# A nurse is caring for a patient with suspected methicillin-resistant Staphylococcus aureus (MRSA) infection. Which action demonstrates the most appropriate implementation of standard precautions?

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> subject: Infectious Diseases

## 문제

A nurse is caring for a patient with suspected methicillin-resistant Staphylococcus aureus (MRSA) infection. Which action demonstrates the most appropriate implementation of standard precautions?

## 보기

1. Wearing gloves only when direct contact with body fluids is anticipated
2. Performing hand hygiene before and after every patient contact, regardless of glove use **✔ 정답**
3. Using contact precautions only after laboratory confirmation of MRSA
4. Applying standard precautions only to patients with confirmed infectious diseases

**정답: 2**

## 해설

Standard precautions require hand hygiene before and after every patient contact, regardless of glove use or infection status. Other options delay or limit precautions, increasing transmission risk.

## 심화 해설

Standard Precautions and MRSA: Core Principle

The cornerstone of standard precautions is the assumption that all patients are potentially colonized or infected with pathogens. This means preventive actions, particularly hand hygiene, must be performed consistently before and after every patient contact, irrespective of the patient's known diagnosis or the anticipated level of exposure to body fluids. Waiting for laboratory confirmation of a specific organism like methicillin-resistant *Staphylococcus aureus* (MRSA) creates a dangerous gap in protection, as colonization often precedes clinical infection and definitive culture results.

Why Option 2 is Correct

Performing hand hygiene before and after every patient contact, regardless of glove use, is the single most effective measure to break the chain of infection transmission [2]. A systematic review of multimodal interventions confirms that hand hygiene is the cornerstone of infection prevention in acute care settings, directly linking improved practices to reductions in healthcare-associated infections (HAIs) [2]. Gloves provide a barrier but are not a substitute for hand hygiene; hands can become contaminated during glove removal, and microscopic defects in gloves can allow pathogen transfer. Therefore, the sequence of degloving followed immediately by hand hygiene is non-negotiable.

Why Other Options are Incorrect

- **Option 1:** Gloves are indicated for any potential contact with blood, body fluids, mucous membranes, non-intact skin, or contaminated equipment—not just when direct fluid contact is "anticipated." This narrow interpretation fails to account for the invisible environmental contamination common with MRSA. A study of nursing home staff found that 20% had multidrug-resistant organism (MDRO) contamination on their hands or forearms, with 90% of those being MRSA, even when simply entering a breakroom or finishing a shift [1]. This underscores that contamination is often unrecognized.

- **Option 3:** Contact precautions for MRSA should be initiated based on suspicion (e.g., known risk factors, purulent drainage, positive history) and implemented empirically, not delayed until laboratory confirmation. The delay allows for ongoing transmission. Standard precautions, which include hand hygiene and appropriate glove use, apply to all patients, forming the baseline defense even before contact precautions are added.

- **Option 4:** Standard precautions are designed for the care of all patients, regardless of their infection status. Applying them only to confirmed cases is a fundamental misunderstanding of infection control principles and would leave both healthcare personnel and other patients vulnerable to undetected colonization.

Clinical Application and Evidence

The risk of staff acquiring MRSA from routine care activities is significant. Research demonstrated that recent high-contact resident-care activities were strongly associated with MDRO contamination on staff skin (Odds Ratio = 9.1, *P* = .04) [1]. This finding powerfully illustrates that transmission can occur even without visible soiling or a confirmed diagnosis. The consistent application of hand hygiene and the judicious use of barrier precautions, such as gloves, before and after these high-contact moments, are critical to preventing staff from becoming vectors who carry MRSA from one patient environment to another or into clean areas like breakrooms [1]. The systematic review further validates that institutional commitment to multimodal hand hygiene strategies translates into tangible clinical benefits by reducing HAI rates [2].References (research sources)

- [1]Multidrug-resistant organism (MDRO) contamination of nursing home staff hands and forearms when entering the breakroom or going home.Research articleNguyen K, Bittencourt CE, Gussin GM, Shimabukuro JA, Singh RD, Saavedra R, Huang SS. (2026) · DOI: 10.1017/ice.2026.10477

- [2]Multimodal Hand Hygiene Interventions and Clinical Healthcare-Associated Infection Outcomes in Acute Care Hospitals: A Systematic Review of Quasi-Experimental Studies.Meta-analysis/systematic reviewPruna ED, Davidescu L, Sorop-Florea M, Demeter I, Iurciuc S, Varga NI, David VL, Buleu F, Horhat FG. (2026) · DOI: 10.3390/jcm15103882

## 임상 시나리오

Standard Precautions & MRSAHand Hygiene as the Core Intervention
The foundation of Standard Precautions is treating all patients as potentially infectious. The single most critical action is performing hand hygiene before and after every patient contact, regardless of glove use.

For a patient with suspected MRSA, do not wait for lab confirmation to act. Gloves are a barrier, not a substitute for hand hygiene, as hands can become contaminated during removal. The sequence is always deglove, then immediately perform hand hygiene.

CautionGloves must be worn for any potential contact with blood, body fluids, mucous membranes, or non-intact skin, not just when exposure is anticipated. Microscopic glove defects can still allow pathogen transfer.

## 핵심 개념

- **Standard Precautions** — The minimum infection prevention practices that apply to all patient care, regardless of suspected or confirmed infection status, in any healthcare setting.
- **MRSA** — Methicillin-resistant Staphylococcus aureus, a type of staph bacteria resistant to many antibiotics, often causing difficult-to-treat healthcare-associated infections.
- **Hand Hygiene** — A general term referring to any action of hand cleansing, including washing hands with soap and water or using an alcohol-based hand rub.
- **Healthcare-Associated Infections (HAIs)** — Infections that patients acquire during the course of receiving healthcare treatment for other conditions.

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