# A nurse is assessing patients in an emergency department. Which patient requires airborne precautions in addition to standard precautions? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=541832 > language: ko > subject: Infectious Diseases ## 문제 A nurse is assessing patients in an emergency department. 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 Clostridium difficile-associated diarrhea 3. A patient with suspected pulmonary tuberculosis awaiting test results **✔ 정답** 4. A patient with vancomycin-resistant enterococci (VRE) urinary tract infection **정답: 3** ## 해설 Suspected pulmonary tuberculosis requires airborne precautions due to potential transmission via airborne droplet nuclei ( ## 심화 해설 Understanding the Question This question tests your ability to apply infection prevention and control principles by selecting the correct transmission-based precautions. Standard precautions are used for all patients, but additional precautions are required when a pathogen is known or suspected to be transmitted via a specific route, such as airborne, droplet, or contact. Analyzing the Options Let's evaluate each patient scenario to determine the primary mode of transmission and the necessary precautions. Option 1: A patient with a methicillin-resistant *Staphylococcus aureus* (MRSA) wound infection. MRSA is a multidrug-resistant (MDR) pathogen primarily transmitted through direct or indirect contact with the infected wound or contaminated surfaces [2]. The additional precaution required here is Contact Precautions, not airborne. Option 2: A patient with *Clostridium difficile*-associated diarrhea. *C. difficile* is a spore-forming bacterium transmitted via the fecal-oral route through contact with contaminated environmental surfaces or healthcare workers' hands. The spores are highly resistant to alcohol-based hand rubs. This patient requires Contact Precautions, with a strong emphasis on hand hygiene with soap and water and environmental cleaning [2]. Option 3: A patient with suspected pulmonary tuberculosis (TB) awaiting test results. Pulmonary TB is caused by *Mycobacterium tuberculosis*, which is transmitted through small droplet nuclei (≤5 microns) that can remain suspended in the air for hours and travel over long distances [3]. A patient with suspected active pulmonary TB must immediately be placed on Airborne Precautions in addition to standard precautions. This is a critical safety measure to protect healthcare workers (HCWs) and other patients, as HCWs are at significant risk of exposure and developing latent tuberculosis infection (LTBI) [1]. The patient should be placed in a negative-pressure airborne infection isolation room (AIIR), and staff must wear a fit-tested N95 respirator or powered air-purifying respirator (PAPR) upon entry [1,3]. Option 4: A patient with vancomycin-resistant enterococci (VRE) urinary tract infection. Similar to MRSA, VRE is another MDR pathogen that is spread primarily by direct or indirect contact [2]. The additional precaution required is Contact Precautions, particularly during handling of urine or contaminated equipment. The Correct Answer and Clinical Rationale The correct answer is Option 3. The decision to initiate airborne precautions is based on the pathogen's mechanism of transmission. The dental study on knowledge and practices regarding airborne isolation highlights that airborne transmission involves the inhalation of infectious particles that can remain viable in the air, which is the hallmark of *M. tuberculosis* transmission [3]. A patient-centered approach to isolation, as discussed in the review by Alp Meşe et al., requires matching the precaution type to the specific pathogen's transmission route to effectively break the chain of infection without overusing resources [2]. For a patient with suspected pulmonary TB, the risk of airborne transmission is high, and delays in isolation can lead to unprotected exposures for HCWs, as suggested by the study on TB exposure frequency among different occupational classifications [1]. The clinical severity of active pulmonary TB, which can lead to complications like acute respiratory distress syndrome (ARDS), further underscores the need for strict, immediate isolation to prevent nosocomial outbreaks . The other options describe infections that require contact precautions because the organisms are transmitted via direct or indirect contact with the patient or their immediate environment, not through the airborne route [2].References (research sources) - [1]Comparison of Tuberculosis Exposure Frequency and Latent Tuberculosis Infection Rates Among Healthcare Workers by Occupational Classification.Research articleCheon S, Kim SH, Park JH, Lee YJ, Shin JM, Ryu JS, Hong NS, Cho J, Jun CH, Wi YM. (2026) · DOI: 10.3390/jcm15031259 - [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 - [3]Knowledge, attitudes, and practices (KAP) towards airborne isolation precautions among dental students and interns: A cross-sectional study.Research articleBellamkonda P, Ahmed H, Singh G, Sachidanandan M, Harini TC, Alshammari AS, Suresh Babu J, Swarnalatha C, Nayyar AS. (2025) · DOI: 10.4103/jfmpc.jfmpc_1825_24 ## 임상 시나리오 Airborne Precautions for Suspected TBKey Clinical Practice Points Place the patient in an Airborne Infection Isolation Room (AIIR) with negative pressure and 6-12 air exchanges per hour immediately upon suspicion of pulmonary TB. All healthcare personnel must wear a fit-tested N95 respirator or higher-level respirator before entering the room, not a standard surgical mask. Instruct the patient to wear a surgical mask if transport outside the AIIR is essential, and keep the door closed at all times. CautionDo not place a suspected TB patient in a regular room or with immunocompromised patients; airborne precautions must be initiated without waiting for confirmatory test results. ## 핵심 개념 - **Airborne Precautions** — Measures to prevent transmission of pathogens that remain infectious over long distances when suspended in the air, requiring an AIIR and N95 respirator. - **Contact Precautions** — Measures to prevent transmission of pathogens spread by direct or indirect contact with the patient or environment, requiring gloves and gown. - **Mycobacterium tuberculosis** — The bacterium causing tuberculosis, transmitted via airborne droplet nuclei that can remain suspended for hours. - **Multidrug-resistant organism (MDRO)** — Bacteria resistant to multiple classes of antimicrobials, such as MRSA and VRE, primarily spread by contact. - **Airborne Infection Isolation Room (AIIR)** — A negative-pressure room with 6-12 air exchanges per hour used to isolate patients requiring airborne precautions. ## 같은 주제 문제 - [A nurse is working in an emergency department. 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