# A 6-year-old child presents to the school nurse with red, swollen eyes and thick, yellow discharge. The child reports that both eyes are 'sticky' in the morning and hurt when blinking. Which nursing intervention should be prioritized to prevent transmission to others?

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> url: https://mymerci.kr/pages/nclex_q.php?qn_id=542569  
> language: ko  
> subject: Child Health

## 문제

A 6-year-old child presents to the school nurse with red, swollen eyes and thick, yellow discharge. The child reports that both eyes are 'sticky' in the morning and hurt when blinking. Which nursing intervention should be prioritized to prevent transmission to others?

## 보기

1. Apply warm compresses to both eyes every 2 hours
2. Administer prescribed antibiotic eye drops as ordered
3. Encourage the child to avoid rubbing the eyes
4. Teach proper hand hygiene and eye care techniques **✔ 정답**

**정답: 4**

## 해설

Teaching proper hand hygiene and eye care techniques is the priority to prevent transmission, as bacterial conjunctivitis spreads through direct contact. Other interventions are important for treatment or comfort but do not directly address transmission prevention.

## 심화 해설

Clinical Presentation Analysis

The child presents with bilateral red, swollen eyes, thick yellow discharge, and crusting that glues the eyelids shut in the morning, accompanied by pain on blinking. This clinical picture is highly suggestive of acute bacterial conjunctivitis. The hallmark "sticky" discharge, which is purulent and thick, differentiates this from viral or allergic conjunctivitis, where the discharge is typically watery or mucoid. The bilateral nature and the school setting raise immediate concern for a highly contagious infectious process.

Priority Nursing Intervention and Rationale

The correct answer is 4. While all the listed interventions are components of comprehensive care for a child with bacterial conjunctivitis, the question specifically asks for the intervention that should be prioritized to prevent transmission to others. This shifts the nursing priority from direct patient treatment to public health and infection control within the school community.

Teaching proper hand hygiene and eye care techniques is the foundational and most impactful intervention for breaking the chain of infection. Conjunctivitis pathogens are most commonly transmitted through direct contact with infected ocular secretions or indirectly via contaminated hands and fomites. The child's report of "sticky" eyes in the morning indicates a significant accumulation of purulent, pathogen-rich discharge. A child's natural response is to rub or wipe the eyes, immediately contaminating their hands. These hands then act as vectors, transferring the bacteria to classmates, desktops, toys, and other surfaces. Therefore, the nurse's priority is to immediately educate the child and supervising adults on meticulous hand hygiene and the correct technique for managing eye discharge to contain the infectious material at its source.

Deep Dive into Infection Control Mechanisms

The rationale for prioritizing education on hand hygiene and eye care is deeply rooted in established infection prevention protocols. A quality improvement project in an ophthalmology department identified hand hygiene and protocol awareness as critical gaps in preventing infection transmission . The study's targeted interventions, which included revised guidelines and training, directly mirror the nursing action of teaching proper techniques. By instructing the child to use a separate, clean tissue for each eye and to perform hand hygiene immediately after, the nurse is implementing the core principle of source containment.

Furthermore, research on infection control awareness among nurses highlights that knowledge of standard precautions is fundamental but must be actively applied . The school nurse bridges the gap between theoretical knowledge and practical application for the child and staff. The effectiveness of this approach is supported by comparative research on hand hygiene modalities, which confirms that the mechanical action of hand washing and the chemical action of alcohol-based hand rubs are both effective in reducing microbial colonization on hands . Teaching the child when and how to use these methods directly reduces the bioburden on their hands, the primary vehicle for transmission. While administering prescribed antibiotic eye drops is essential for resolving the infection, it does not provide an immediate barrier to transmission; the child remains contagious for a period after treatment initiation. Applying warm compresses and discouraging eye rubbing are comfort and complication-prevention measures, but they do not address the primary mechanism of spread as directly and effectively as comprehensive hygiene education .

## 임상 시나리오

School Nurse Outbreak ControlManaging Highly Contagious Bacterial Conjunctivitis
The priority intervention for a child with purulent conjunctivitis in a group setting is teaching proper hand hygiene. Pathogens spread via direct contact with ocular secretions or contaminated fomites.

Instruct the child to wash hands with soap and water for at least 20 seconds after touching the eyes, and to use a separate, clean towel. Demonstrate correct technique for wiping discharge from the inner to outer canthus using a tissue that is immediately discarded.

CautionDo not allow sharing of towels, washcloths, or pillows. The child should be excluded from school until 24 hours after the initiation of effective antibiotic therapy, per standard infection control guidelines.

## 핵심 개념

- **Bacterial Conjunctivitis** — Inflammation of the conjunctiva caused by bacteria, characterized by purulent, thick yellow-green discharge and bilateral eye crusting.
- **Chain of Infection** — A model illustrating the six elements needed for infection transmission; breaking the 'mode of transmission' link via hand hygiene is key for conjunctivitis control.
- **Purulent Discharge** — Thick, opaque exudate containing white blood cells and pathogens, indicating bacterial infection and serving as a primary source of contagion.
- **Fomite Transmission** — Indirect contact spread where inanimate objects (e.g., towels, tissues) contaminated by infectious ocular secretions transfer pathogens to a new host.
- **Priority Setting** — A clinical judgment process where public health and infection control interventions are prioritized over comfort or direct treatment when the goal is preventing transmission.

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