# A nurse is caring for a 45-year-old patient with a confirmed MRSA skin infection on the lower leg. Which nursing intervention should be the highest priority to prevent transmission to other patients and healthcare workers? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=540911 > language: ko > subject: Adult Health ## 문제 A nurse is caring for a 45-year-old patient with a confirmed MRSA skin infection on the lower leg. Which nursing intervention should be the highest priority to prevent transmission to other patients and healthcare workers? A 45-year-old patient has been admitted with a large, purulent wound on the lower leg that has tested positive for MRSA. The patient is ambulatory and frequently leaves the room to walk in the hallways. ## 보기 1. Implement contact precautions with dedicated equipment and proper hand hygiene protocols **✔ 정답** 2. Administer prescribed vancomycin intravenously as ordered 3. Perform wound irrigation with normal saline twice daily 4. Educate the patient about the importance of completing antibiotic therapy **정답: 1** ## 해설 Contact precautions are the highest priority to prevent MRSA transmission in healthcare settings. Other interventions are important but secondary to infection control. ## 심화 해설 Understanding the Priority: Breaking the Chain of Infection In the NCLEX-RN framework, questions about infection control require you to prioritize interventions based on the "Chain of Infection." For a patient with a confirmed multidrug-resistant organism (MDRO) like MRSA, the immediate safety goal is preventing transmission to others. While all the listed options are important components of the patient's care plan, the nurse must first establish a physical barrier to contain the infectious agent at its source. The patient's ambulatory status and frequent room exits make this an urgent safety concern, as the pathogen can easily contaminate the environment and be transferred to other patients and healthcare workers. Why Contact Precautions Are the Highest Priority The correct intervention is implementing contact precautions with dedicated equipment and proper hand hygiene protocols. Contact precautions are a core, evidence-based strategy specifically designed to interrupt the primary mode of transmission for organisms like MRSA (Methicillin-resistant Staphylococcus aureus), which is direct and indirect contact. A 2025 systematic review on preventing the transmission of MDROs reaffirms that a bundle of interventions, with contact precautions as a central element, is critical for patient safety [1]. The rationale is twofold: 1. Physical Barrier: Donning a gown and gloves upon room entry creates a physical barrier that prevents the nurse's clothing and hands from becoming contaminated vectors that carry the organism to the next patient or surface. 2. Source Containment: Dedicated equipment (e.g., a stethoscope, blood pressure cuff, and thermometer that remain in the patient's room) prevents the organism from being shared via fomites. This is particularly crucial for an ambulatory patient who may touch surfaces in the hallway, making the immediate environment outside the room a potential contamination zone. A patient-centered framework for isolation emphasizes that these precautions must be applied immediately and systematically upon identification of the pathogen to optimize safety without delay [2]. The priority is to physically contain the biological hazard before focusing on pharmacological treatment or patient education. Analyzing the Other Options The other options, while clinically important, are secondary to the immediate safety need of preventing an outbreak. - Option 2: Administering prescribed vancomycin intravenously. This addresses the portal of exit by treating the infection and eventually reducing the bioburden of the pathogen. However, antibiotic therapy takes time to become effective. Transmission can occur for hours or days before the antibiotic concentration in the wound is sufficient to kill the bacteria. Physical source containment via contact precautions provides an immediate barrier, which is the higher priority for a nurse implementing a care plan. - Option 3: Performing wound irrigation with normal saline twice daily. This is a supportive care measure that aids in wound healing by removing purulent drainage and debris. While it helps clean the wound, the very act of performing wound care without proper barrier precautions is a high-risk moment for contaminating the environment and the nurse's attire. The contact precautions must be in place before this procedure is performed to make it safe. - Option 4: Educating the patient about completing antibiotic therapy. Patient education is a vital nursing intervention to prevent recurrence and further development of antimicrobial resistance. However, education is a long-term strategy for the individual patient's health outcome. It does not provide an immediate, physical barrier to prevent the direct and indirect contact transmission of MRSA to other vulnerable patients in the hallway right now. The nurse's first duty is to protect all patients on the unit from a known safety hazard. Connecting to Core Infection Control Principles Current evidence-based prevention strategies for MDROs consistently rank hand hygiene and targeted contact precautions as the foundational interventions . The systematic review on MDRO transmission prevention highlights that these practices are standard-of-care safety practices with broad acceptance because they physically interrupt the chain of infection at its most vulnerable link: the mode of transmission [1]. For an ambulatory patient with a purulent MRSA wound, the risk of environmental contamination is exceptionally high. The nurse's immediate action of instituting contact precautions and using dedicated equipment directly mitigates this risk, making it the unequivocal highest priority nursing intervention.References (research sources) - [1]Prevention in adults of transmission of infection with multidrug-resistant organisms: an updated systematic review from Making Healthcare Safer IV.Meta-analysis/systematic reviewMcCarthy S, Motala A, Shekelle PG. (2025) · DOI: 10.1136/bmjqs-2024-017545 - [2]Prioritizing isolation precautions: a patient-centered approach to infection prevention and control.Research articleAlp Meşe E, Carrara E, Tartari E, Mutters NT, Tsioutis C, Birgand G, Tacconelli E. (2025) · DOI: 10.1017/ash.2025.173 ## 임상 시나리오 MRSA Contact Precautions ImplementationImmediate steps to contain transmission from an ambulatory patient Upon identifying a MRSA-positive draining wound, the nurse's first priority is to initiate Contact Precautions. This involves placing the patient in a single room and donning a gown and gloves before entering the patient zone, regardless of anticipated contact. Use dedicated patient equipment such as a stethoscope, blood pressure cuff, and thermometer that remain in the room. If equipment must be shared, it requires thorough cleaning and disinfection with a hospital-approved agent effective against C. difficile spores and MDROs before use on another patient. CautionFor an ambulatory patient, reinforce that leaving the room requires a clean, covered wound, a fresh gown, and strict hand hygiene. The patient must not linger in common areas. Immediate environmental cleaning of any surfaces touched outside the room is critical. ## 핵심 개념 - **Contact Precautions** — A set of infection control practices used to prevent transmission of diseases spread by direct or indirect contact, requiring gloves and gowns for all interactions. - **MRSA (Methicillin-resistant Staphylococcus aureus)** — A type of multidrug-resistant bacteria resistant to many antibiotics, commonly causing skin infections and primarily spread through direct contact with contaminated hands or surfaces. - **Chain of Infection** — A model describing the six elements needed for an infection to spread: infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, and susceptible host. - **Dedicated Equipment** — Medical devices and supplies (e.g., stethoscope, blood pressure cuff) assigned to a single patient to prevent cross-contamination between patients. - **Hand Hygiene** — The act of cleaning hands with soap and water or an alcohol-based hand rub to remove pathogens, considered the single most important practice to reduce healthcare-associated infections. ## 같은 주제 문제 - [A nurse is caring for a 68-year-old patient with a confirmed MRSA wound infection on the l…](https://mymerci.kr/pages/nclex_q.php?qn_id=540907) - [A nurse is caring for a patient with a confirmed MRSA wound infection. 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