# A nurse is caring for a patient with suspected tuberculosis (TB) who has been placed in airborne precautions. Which action by the nurse demonstrates correct implementation of airborne precautions?

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> subject: Fundamentals

## 문제

A nurse is caring for a patient with suspected tuberculosis (TB) who has been placed in airborne precautions. Which action by the nurse demonstrates correct implementation of airborne precautions?

## 보기

1. Wearing a surgical mask when entering the patient's room
2. Placing the patient in a private room with the door open for ventilation
3. Using standard precautions only since TB is not highly contagious
4. Wearing an N95 respirator mask when entering the patient's room **✔ 정답**

**정답: 4**

## 해설

Airborne precautions for TB require an N95 respirator to filter airborne droplet nuclei. Surgical masks, open doors, or standard precautions alone are insufficient for this highly contagious airborne disease.

## 심화 해설

Understanding Airborne Precautions for Tuberculosis

When caring for a patient with suspected or confirmed pulmonary tuberculosis, the primary goal is to prevent the inhalation of infectious droplet nuclei. Mycobacterium tuberculosis is transmitted through the airborne route, meaning the bacteria are carried in tiny particles (less than 5 microns) that can remain suspended in the air for hours and travel through ventilation systems. Standard surgical masks are insufficient because they are loose-fitting and do not filter these small airborne particles. The correct implementation of airborne precautions requires a properly fitted, fit-tested N95 respirator or a powered air-purifying respirator (PAPR), which filters at least 95% of airborne particles, creating a tight facial seal to protect the healthcare worker from inhalation exposure [1].

The rationale for this strict approach is grounded in the occupational risk described in infection prevention literature. Healthcare workers have persistent contact with potentially infectious patients, making primary preventive interventions—those that aim to diminish exposure at the source—essential [1]. Wearing an N95 respirator is a critical component of these primary interventions, acting as a barrier at the portal of entry, the respiratory tract. The narrative review on TB prevention strategies emphasizes that effective preventive interventions must be comprehensively evaluated and implemented to reduce the occupational burden of tuberculosis among healthcare workers [1]. This directly supports the action of using an N95 respirator as a non-negotiable standard of care.

The other options fail to meet the requirements for airborne precautions. Placing the patient in a private room is correct, but the door must remain closed to maintain negative pressure, which prevents contaminated air from escaping into the hallway. Leaving the door open for ventilation would breach this environmental control. Relying on standard precautions alone is a critical error, as standard precautions include hand hygiene and glove use for contact with body fluids but do not provide respiratory protection against airborne pathogens. The discussion of complex infection prevention decisions highlights that in high-stakes scenarios where guidance is clear, such as TB management, strict adherence to established protocols for healthcare worker protection is mandatory to mitigate significant safety and legal risks . Therefore, the N95 respirator is the only option that aligns with the hierarchy of controls for airborne infectious diseases.References (research sources)

- [1]Strategies for Tuberculosis Prevention in Healthcare Settings: A Narrative Review.Research articleDaradkeh AF, Alawyia B, Ballas H, Spernovasilis N, Alon-Ellenbogen D. (2025) · DOI: 10.3390/tropicalmed10110316

## 임상 시나리오

Clinical Implementation of Airborne Precautions for Tuberculosis

Room Setup and Environment

- Place the patient in a private, negative-pressure airborne infection isolation room (AIIR) with 6-12 air exchanges per hour.

- Keep the door closed at all times to maintain negative pressure and prevent contaminated air from escaping into the hallway.

- Verify that air from the room is exhausted directly outside or filtered through a high-efficiency particulate air (HEPA) filter before recirculation.

Respiratory Protection for Healthcare Workers

- Don a fit-tested N95 respirator or powered air-purifying respirator (PAPR) before entering the patient’s room.

- Perform a user seal check each time the N95 is applied to ensure an airtight facial seal.

- Remove the respirator only after exiting the room and closing the door to prevent inhalation exposure.

- Dispose of disposable respirators according to facility infection control policy after each use.

Patient Transport and Activity

- Limit patient movement outside the AIIR to essential medical purposes only.

- Instruct the patient to wear a surgical mask during transport to contain respiratory secretions.

- Notify the receiving department or area of the patient’s airborne precautions status before transport.

Additional Safety Measures

- Educate the patient on respiratory hygiene and cough etiquette, including covering the mouth and nose with a tissue when coughing.

- Place a sign on the door indicating airborne precautions to alert all staff and visitors.

- Ensure annual TB screening and fit-testing for all healthcare workers with potential exposure.

## 핵심 개념

- **Airborne Precautions** — Infection control measures used for diseases transmitted by small droplet nuclei (less than 5 microns) that remain suspended in air, requiring a negative pressure room and N95 respirator.
- **N95 Respirator** — A tight-fitting mask that filters at least 95% of airborne particles, requiring fit-testing to ensure a proper seal for healthcare workers.
- **Mycobacterium tuberculosis** — The bacterium causing tuberculosis, transmitted via airborne droplet nuclei that can travel through ventilation systems and remain suspended for hours.

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