# A 6-month-old infant is admitted to the pediatric unit with RSV bronchiolitis. The infant is receiving supplemental oxygen via nasal cannula at 2 L/min and has been placed in contact isolation. Which nursing action is the MOST important to prevent transmission of RSV to other patients and healthcare workers?

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> subject: Infectious Diseases

## 문제

A 6-month-old infant is admitted to the pediatric unit with RSV bronchiolitis. The infant is receiving supplemental oxygen via nasal cannula at 2 L/min and has been placed in contact isolation. Which nursing action is the MOST important to prevent transmission of RSV to other patients and healthcare workers?

## 보기

1. Wearing a surgical mask when entering the patient's room
2. Placing the infant in a negative pressure isolation room
3. Administering palivizumab (Synagis) to exposed patients
4. Performing strict hand hygiene before and after patient contact **✔ 정답**

**정답: 4**

## 해설

RSV is primarily transmitted via contact with contaminated surfaces and respiratory droplets. Strict hand hygiene is the most effective measure to prevent transmission, directly blocking this route. Other options are less critical: surgical masks are not primary for RSV, negative pressure rooms are for airborne pathogens, and palivizumab is for prophylaxis, not immediate prevention.

## 심화 해설

Understanding the Rationale

The question asks for the most important nursing action to prevent RSV transmission. While RSV is primarily known to spread through direct contact with infectious secretions, the provided evidence introduces a critical nuance regarding airborne presence. The correct answer is grounded in the fundamental and most effective measure against contact-spread organisms, which remains the cornerstone of prevention.

Analysis of the Correct Answer: Strict Hand Hygiene

Performing strict hand hygiene before and after patient contact is the single most critical action. RSV is an enveloped virus that is easily inactivated by soap and water, as well as alcohol-based hand rubs. The virus can survive for hours on nonporous surfaces like bed rails, stethoscopes, and doorknobs. A healthcare worker's hands become contaminated by touching these fomites or the infant directly, and then serve as a vector to inoculate the virus into their own mucous membranes or those of another patient. This is the primary transmission route that hand hygiene directly breaks.

Analysis of Incorrect Answers

Option 1: Wearing a surgical mask when entering the patient's room

While the provided study by Alfaro-Perez et al. detected airborne RSV genetic material in a pediatric emergency corridor, demonstrating the potential for aerosol transmission, current standard infection control practices for routine care of RSV bronchiolitis do not mandate a surgical mask as the most important intervention. Contact precautions are the primary standard. The detection of viral RNA in the air does not definitively confirm that the detected particles are fully infectious virions capable of causing disease. Therefore, while a mask may offer an added layer of protection, it is secondary to breaking the dominant contact transmission chain with hand hygiene. [1]

Option 2: Placing the infant in a negative pressure isolation room

A negative pressure room is reserved for pathogens that are transmitted exclusively over long distances via small droplet nuclei (airborne transmission), such as tuberculosis, measles, or varicella. Although the research by Alfaro-Perez et al. suggests RSV can be an opportunistic airborne pathogen in certain settings, it is not classified as a strict airborne-transmitted disease requiring negative pressure. Standard contact and droplet precautions in a private room are sufficient and appropriate. [1]

Option 3: Administering palivizumab (Synagis) to exposed patients

Palivizumab is a monoclonal antibody used for prophylaxis (prevention) of serious RSV disease in specific high-risk infants, such as those born extremely premature or with hemodynamically significant congenital heart disease. It is not a treatment for active infection, nor is it a post-exposure prophylactic agent for healthcare workers or other patients on a general pediatric unit. Administering it to exposed patients is not a standard infection control practice and would not be an effective immediate measure to halt an outbreak.

Integrating the Evidence for a Deeper Understanding

The study by Alfaro-Perez et al. is significant because it challenges the traditional view of RSV transmission. By using RT-qPCR to detect the RSV matrix gene in air samples from a pediatric emergency corridor, the study provides molecular evidence that viral genetic material can become airborne. This finding suggests that in real-world, high-traffic clinical environments, aerosolization of the virus is possible, likely through coughing, sneezing, or even aerosol-generating procedures. [1]

This evidence underscores why a multi-faceted approach to infection control is prudent. While hand hygiene remains the most critical step to break the primary contact transmission cycle, the potential for airborne spread highlights the importance of other measures. These include wearing a mask for close patient contact, especially during suctioning or when an infant is coughing vigorously, and ensuring the patient is in a private room to contain both large droplets and any potential smaller aerosols. The research does not negate the primacy of contact precautions but rather reinforces the need for rigorous compliance with all components of isolation, with hand hygiene as the non-negotiable foundation.References (research sources)

- [1]Pediatric respiratory syncytial virus infections associated with hospital airborne viral genetic load detection.Research articleAlfaro-Perez C, de Llanos R, Herrero Cucó LA, Delgado-Saborit JM. (2026) · DOI: 10.1017/ice.2025.10372

## 임상 시나리오

Clinical Practice Guide: Preventing RSV Transmission in the Pediatric Unit

**Core Principle:** RSV is an enveloped virus that is easily inactivated by soap, water, and alcohol-based hand rubs. It can survive for hours on nonporous surfaces. The primary transmission route is via contaminated hands, making strict hand hygiene the most critical intervention.

Key Nursing Actions:

- **Hand Hygiene:** Perform meticulous hand hygiene using an alcohol-based hand rub or soap and water before and after every patient contact, after touching potentially contaminated surfaces, and after glove removal.

- **Contact Precautions:** Wear gloves and a gown upon entering the room. Remove and discard PPE before exiting, followed immediately by hand hygiene.

- **Patient Placement:** Place the infant in a single room or cohort with other RSV-positive patients. A negative pressure room is not indicated for routine care.

- **Environmental Cleaning:** Ensure frequent cleaning and disinfection of high-touch surfaces (bed rails, doorknobs, medical equipment) with an EPA-registered hospital disinfectant.

- **Respiratory Etiquette:** Educate visitors and staff on covering coughs and sneezes. A surgical mask is not required for standard contact isolation but may be worn for source control if the patient has a productive cough.

**Note on Palivizumab:** This is a prophylactic agent for specific high-risk populations (e.g., premature infants with chronic lung disease). It is not a post-exposure treatment and plays no role in acute outbreak control.

## 핵심 개념

- **RSV (Respiratory Syncytial Virus)** — A highly contagious enveloped virus causing respiratory tract infections, primarily spread through direct contact with infectious secretions and fomites.
- **Contact Isolation** — Infection control precautions used for pathogens spread by direct or indirect contact, emphasizing hand hygiene, gloves, and gowns.
- **Fomite** — An inanimate object or surface, such as a stethoscope or bed rail, that can become contaminated with infectious agents and transmit them to a new host.
- **Palivizumab (Synagis)** — A monoclonal antibody given prophylactically to high-risk infants to prevent severe RSV disease, not used for treatment or outbreak control.
- **Hand Hygiene** — The act of cleaning hands with soap and water or an alcohol-based hand rub to remove or destroy transient microorganisms, the most effective way to prevent contact transmission.

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