# A 6-year-old child has been diagnosed with pinworms (Enterobius vermicularis). Which intervention should the nurse prioritize when educating the family about preventing reinfection?

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> url: https://mymerci.kr/pages/nclex_q.php?qn_id=542131  
> language: ko  
> subject: Child Health

## 문제

A 6-year-old child has been diagnosed with pinworms (Enterobius vermicularis). Which intervention should the nurse prioritize when educating the family about preventing reinfection?

## 보기

1. Administer antiparasitic medication only to the infected child
2. Wash all clothing and bedding in cold water with regular detergent
3. Keep the child isolated from siblings for 2 weeks after treatment
4. Ensure all family members trim their fingernails short and practice frequent handwashing **✔ 정답**

**정답: 4**

## 해설

Pinworm reinfection is prevented by meticulous hygiene for all family members, including short fingernails and frequent handwashing. Other options are less effective as they don't address the primary fecal-oral transmission route.

## 심화 해설

Understanding Pinworm Transmission and Reinfection

Pinworm (Enterobius vermicularis) infection is highly prevalent among children, particularly in group settings like schools, due to its efficient fecal-oral and fomite-mediated transmission cycle . The female worm migrates to the perianal area, typically at night, to deposit eggs, causing intense pruritus. When a child scratches, eggs are trapped under the fingernails and can be immediately re-ingested (auto-infection) or transferred to surfaces, clothing, and bedding, where they can survive for up to two to three weeks. Therefore, breaking the hand-to-mouth cycle is the cornerstone of preventing reinfection and household spread.

Prioritizing the Correct Intervention

The nurse should prioritize ensuring all family members trim their fingernails short and practice frequent handwashing. The perianal scratching response is a direct vector for egg dissemination. A cross-sectional study of rural schoolchildren identified specific hygiene habits as significant risk factors for E. vermicularis infection, including the failure to wash hands before meals and after defecation, as well as not trimming fingernails . Long fingernails provide a protected reservoir for eggs, making mechanical removal through handwashing less effective. Educating the family that meticulous hand hygiene and short nails physically remove and prevent the harboring of eggs directly interrupts the primary route of reinfection and transmission to siblings and caregivers [1,4].

Analysis of Incorrect Options

- **Option 1:** Administering antiparasitic medication only to the infected child is insufficient. Because pinworm is easily transmitted within a household through contaminated fomites and close contact, asymptomatic carriage among family members is common. Treating only the index case often leads to a "ping-pong" effect of reinfection; therefore, treating the entire household simultaneously is the standard recommendation to eliminate the reservoir .

- **Option 2:** Washing clothing and bedding in cold water is ineffective. Pinworm eggs are hardy and require hot water and high-heat drying to be reliably killed. Cold water washing will not eliminate the eggs from contaminated linens and pajamas, allowing for continued fomite transmission .

- **Option 3:** Isolating the child from siblings for two weeks is not necessary or evidence-based. By the time a diagnosis is made, exposure has already occurred. The focus should be on simultaneous treatment of all household contacts and rigorous environmental and hand hygiene rather than physical isolation, which is impractical and psychologically burdensome for a young child [1,4].

## 임상 시나리오

Clinical Practice Guide

Pinworm (Enterobius vermicularis) Reinfection Prevention

The highest priority for family education is strict hand hygiene and short fingernails for **all household members** to break the fecal-oral transmission cycle.

Hygiene Protocol

- Trim fingernails short and keep them clean; avoid nail-biting.

- Perform thorough handwashing with soap and water after using the toilet, before eating, and upon waking.

- Shower each morning to remove eggs deposited overnight.

Environmental Control

- Wash all bedding, pajamas, and underwear in hot water and dry on high heat.

- Vacuum and damp-dust living areas to remove eggs from surfaces.

- Avoid shaking linens to prevent aerosolizing eggs.

**Key Point:** Treat all household members simultaneously with medication (e.g., albendazole or mebendazole) as prescribed, with a repeat dose in 2 weeks. Eggs can survive on fomites for 2-3 weeks.

## 핵심 개념

- **Enterobius vermicularis** — A parasitic nematode causing pinworm infection, characterized by perianal itching due to nocturnal egg deposition by the female worm.
- **Auto-infection** — A reinfection process where eggs transferred from the perianal area to the mouth via contaminated fingers are re-ingested by the same host.
- **Fomite-mediated transmission** — The spread of infectious agents through inanimate objects such as bedding, clothing, or toys that have been contaminated with pinworm eggs.

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