# A nurse is developing an infection control plan for a 65-year-old adult admitted to the medical unit with a confirmed diagnosis of hepatitis A. Which nursing intervention is the most appropriate priority to effectively prevent the transmission of this virus to staff and other clients?

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> subject: Adult Health

## 문제

A nurse is developing an infection control plan for a 65-year-old adult admitted to the medical unit with a confirmed diagnosis of hepatitis A. Which nursing intervention is the most appropriate priority to effectively prevent the transmission of this virus to staff and other clients?

## 보기

1. Maintain the client on contact precautions with hand hygiene emphasis
2. Implement contact precautions and ensure proper hand hygiene **✔ 정답**
3. Place the client in negative pressure isolation room
4. Administer prophylactic antibiotics to family members

**정답: 2**

## 해설

Hepatitis A spreads via fecal-oral route, making contact precautions and hand hygiene the priority to prevent transmission. Other options are inappropriate as they target respiratory or bacterial infections.

## 심화 해설

Understanding the Pathophysiology and Transmission of Hepatitis A

To determine the most appropriate priority intervention, it is essential to understand the mechanism of transmission for the hepatitis A virus (HAV). HAV is primarily transmitted via the fecal-oral route. This means the virus is shed in the stool of an infected person and enters a new host through ingestion, often via contaminated hands, food, or fomites. Unlike respiratory viruses, it is not suspended in the air over long distances, which immediately rules out airborne precautions. The clinical implication is that the patient's immediate environment and the hands of caregivers become the primary vectors for spread [1]. The review by Gehanno et al. highlights that direct contact and contaminated environments are major transmission pathways for biological hazards faced by healthcare workers, a mechanism that perfectly describes the risk posed by HAV [1].

Analyzing the Intervention Options

A systematic evaluation of each option against the known transmission pathway reveals why one intervention is clearly superior.

*   Option 1: Maintain the child on droplet precautions with mask requirement. This is incorrect for two critical reasons. First, the client is a 65-year-old adult, not a child, indicating a fundamental misreading of the scenario. Second, droplet precautions are designed for pathogens transmitted via large respiratory droplets (e.g., influenza, pertussis), not for enteric viruses like HAV. Applying a mask requirement would not interrupt the fecal-oral transmission cycle and would provide a false sense of security.

*   Option 3: Place the client in a negative pressure isolation room. This intervention is reserved for airborne precautions, which are necessary for pathogens that remain suspended in the air on small droplet nuclei (e.g., tuberculosis, measles). Hepatitis A is not transmitted via the airborne route, making this an inappropriate and resource-intensive measure that does not address the actual mechanism of spread.

*   Option 4: Administer prophylactic antibiotics to family members. This option demonstrates a dangerous misunderstanding of microbiology and pharmacology. Hepatitis A is a viral illness, and antibiotics are only effective against bacterial infections. Prophylactic antibiotics would have no effect on preventing HAV transmission and would contribute to unnecessary adverse effects and antimicrobial resistance. The appropriate post-exposure prophylaxis for HAV is the hepatitis A vaccine or immune globulin, not antibiotics.

*   Option 2: Implement contact precautions and ensure proper hand hygiene. This is the correct answer. Contact precautions are the standard of care for diseases transmitted by direct or indirect contact with the patient or their environment, which directly aligns with the fecal-oral route of HAV. This involves the use of gloves and a gown when entering the patient's room. The cornerstone of this intervention, however, is effective hand hygiene. The multisociety guidance on infection prevention and control emphasizes that adherence to precautions and effective hand hygiene are fundamental to preventing transmission in healthcare settings . The critical importance of hand hygiene in breaking the chain of infection is a universal principle, applicable from community education by nursing students to high-acuity medical units . A study on emergency health workers further confirms that knowledge and application of isolation precautions, of which contact isolation is a key component, are directly related to the prevention of infectious disease transmission . For a patient with hepatitis A, rigorous handwashing with soap and water after any contact with the patient or their surroundings is the single most effective measure to remove spores and viruses from the hands, thereby protecting staff and other clients.References (research sources)

- [1]Infectious contamination of healthcare workers.Research articleGehanno JF, Rollin L, Bensefa-Colas L. (2026) · DOI: 10.1016/j.lpm.2026.104349

## 임상 시나리오

Clinical Practice Guide: Hepatitis A Infection Control

Transmission and Risk

Hepatitis A virus (HAV) is transmitted primarily via the fecal-oral route. The virus is shed in high concentrations in the stool of infected individuals during the late incubation period and early symptomatic phase. Healthcare workers are at risk through direct contact with contaminated feces, soiled linens, or environmental surfaces. Unlike bloodborne hepatitis viruses (HBV, HCV), HAV does not establish chronic infection and viremia is transient, making bloodborne transmission rare.

Priority Nursing Interventions

- **Contact Precautions:** Implement immediately upon suspicion or confirmation of HAV. Wear gloves upon room entry and a gown if substantial contact with the patient or environmental surfaces is anticipated. Use dedicated patient-care equipment (e.g., stethoscope, thermometer) or clean and disinfect shared equipment between patients.

- **Hand Hygiene:** Perform hand hygiene with soap and water after removing gloves and after any contact with the patient or their immediate environment. Alcohol-based hand rubs are less effective against non-enveloped viruses like HAV; therefore, soap and water washing is preferred when hands are visibly soiled or after potential fecal exposure.

- **Patient Placement:** A private room is preferred. If unavailable, cohort with another patient with the same confirmed infection. A negative pressure room is not indicated as HAV is not airborne.

- **Environmental Cleaning:** Use an EPA-registered disinfectant effective against non-enveloped viruses. Frequently touched surfaces (bed rails, call bell, bathroom fixtures) require meticulous daily and terminal cleaning.

Post-Exposure Management

For unvaccinated staff or close contacts with significant exposure (e.g., fecal-oral contact), post-exposure prophylaxis (PEP) should be administered within 2 weeks. Options include a single dose of hepatitis A vaccine (preferred for healthy individuals aged 1-40 years) or hepatitis A immune globulin (IG) for those outside this age range or with contraindications. Prophylactic antibiotics have no role in viral post-exposure management.

Patient and Family Education

- Reinforce strict handwashing with soap and water after using the bathroom and before eating or preparing food.

- Advise against preparing food for others while symptomatic.

- Explain that the patient is most infectious during the 2 weeks before jaundice onset and remains infectious for about 1 week after jaundice appears.

- Recommend vaccination for all unvaccinated household members and close contacts.

## 핵심 개념

- **Hepatitis A Virus (HAV)** — A liver infection caused by the hepatitis A virus, primarily transmitted via the fecal-oral route through ingestion of contaminated food, water, or direct contact with an infected person.
- **Contact Precautions** — Infection prevention measures used for pathogens spread by direct or indirect contact; includes wearing gloves and gowns, and dedicated patient equipment.
- **Fecal-Oral Route** — A transmission pathway where pathogens from fecal matter of an infected person enter the mouth of another person, often through contaminated hands, food, or surfaces.
- **Hand Hygiene** — The act of cleaning hands with soap and water or alcohol-based hand rub to remove pathogens; the single most critical measure to prevent infection spread.

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