# A nurse is providing education to hospital staff about bioterrorism preparedness. Which action should be the nurse's first priority when a suspected biological agent exposure occurs?

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> subject: Fundamentals

## 문제

A nurse is providing education to hospital staff about bioterrorism preparedness. Which action should be the nurse's first priority when a suspected biological agent exposure occurs?

## 보기

1. Notify the Centers for Disease Control and Prevention (CDC)
2. Implement standard and transmission-based precautions immediately **✔ 정답**
3. Begin decontamination procedures for all exposed individuals
4. Evacuate the affected area and seal all entrances

**정답: 2**

## 해설

Immediate infection control with standard and transmission-based precautions is the priority to prevent transmission. Other actions like notification or decontamination follow after.

## 심화 해설

Understanding the Priority in a Biological Exposure Event

When a suspected biological agent exposure occurs in a healthcare setting, the immediate priority is not notification, decontamination, or area evacuation. It is the rapid implementation of infection prevention and control measures to protect healthcare workers, other patients, and the exposed individual from further harm. The primary goal is to break the chain of infection at the point of care. This is achieved by immediately applying standard precautions (hand hygiene, appropriate personal protective equipment or PPE) and, based on the suspected agent's mode of transmission, transmission-based precautions (contact, droplet, or airborne). This action contains the threat at the source, which is the most critical first step in any biological incident response.

The rationale is rooted in the fundamental principles of hospital preparedness for chemical, biological, radiological, and nuclear (CBRN) incidents. Research on hospital preparedness highlights that a lack of robust, immediately actionable infection control protocols is a primary barrier to effective response. A qualitative study on CBRN preparedness identified that the absence of standard operating procedures and insufficient training for healthcare staff are critical obstacles [1]. This evidence directly supports that the first clinical action must be the execution of a pre-established, practiced protocol—namely, the immediate initiation of isolation precautions. Without this step, the biological agent can spread unchecked within the facility, turning the hospital itself into a source of secondary contamination and compromising the entire response effort.

An audit of a military hospital's preparedness for biological threats reinforces this sequence of actions. The study's action research methodology focused on developing and implementing a structured response plan, where the very first operational step upon suspecting a biological exposure is the activation of infection control measures . This includes donning appropriate PPE and isolating the patient using the correct precautions. The audit process itself was designed to measure and improve this immediate clinical behavior. Therefore, while notifying public health authorities like the CDC (option 1), initiating formal decontamination (option 3), and securing the physical environment (option 4) are all essential components of a comprehensive response, they are secondary actions that follow the immediate clinical imperative of protecting the care environment and its occupants through standard and transmission-based precautions.

References (research sources)

- [1]A qualitative study on barriers and strategies to hospital preparedness against chemical, biological, radiological, and nuclear incidents.Research articleBaikmohammadi S, Amirheidari B, Dehesh T, Moghadam MN, Yazdi-Feyzabadi V, Hassani E, Habibzadeh H. (2024) · DOI: 10.4103/jehp.jehp_1827_22

## 임상 시나리오

Clinical Practice Guide: First Response to a Suspected Biological Exposure

**Immediate Action:** Upon suspicion of a biological agent exposure, the nurse's first priority is to immediately implement **Standard Precautions** (hand hygiene, donning appropriate PPE) and initiate **Transmission-Based Precautions** based on the suspected agent's likely route of transmission (contact, droplet, or airborne). This action contains the threat at the source, breaking the chain of infection to protect the exposed individual, staff, and other patients.

**Critical Reminder:** Do not delay isolation and PPE use to await confirmation of the agent or to notify external agencies. The safety of the immediate environment depends on this first clinical step.

Sequential Response Steps

- **Isolate and Protect:** Place the patient in a private room with the appropriate ventilation (e.g., airborne infection isolation room if aerosolized agent is suspected) and ensure all staff entering the room use the correct PPE.

- **Notify Internal Chain of Command:** Immediately inform the charge nurse, infection control department, and facility emergency management coordinator per hospital policy.

- **Assess and Stabilize:** Provide life-saving medical care concurrently with infection control measures. Decontamination, if indicated, is performed after initial isolation and PPE donning.

- **External Notification:** The facility's designated official, not the bedside nurse, typically contacts public health authorities (e.g., CDC) after internal notification and initial containment are underway.

- **Area Management:** Decisions regarding evacuation or sealing of the area are made by the incident command team based on the nature of the agent and facility protocols, not as a first-line nursing action.

**Evidence-Based Rationale:** Research on hospital CBRN preparedness identifies the lack of immediately actionable infection control protocols as a primary barrier to effective response. A qualitative study found that the absence of standard operating procedures and insufficient staff training are critical obstacles, reinforcing that the first clinical action must be the execution of a pre-established, practiced protocol of isolation and precautions.

## 핵심 개념

- **Standard Precautions** — The minimum infection prevention practices that apply to all patient care, including hand hygiene and use of PPE, to protect healthcare workers and patients.
- **Transmission-Based Precautions** — Additional infection control measures used for patients known or suspected to be infected with highly transmissible pathogens, categorized as contact, droplet, or airborne.
- **Bioterrorism** — The intentional release of viruses, bacteria, or other germs that can sicken or kill people, livestock, or crops.
- **Chain of Infection** — A model describing the six components necessary for an infection to spread: infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, and susceptible host.
- **CBRN** — An acronym for Chemical, Biological, Radiological, and Nuclear incidents, representing types of hazardous events requiring specialized preparedness and response.

## 같은 주제 문제

- [A nurse is educating hospital staff about responding to a potential bioterrorism attack. W…](https://mymerci.kr/pages/nclex_q.php?qn_id=542769)

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