Patient with MRSA admitted in MICU, the nurse has to provide colostomy care to patient. Which PPE should the… - AIIMS Delhi NO- 2019

AIIMS Delhi NO- 2019

Nursing Foundation

Hard

Appeared in: AIIMS Delhi NO- 2019

Explanation

The patient has MRSA, which requires Contact Precautions (gloves and gown) to prevent transmission through direct contact.
Colostomy care presents a significant risk of splashing or spraying of feces, which necessitates facial protection (mask and eye protection) as part of Standard Precautions.
Combining these precautions means the nurse must wear gloves, a gown, and a mask to be fully protected.
This combination effectively blocks the routes of transmission for MRSA (contact) and protects the nurse from exposure to infectious bodily fluids (splash).

Option B: Using only gloves is insufficient. A gown is mandatory for Contact Precautions with MRSA to protect the nurse's clothing and skin from contamination. Colostomy care involves extensive contact, making a gown essential.
Option C: This option omits the gown, which is a critical component of Contact Precautions for MRSA. Without a gown, the nurse's uniform is exposed to contamination.
Option D: Shoe covers are not a standard part of Contact Precautions for MRSA. They are typically only used in specific situations like widespread environmental contamination or in certain high-risk areas like operating rooms. This option also incorrectly omits the essential gown and mask.

Clinical Relevance

Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Application of Standard and Transmission-Based Precautions (Contact) for a patient with MRSA undergoing a procedure with splash risk in acute care settings.
Correct PPE use is a fundamental patient and staff safety measure. Failure to use appropriate PPE can lead to healthcare-associated infections (HAIs) in other patients and occupational exposure for the nurse.
Nurses must be able to assess the patient's diagnosis (MRSA) and the procedure (colostomy care) to determine the necessary level of precautions (Contact + Standard with splash risk).
What if? If the patient did not have MRSA but still required colostomy care, the nurse would still need to wear gloves and likely a gown and face protection due to the high risk of splash, as per Standard Precautions. The isolation requirement (Contact Precautions) is specific to the MRSA diagnosis.

How to Approach the Question

First, identify the key information in the stem: the patient's infectious status (MRSA) and the nursing procedure (colostomy care).
Recall the type of transmission-based precautions required for MRSA. MRSA is spread by contact, so Contact Precautions are necessary.
Remember the components of Contact Precautions: at a minimum, gloves and a gown.
Next, analyze the procedure. Colostomy care involves a high risk of splashing with feces (a body fluid).
Recall Standard Precautions for procedures with a risk of splash. This requires facial protection (mask and/or eye shield) in addition to gloves and a gown.
Combine the requirements: Contact Precautions (gown, gloves) + Standard Precautions for splash risk (mask). Evaluate the options to find the one that includes all three: Gloves, Gown, and Mask.

Concept Tested & Keywords

Concept Tested: Application of Standard and Transmission-Based Precautions (Contact) for a patient with MRSA undergoing a procedure with splash risk.
Stem keywords: MRSA, colostomy care, PPE
Lead-in keywords: Which
Clinical cues: Patient has MRSA, indicating the need for Contact Precautions.
Clinical cues: Procedure is colostomy care, indicating a risk of splashing bodily fluids.