# A nurse is caring for an elderly patient with a confirmed MRSA wound infection in a long-term care facility. Which nursing intervention demonstrates the most appropriate evidence-based practice for preventing transmission while promoting wound healing?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=540912  
> language: ko  
> subject: Adult Health

## 문제

A nurse is caring for an elderly patient with a confirmed MRSA wound infection in a long-term care facility. Which nursing intervention demonstrates the most appropriate evidence-based practice for preventing transmission while promoting wound healing?

The nurse must implement comprehensive care strategies that address both infection control and optimal wound healing outcomes.

## 보기

1. Apply topical antibiotic ointment to the wound and change dressing every 48 hours using clean technique
2. Irrigate the wound with hydrogen peroxide solution and apply dry gauze dressing with tape securement
3. Use contact precautions only when directly handling the wound and remove gloves immediately after wound care
4. Implement strict contact precautions, perform hand hygiene before and after patient contact, and use dedicated equipment **✔ 정답**

**정답: 4**

## 해설

Strict contact precautions with hand hygiene and dedicated equipment are essential for MRSA transmission prevention while using normal saline for wound irrigation promotes healing. Other options are suboptimal for infection control or wound care.

## 심화 해설

Evidence-Based Rationale for Preventing MRSA Transmission

The correct answer is 4. The cornerstone of preventing methicillin-resistant Staphylococcus aureus (MRSA) transmission in any healthcare setting, including long-term care, is the rigorous and consistent application of contact precautions. This is not merely a task-based activity but a comprehensive strategy. The evidence underscores that MRSA transmission is a significant and persistent challenge within healthcare environments, driven by both patient and environmental reservoirs [1,3]. Implementing strict contact precautions, performing hand hygiene before and after every patient interaction, and dedicating non-critical equipment to a single patient are all essential, non-negotiable components of an evidence-based infection control bundle designed to interrupt the chain of transmission.

Let's analyze why the other options are incorrect and represent a lower standard of care.

Why Option 1 is Incorrect

Applying a topical antibiotic and changing a dressing every 48 hours using "clean technique" is insufficient and potentially harmful. First, MRSA wound management requires sterile technique for dressing changes, not clean technique, to prevent introducing new pathogens into an already compromised wound. Second, the decision to use a topical antibiotic must be guided by culture and sensitivity results, not applied empirically, especially given the complex antibiotic resistance patterns of MRSA [3]. A fixed 48-hour dressing change interval is not evidence-based; dressing changes should occur when the dressing is saturated, soiled, or as clinically indicated to maintain a moist wound environment conducive to healing while containing drainage.

Why Option 2 is Incorrect

Irrigating a wound with hydrogen peroxide is contraindicated. Hydrogen peroxide is a cytotoxic agent that indiscriminately destroys healthy granulation tissue and fibroblasts, which are critical for wound healing. This practice would actively delay wound closure. Standard wound cleansing involves irrigation with normal saline at a safe pressure. Furthermore, a dry gauze dressing is not an optimal choice for promoting a moist wound-healing environment, which is the gold standard for most chronic wounds.

Why Option 3 is Incorrect

Using contact precautions only when directly handling the wound is a fundamental misunderstanding of how MRSA is transmitted. Research on MRSA transmission dynamics reveals that the organism can be present on intact skin, in the nares, and on environmental surfaces far beyond the immediate wound site [1,3]. A patient with a confirmed MRSA infection is considered colonized or infected at multiple body sites. Therefore, contact precautions must be maintained for the entire patient encounter and the patient's immediate environment, not just during wound manipulation. Removing gloves immediately after wound care without performing hand hygiene and without considering environmental contamination creates a critical break in infection control practice.

Integrating Infection Control with Wound Healing

The question asks for a strategy that addresses both transmission prevention and wound healing. Option 4 achieves this by creating a safe care environment that allows the wound to heal without the risk of autoinoculation or cross-contamination. The use of dedicated equipment prevents the organism from being transferred to another patient via a shared blood pressure cuff or stethoscope, a concept supported by studies investigating potential MRSA reservoirs on surfaces and among healthcare workers [3]. By strictly adhering to this comprehensive contact precaution protocol, the nurse prevents the organism's spread, which is the foundational step that allows any subsequent wound-healing interventions to be effective and safe. The Bayesian modeling of transmission rates in hospitals confirms that consistent, unit-wide adherence to such barrier precautions is essential to controlling the basic reproduction number of HA-MRSA [1].References (research sources)

- [1]Bayesian inference of nosocomial meticillin-resistant Staphylococcus aureus transmission rates in an urban safety-net hospital.Research articleCorkran K, Bani-Yaghoub M, Sutkin G, Arjmand A, Paschal S. (2025) · DOI: 10.1016/j.jhin.2025.07.018

- [3]Antibiotic resistance characteristics, molecular typing, and potential transmission reservoirs of methicillin-resistant <i>Staphylococcus aureus</i> in patients with postoperative infection.Research articleCao N, Li MX, Zhu MY, Wang Y, Wan B, Xu J. (2026) · DOI: 10.3389/fmicb.2026.1630249

## 임상 시나리오

MRSA Infection Control & Wound CareEvidence-Based Bundle for Long-Term Care
The cornerstone of preventing MRSA transmission is a comprehensive contact precautions bundle, not a single task. This includes strict use of gown and gloves for all patient and environmental contact.

Perform hand hygiene using alcohol-based hand rub or soap and water before and after every patient interaction, even if gloves were worn.

Use dedicated equipment (stethoscope, BP cuff, thermometer) that remains in the patient's room. If equipment must be shared, clean and disinfect it thoroughly between patients.

Wound care must utilize sterile technique to prevent secondary infection. Avoid cytotoxic agents like hydrogen peroxide; maintain a moist wound environment with appropriate dressings to promote healing.

CautionContact precautions apply to the entire patient environment, not just direct wound contact. Do not remove gloves immediately after wound care; keep them on to handle contaminated linens or equipment to break the chain of transmission.

## 핵심 개념

- **Contact Precautions** — Infection control practices including gown and gloves for all interactions involving contact with the patient or their environment to prevent transmission of epidemiologically important organisms like MRSA.
- **Methicillin-resistant Staphylococcus aureus (MRSA)** — A type of staph bacteria resistant to many antibiotics, transmitted primarily via contaminated hands and fomites in healthcare settings.
- **Sterile Technique** — A set of specific practices performed to eliminate all microorganisms, required for invasive procedures and wound care where skin integrity is broken.
- **Dedicated Equipment** — Medical devices (e.g., stethoscope, blood pressure cuff) assigned to a single patient to prevent cross-contamination between patients.

## 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. Which nursing actio…](https://mymerci.kr/pages/nclex_q.php?qn_id=540908)
- [A nurse is caring for a patient with a confirmed MRSA wound infection. Which nursing actio…](https://mymerci.kr/pages/nclex_q.php?qn_id=540909)
- [A nurse is caring for a patient with a confirmed MRSA wound infection. Which nursing inter…](https://mymerci.kr/pages/nclex_q.php?qn_id=540910)
- [A nurse is caring for a 45-year-old patient with a confirmed MRSA skin infection on the lo…](https://mymerci.kr/pages/nclex_q.php?qn_id=540911)
- [A nurse is caring for a patient with a confirmed MRSA wound infection. Which nursing inter…](https://mymerci.kr/pages/nclex_q.php?qn_id=540913)

---

More free questions: [기출문제](https://mymerci.kr/)

_학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._