# A nurse is caring for multiple patients with different infectious diseases. Which patient requires airborne precautions in addition to standard precautions?

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> subject: Infectious Diseases

## 문제

A nurse is caring for multiple patients with different infectious diseases. Which patient requires airborne precautions in addition to standard precautions?

## 보기

1. A patient with methicillin-resistant Staphylococcus aureus (MRSA) wound infection
2. A patient with active pulmonary tuberculosis **✔ 정답**
3. A patient with Clostridium difficile-associated diarrhea
4. A patient with influenza A

**정답: 2**

## 해설

Airborne precautions are required for diseases transmitted via small airborne droplet nuclei (≤5 μm) that remain suspended in air. Active pulmonary tuberculosis requires airborne precautions due to transmission via these nuclei. MRSA, C. difficile, and influenza require contact or droplet precautions, not airborne.

## 심화 해설

Understanding Transmission-Based Precautions

The NCLEX-RN frequently tests your ability to match a specific infectious disease with the correct category of transmission-based precautions. These precautions are always implemented in addition to standard precautions, which are used for every patient regardless of their diagnosis. The core concept is understanding the portal of exit from the infected host and the mechanism of transmission to a susceptible host.

Analysis of the Correct Answer

Active pulmonary tuberculosis is the classic exemplar for airborne precautions. Mycobacterium tuberculosis is carried in droplet nuclei—tiny infectious particles measuring 5 microns or less that are expelled when the patient coughs, sneezes, or during aerosol-generating procedures. These particles can remain suspended in the air for hours and travel long distances via air currents. The updated AORN guideline explicitly outlines strategies for airborne precautions, which include placing the patient in a negative-pressure airborne infection isolation room (AIIR) and using a fit-tested N95 respirator or powered air-purifying respirator (PAPR) [1]. The systematic review on Nipah virus similarly reinforces that for pathogens with demonstrated airborne potential, stringent respiratory protection and environmental controls are critical to protect healthcare workers [2]. The RCT protocol for TB preventive treatment highlights the elevated risk of acquisition among close contacts, underscoring why immediate isolation with airborne precautions is non-negotiable for an active pulmonary case .

Analysis of Incorrect Options

- Option 1: MRSA wound infection requires contact precautions. The organism is transmitted by direct or indirect contact with the infected wound or contaminated surfaces. A gown and gloves are essential. Airborne precautions are not indicated because MRSA is not suspended in the air in droplet nuclei.

- Option 3: Clostridium difficile-associated diarrhea also requires contact precautions, with a critical emphasis on hand hygiene with soap and water, as alcohol-based hand rubs are not effective against C. difficile spores. Transmission occurs via the fecal-oral route through contact with contaminated surfaces.

- Option 4: Influenza A requires droplet precautions. The virus is transmitted via large respiratory droplets (> 5 microns) that travel short distances (typically 3 to 6 feet) when the patient coughs or sneezes. A standard surgical mask is the appropriate respiratory protection, not an N95 respirator, unless an aerosol-generating procedure is being performed.

Clinical Integration for Practice

The CSPS validation study reminds us that consistent compliance with standard precautions is the foundation upon which all transmission-based precautions are built . When assessing a patient with a suspected or confirmed airborne illness, your clinical judgment must immediately prioritize the placement of a surgical mask on the patient during transport and ensuring they are placed in a negative-pressure room. For the NCLEX, remember that the "airborne" trio most commonly tested includes Tuberculosis, Measles (Rubeola), and Varicella (Chickenpox)/Disseminated Herpes Zoster. The mode of transmission dictates the precaution type, and for pulmonary TB, the generation of airborne droplet nuclei makes the N95 respirator and AIIR the only correct choice.References (research sources)

- [1]Guidelines in Practice: Transmission-Based Precautions.GuidelineMarr J. (2025) · DOI: 10.1002/aorn.14411

- [2]The role of infection prevention and control in the mitigation of human-to-human transmission of Nipah virus: a systematic review.Meta-analysis/systematic reviewPritchard S, Hornsey E. (2025) · DOI: 10.1186/s13756-025-01677-5

## 임상 시나리오

Airborne Precautions for Pulmonary TBKey Clinical Practice Points for Nurses
Place the patient immediately in a negative-pressure AIIR with 6-12 air exchanges per hour. Keep the door closed at all times.

Wear a fit-tested N95 respirator or PAPR before entering the room. A standard surgical mask does not provide adequate protection against droplet nuclei.

Instruct the patient to wear a surgical mask if transport outside the AIIR is essential. Notify the receiving department of the patient's airborne precautions status.

CautionPerform annual N95 fit testing for all staff. Patients with suspected or confirmed active TB must not be placed in a regular room or share a room with immunocompromised patients.

## 핵심 개념

- **Airborne Precautions** — Measures for pathogens transmitted via droplet nuclei (≤5 microns) that remain suspended in air; includes AIIR and N95 respirator.
- **Droplet Nuclei** — Tiny infectious particles (≤5 microns) expelled during coughing or sneezing that can remain airborne for hours and travel long distances.
- **Airborne Infection Isolation Room (AIIR)** — A negative-pressure room with 6-12 air exchanges per hour used to contain airborne pathogens and prevent spread to other areas.
- **N95 Respirator** — A fit-tested mask that filters at least 95% of airborne particles; required for healthcare workers entering an airborne precaution room.
- **Standard Precautions** — Basic infection prevention practices applied to all patients regardless of diagnosis, including hand hygiene and appropriate PPE use.

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