# A nurse is caring for multiple patients with different types of multidrug-resistant infections. Which nursing action demonstrates the highest priority safety measure when transitioning between patient rooms?

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> subject: Infectious Diseases

## 문제

A nurse is caring for multiple patients with different types of multidrug-resistant infections. Which nursing action demonstrates the highest priority safety measure when transitioning between patient rooms?

## 보기

1. Changing gloves between each patient contact while keeping the same gown
2. Using alcohol-based hand sanitizer after removing personal protective equipment
3. Removing all personal protective equipment and performing hand hygiene before entering each new patient room **✔ 정답**
4. Wearing the same N95 mask throughout the shift while changing other protective equipment

**정답: 3**

## 해설

Complete removal of all PPE and hand hygiene between rooms prevents cross-contamination of multidrug-resistant organisms. Other options are insufficient as they risk contamination via retained PPE or inadequate hand hygiene.

## 심화 해설

Understanding the Priority in Multidrug-Resistant Infection Control

The core of this question lies in understanding the chain of infection, specifically the mode of transmission. Multidrug-resistant organisms (MDROs) are primarily spread via contact, often on the hands or clothing of healthcare workers. The study by Cheng et al. highlights that effective nursing safety management is essential to control MDRO transmission and improve patient outcomes in high-acuity settings like the emergency intensive care unit (EICU) [1]. Therefore, the highest priority action is the one that most effectively breaks this chain of transmission between two different patient environments.

Analysis of Each Option

Option 1: Changing gloves between each patient contact while keeping the same gown.

This action is insufficient. While changing gloves is a basic standard precaution, the gown itself can become contaminated with MDROs during patient care. A contaminated gown then serves as a vehicle for transmitting organisms to the next patient or the environment, even if gloves are new. This practice does not fully interrupt the transmission pathway, as the clothing beneath the gown can also be a source of contamination.

Option 2: Using alcohol-based hand sanitizer after removing personal protective equipment.

This is a correct step in the doffing sequence, but it is not the complete action of highest priority. Hand hygiene is a critical component of infection prevention, as emphasized by guidelines from the World Health Organization and the Centers for Disease Control and Prevention [2]. However, if personal protective equipment (PPE) is not fully removed and donned fresh between rooms, the healthcare worker's body or underlying scrubs can still carry pathogens from the previous patient. This option describes a component of a larger, more critical process.

Option 3: Removing all personal protective equipment and performing hand hygiene before entering each new patient room.

This is the correct answer. This action represents the complete and definitive break in the chain of infection. By removing all PPE, which is likely contaminated with the previous patient's MDROs, and then performing hand hygiene, the healthcare worker eliminates the primary vectors for transmission. This practice creates a clean starting point before entering the next patient's environment, directly preventing the transfer of organisms from one patient to another. Sanvitti et al. note that prevention strategies, including consistent application of such protocols, are crucial in minimizing hospital-acquired infections in intensive care units [2]. This comprehensive approach is the gold standard for contact precautions.

Option 4: Wearing the same N95 mask throughout the shift while changing other protective equipment.

This practice is unsafe and contradicts infection control principles. An N95 mask is a form of PPE for airborne precautions, not the primary defense against MDROs, which are most often spread by contact. Wearing the same mask between patients risks contaminating the mask's outer surface with pathogens from one patient and then transferring them to another, or self-contaminating during removal and reapplication. All PPE, including masks, should be considered single-use for a patient encounter or discarded when moving between patients on contact precautions.

Clinical Application and Key Takeaway

The highest priority safety measure is the one that provides the most comprehensive barrier to pathogen transmission. The sequence of donning fresh PPE and performing hand hygiene before each patient encounter is a non-negotiable standard. This principle is rooted in the fundamental understanding that MDROs, which pose significant challenges due to patient vulnerability and invasive procedures, are controlled through rigorous, systematic nursing actions that prevent cross-contamination at the point of care [1].References (research sources)

- [1]Impact of nursing safety management on the control of multidrug-resistant organisms infections in emergency intensive care units.Research articleCheng L, Liu F, Zhao L, Liang M, Li R, Wu M. (2026) · DOI: 10.1097/md.0000000000046490

- [2]Minimizing hospital acquired intensive care unit infections: A focus on prevention.Research articleSanvitti M, Kanapeckas L, Bilotta F. (2026) · DOI: 10.5492/wjccm.v15.i1.113252

## 임상 시나리오

Clinical Practice Guide for MDRO Patient Transitions

The highest priority when moving between patients with multidrug-resistant infections is the complete removal of all personal protective equipment and thorough hand hygiene before entering the next room. This action breaks the contact transmission chain, which is the primary route for MDROs.

- **Doffing Sequence:** Remove PPE in the order of gloves, gown, eye protection, and mask/respirator while still inside the patient's room. Discard immediately into designated waste containers to prevent environmental contamination.

- **Hand Hygiene:** Perform hand hygiene immediately after removing all PPE using an alcohol-based hand rub or soap and water. This is critical even if gloves were worn, as hands can become contaminated during removal.

- **No Shared PPE:** Never wear the same gown, mask, or gloves between patients. A contaminated gown or mask acts as a fomite, carrying pathogens to the next patient or surface.

- **Room Entry Protocol:** Don a completely new set of PPE appropriate for the next patient's isolation precautions before entering their room. This ensures no cross-contamination from the previous patient.

## 핵심 개념

- **Multidrug-Resistant Organisms** — Multidrug-resistant organisms. Bacteria resistant to multiple types of antibiotics (e.g., MRSA, VRE). Enhanced isolation precautions beyond standard infection control procedures are required.
- **Contact Precautions** — Contact precautions. An isolation method applied to pathogens transmitted through direct or indirect contact with the patient's skin, mucous membranes, or contaminated objects. Wearing a gown and gloves is mandatory.
- **Clostridioides difficile (C. diff)** — A gram-positive bacillus that causes antibiotic-associated diarrhea and colitis. It forms spores, allowing it to survive for long periods in the environment, and is resistant to alcohol-based hand sanitizers, so hand washing with soap and water is recommended.
- **Personal Protective Equipment** — Personal protective equipment. Gowns, gloves, masks, goggles, face shields, and other equipment worn by healthcare workers to protect them from sources of infection. Since contaminated PPE itself can become a vehicle for infection transmission, proper removal sequence and disposal are important.
- **Hand Hygiene** — Hand hygiene. The most basic and effective method for preventing infection. It includes using alcohol-based hand sanitizer or washing hands with soap and water. For certain pathogens like C. difficile, using soap and water is essential.

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