's hands and clothing, and subsequently to the bed rails, supply carts, and other surfaces [4]. This "trail of contamination" is precisely what contact precautions are designed to break. The nurse must view the entire patient zone as potentially contaminated and act to prevent carrying the organism out of that zone. A retrospective review in a healthcare setting further highlights the prevalence of contact precautions for managing such infections, underscoring its role as a standard, high-priority intervention . The core principle is to contain the reservoir of infection, a concept central to all infection prevention and control guidelines.References (research sources)

- [4]Transmission pathways during high-contact care activities in nursing homes: a high-fidelity simulation study with surrogate markers.Research articleGannon PR, Dotto VR, Burke KB, Regina R, Jacob JT, Mumma JM. (2026) · DOI: 10.1017/ice.2026.10431

## 임상 시나리오

MRSA Transmission Prevention in Wound CarePrioritizing Contact Precautions and Hand Hygiene
For a patient with a draining MRSA wound infection, the highest priority is interrupting the chain of infection at its primary mode of transmission: direct and indirect contact. Implementing Contact Precautions (donning a gown and gloves for all patient interactions) and performing meticulous hand hygiene before and after care are non-negotiable first steps.

Hand hygiene must be performed using an alcohol-based hand rub or soap and water, with special emphasis on the 5 Moments for Hand Hygiene, particularly before touching a patient and after body fluid exposure risk. Gloves are not a substitute for hand hygiene; hands must be cleaned immediately after glove removal.

CautionUsing only sterile gloves for a wound procedure does not constitute full contact precautions. Organisms can contaminate the nurse's clothing and forearms during wound irrigation, acting as a vector to other patients. A fluid-resistant gown is required to prevent this transmission.

## 핵심 개념

- **MRSA (Methicillin-resistant Staphylococcus aureus)** — A type of staph bacteria resistant to many antibiotics, primarily spread through direct or indirect contact, often in healthcare settings.
- **Contact Precautions** — Infection prevention measures including the use of gloves and gowns for all interactions involving contact with the patient or their environment, designed to stop direct and indirect contact transmission.
- **Chain of Infection** — A model illustrating the six components needed for an infection to spread: infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, and susceptible host.
- **Hand Hygiene** — The act of cleaning hands with soap and water or an alcohol-based hand rub, recognized as the single most important measure to prevent the spread of pathogens.
- **MDRO (Multidrug-Resistant Organism)** — Microorganisms, predominantly bacteria, that are resistant to one or more classes of antimicrobial agents, making treatment challenging.

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