Nursing Application: Infection Prevention and Control

Ms. Martin has not had much of an appetite since her surgery and has lost 4 pounds. Which nutrients should Ms. Martin increase to support healing?

Clients who have had an infection or wound should increase protein in their diet. ​ Dairy, water, and carbohydrates will not support healing as much as proteins. ​

The nurse is having a conversation about Ms. Martin's nursing diagnoses with the next nurse taking over her care:

"Ms. Martin has impaired skin integrity. She has this because she had a left total knee replacement. I know this because I assessed pain, redness, swelling, and drainage in her left knee. She also has anxiety. She developed this after I told her she had MRSA. I know this because she appeared upset. Finally, she has deficient knowledge due to her new diagnosis of MRSA. I gave her this diagnosis since she asked what MRSA was and made a remark about leaving. She may be at risk for impaired social interaction related to isolation since she asked about friends visiting."

Jane Martin's son visits her and asks the nurse what could have contributed to Ms. Martin getting an infection. The nurse bases their answer on knowing that Ms. Martin has a higher risk for developing an infection. Which factors make Ms. Martin more susceptible to infection? Select all that apply.​

Age, poor nutrition, and stress can contribute to infection by decreasing the effectiveness of the immune system. A higher blood sugar level, not a lower blood sugar level, will also decrease the effectiveness of the immune system. Ms. Martin's gender is not a risk factor in this situation.

One of the goals for Ms. Martin was to describe ways to prevent transmission of methicillin-resistant Staphylococcus aureus (MRSA)​. Which statement demonstrates the expected outcome?

If the goal is to describe ways to prevent transmission of MRSA, an expected outcome would be that Ms. Martin will demonstrate appropriate hand hygiene. It is the staff (not clients) who don PPE to protect themselves from transmission. Describing a diet and risk factors does not support the goal.

Negative psychological effects of being in isolation occur when typical social relations are disrupted. What can the nurse do to ease these effects?​

Implementing other social options, such as video chat, can help the client stay in contact with loved ones. ​ Encouraging more visitors can promote infection transmission. Clumping care will cause the client to be alone more. Having unlicensed assistive personnel in the room will decrease loneliness but is not cost effective. Nurses need to be aware of unit costs and try alternative options before using additional staff. ​

Reflect on Ms. Martin's discharge teaching and how methicillin-resistant Staphylococcus aureus (MRSA)​ could be transmitted to her husband if precautions are not taken. Use the drop-down menus to match the element with the correct stage of the chain of infection.​

MRSA is the infectious agent that lives in the reservoir of the left knee. It exits through the drainage from the knee and is transmitted by physical contact. All it takes is the drainage to come in contact with broken skin to be transmitted. Ms. Martin's husband is a susceptible host due to age and diabetic status. ​

After the discharge teaching was completed, which statement made by Ms. Martin indicates a need for further clarification by the nurse?​

Ms. Martin should avoid sharing personal items that have contact with the infected area. She should notify other providers of her status, take the antibiotics as directed, and wash her hands after caring for the wound.

Ms. Martin was admitted for treatment for methicillin-resistant Staphylococcus aureus (MRSA)​ and is in contact precautions. Which of Ms. Martin's statements is of most concern to the nurse?

Ms. Martin would be putting herself and others at risk if she left or had visitors. Her infection could worsen and others, such as her husband and friends, could be exposed. It is appropriate for her to ask questions and worry about her infection​.

Review the scenario. Select all the factors that put Ms. Martin at risk for infection. ​

Ms. Martin's risk factors include her age, recent surgery, and her diabetic status. Her vital signs and oral antihyperglycemic medication do not put her at risk

Ms. Martin's healthcare provider has decided to put in a peripherally inserted central catheter (PICC) line, so Ms. Martin can receive intravenous antibiotics for 3 weeks. What type of preparation should the nurse anticipate for this invasive procedure? Select all that apply.​

Surgical asepsis is a sterile technique that is used for any invasive procedures. Surgical asepsis eliminates all microorganisms from an object or area. This can be done at the client's bedside as well as in the operating room. The staff will be wearing a cap, gown, mask, and sterilized gloves during the procedure. The catheter and equipment must be sterile.

Ms. Martin asks the nurse why some of the staff members wash their hands at the sink and others just wipe their hands with the stuff in the container. How should the nurse correctly respond to Ms. Martin about hand hygiene?

The Centers for Disease Control and Prevention (CDC, 2019) states that alcohol-based hand sanitizers have excellent germicidal activity and are as effective as soap and water "when the hands are not visibly dirty" ("Which One?" Section). Hand sanitizers improve hand hygiene practices, protect the hands, and reduce the transmission of pathogens. Soap and water should be used if the hands are visibly soiled or the client has infectious diarrhea. ​

The client is on precautions and the nurse is finished with care. What is the correct order of removing the personal protective equipment (PPE)?

The correct order for removing personal protective equipment​ (PPE) is: gloves face shield gown mask During removal, the goal is to avoid contamination of the person themselves or the environment with the contaminated equipment. Generally, the outside front and sleeves of a gown, the outside front of face protection, and the outside of gloves are considered contaminated regardless of whether they appear soiled. ​ When a gown or full PPE is worn, PPE should be removed at the doorway to a client's room or in an anteroom. Masks should always be taken off outside a client's room, once the door is closed. ​

The infectious agent is a microorganism like a bacteria or virus. It lives in a reservoir such as a person. It leaves via the portal of exit through excretions or secretions. Then it infects another person by the mode of transmission. It passes to the next person through the portal of entry like the mucous membranes or skin. The person will not be infected unless they are a susceptible host.

The infectious agent is a microorganism like a bacteria or virus. It lives in a reservoir such as a person. It leaves via the portal of exit through excretions or secretions. Then it infects another person by the mode of transmission. It passes to the next person through the portal of entry like the mucous membranes or skin. The person will not be infected unless they are a susceptible host.

The client tests positive for methicillin-resistant Staphylococcus aureus (MRSA). What are the nurse's best actions? Select all that apply.

The nurse should first contact the provider for contact isolation orders, then gather the supplies needed and educate the client. MRSA is not an airborne infection. Notifying the family will violate the Health Insurance Portability and Accountability Act of 1996 (HIPAA). ​

The nurse sees a group of nursing students enter Ms. Martin's room who has been diagnosed with methicillin-resistant Staphylococcus aureus (MRSA). They are going to watch a head-to-toe assessment. Which students should the nurse talk with about proper contact precautions? Select all that apply.

When interacting with a client on contact precaution (such as is required for MRSA), the student needs a gown and gloves. The stethoscope should not be taken inside the room. The student does not need a hair covering or mask. The student needs a gown but not a mask.

​Infectious agent—MRSA = Decontamination or treatment ​ Reservoir—Left knee incision = Disinfection and hygiene​ Portal of exit—Wound drainage = Control of secretions and hygiene​ Mode of transmission—Physical contact = Isolation precautions​ Portal of entry—Broken skin on husband's hand = Cover openings and hygiene​ Susceptible host—Age and Diabetes = Recognize high risk persons

​Infectious agent—MRSA = Decontamination or treatment ​ Reservoir—Left knee incision = Disinfection and hygiene​ Portal of exit—Wound drainage = Control of secretions and hygiene​ Mode of transmission—Physical contact = Isolation precautions​ Portal of entry—Broken skin on husband's hand = Cover openings and hygiene​ Susceptible host—Age and Diabetes = Recognize high risk persons