# A nurse is caring for a patient with a confirmed MRSA wound infection. Which nursing intervention demonstrates the most appropriate evidence-based practice for managing this patient?

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> subject: Adult Health

## 문제

A nurse is caring for a patient with a confirmed MRSA wound infection. Which nursing intervention demonstrates the most appropriate evidence-based practice for managing this patient?

The nurse must implement comprehensive care strategies for a patient with methicillin-resistant Staphylococcus aureus infection while preventing transmission to other patients and healthcare workers.

## 보기

1. Apply topical antibiotic ointment to the wound and change dressing using clean technique
2. Administer oral antibiotics as prescribed and monitor for signs of systemic infection
3. Isolate the patient in a private room and use droplet precautions during all patient care
4. Implement contact precautions, perform hand hygiene before and after patient contact, and use dedicated equipment **✔ 정답**

**정답: 4**

## 해설

Contact precautions with hand hygiene and dedicated equipment are the evidence-based standard for MRSA to prevent transmission. Other options are inadequate for infection control.

## 심화 해설

Understanding MRSA and Transmission-Based Precautions

Methicillin-resistant Staphylococcus aureus (MRSA) is a multidrug-resistant pathogen that poses significant challenges in healthcare settings due to its ability to cause severe wound infections and its capacity for biofilm formation, as highlighted in recent antimicrobial research [2]. The primary mode of transmission for MRSA is through direct contact with an infected wound or contaminated surfaces and equipment, not through airborne or droplet routes. This distinction is critical for selecting the correct isolation precautions.

Why Contact Precautions Are the Gold Standard

For a patient with a confirmed MRSA wound infection, the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) Infection Prevention and Control Assessment Framework (IPCAF) recommend contact precautions as the evidence-based standard . This involves placing the patient in a private room, performing rigorous hand hygiene before and after all patient contact using an alcohol-based hand rub or soap and water, and donning a gown and gloves for any interaction that might involve contact with the patient or their immediate environment. The use of dedicated or disposable equipment (such as stethoscopes, blood pressure cuffs, and thermometers) that remains in the patient's room is another essential component, preventing the organism from being carried to other patients on shared devices.

Analyzing the Incorrect Options

Option 1 is incorrect because applying topical antibiotics alone is insufficient for treating an established MRSA infection, and a clean technique for dressing changes is not appropriate. A wound infected with a multidrug-resistant organism requires sterile technique to prevent introducing additional pathogens and to contain the existing infection. Option 2, while a necessary part of the treatment plan (administering systemic antibiotics), does not address the crucial nursing responsibility of preventing transmission to other patients and healthcare workers. Option 3 incorrectly specifies droplet precautions. Droplet precautions are reserved for pathogens transmitted via large respiratory droplets (e.g., influenza, pertussis). MRSA does not spread via this route, making this choice a fundamental misunderstanding of transmission-based precautions.

Connecting Evidence to Clinical Practice

The rationale for strict contact precautions is directly supported by infection prevention research. A cluster-randomized clinical trial investigating extended barrier precautions in intensive care settings demonstrated that interventions like gown and glove use are actively studied and refined to reduce the risk of nosocomial sepsis from drug-resistant organisms . Furthermore, a review of hospital-acquired infection prevention in ICUs emphasizes that consistent application of staff-level strategies, including adherence to hand hygiene and appropriate barrier precautions, is a cornerstone of patient safety, though implementation remains inconsistent . The WHO IPCAF framework reinforces that a facility's capacity to implement these core components—hand hygiene, personal protective equipment, and environmental cleaning—is what defines a robust infection prevention and control program . For a nurse, integrating these practices means that before entering the patient's room, you perform hand hygiene, don a gown and gloves, and ensure any equipment you carry in either stays in the room or is thoroughly disinfected with an EPA-registered hospital-grade disinfectant upon removal. This bundle of interventions directly breaks the chain of infection at its most critical link: the contaminated hands and equipment of the healthcare worker.

References (research sources)

- [2]Preparation and in vitro evaluation of photodynamic-responsive nanoliposome loaded PL-5.Research articleLin W, Shi QZ, Liao XR, Zeng Y, Xie XY, Ji GJ, Li YK. (2026) · DOI: 10.1371/journal.pone.0351679

## 임상 시나리오

Clinical Practice Guide: MRSA Wound Infection Management

For a patient with a confirmed MRSA wound infection, immediately implement contact precautions as per CDC guidelines. Place the patient in a private room with a dedicated bathroom whenever possible. All healthcare workers must perform rigorous hand hygiene using an alcohol-based hand rub or soap and water before and after every patient encounter. Don a clean gown and gloves upon room entry, ensuring the gown covers the torso and arms to prevent contamination of clothing. Remove and discard PPE inside the room before exiting, followed by immediate hand hygiene.

Use dedicated or disposable patient-care equipment, such as a stethoscope, blood pressure cuff, and thermometer, that remains in the room. If equipment must be shared, thoroughly clean and disinfect it with an EPA-registered hospital disinfectant effective against MRSA before use on another patient. During wound care, employ sterile technique for dressing changes. Cleanse the wound with normal saline, debride as ordered, and apply a sterile dressing. Avoid topical antibiotics unless specifically prescribed, as systemic antibiotics like vancomycin are the mainstay for invasive MRSA infections.

Educate the patient and family about MRSA transmission, emphasizing hand hygiene and the importance of keeping the wound covered. Instruct visitors to wear PPE and limit contact with other patients. Monitor the wound daily for signs of healing or deterioration, such as increased purulence, erythema, or foul odor, and report findings to the provider promptly. Document all interventions, including isolation status, wound assessment, and patient education, in the medical record.

## 핵심 개념

- **MRSA** — Methicillin-resistant Staphylococcus aureus, a multidrug-resistant pathogen causing severe infections, primarily transmitted via direct contact.
- **Contact Precautions** — CDC-recommended isolation requiring a private room, gown, gloves, and dedicated equipment to prevent direct or indirect contact transmission.
- **Hand Hygiene** — Using alcohol-based hand rub or soap and water before and after patient contact, a cornerstone of infection prevention.
- **Dedicated Equipment** — Medical devices like stethoscopes and blood pressure cuffs kept in the patient's room to avoid cross-contamination.
- **Transmission-Based Precautions** — Isolation guidelines (contact, droplet, airborne) used in addition to standard precautions for known or suspected infections.

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