CNA Isolation Precautions 2 — Questions and Answers

Question 1: A resident is diagnosed with MRSA (Methicillin-resistant Staphylococcus aureus) in a wound. Which type of isolation precautions is required?

Contact precautions (Correct answer)
Droplet precautions
Airborne precautions
Neutropenic precautions

Correct answer: Contact precautions

MRSA is transmitted through direct contact with infected wounds or contaminated surfaces. Contact precautions are required to prevent spread to other residents and staff.

Contact precautions are used when a pathogen is spread primarily through direct contact with the resident or indirect contact with contaminated surfaces and objects. Pathogens requiring contact precautions include: - MRSA (Methicillin-resistant Staphylococcus aureus) - VRE (Vancomycin-resistant Enterococcus) - C. difficile (Clostridioides difficile) — diarrheal disease - Scabies - Wound infections with resistant organisms - Some viral gastroenteritis Contact precaution requirements: - Single room preferred (or cohort with same infection) - Gloves: Don upon entering room; remove and dispose before leaving - Gown: Don upon entering; remove before leaving room - Hand hygiene with soap and water or alcohol-based hand rub before and after glove/gown use - Dedicated equipment: Use single-use or resident-dedicated equipment (stethoscope, BP cuff, thermometer) to avoid cross-contamination - Limit transport of resident outside the room to essential medical needs only - Inform receiving departments of precaution status when transporting For C. difficile specifically, alcohol-based hand rubs are NOT effective — hand hygiene must be done with soap and water, as C. diff spores resist alcohol.

Question 2: Influenza (flu) spreads primarily through respiratory droplets produced when an infected person coughs or sneezes. Which precaution type is required?

Droplet precautions (Correct answer)
Airborne precautions
Contact precautions
Standard precautions only

Correct answer: Droplet precautions

Influenza spreads through large respiratory droplets (not tiny airborne particles) that fall quickly and travel less than 6 feet. Droplet precautions are required.

Droplet precautions are used when pathogens spread through large respiratory droplets (>5 microns in diameter) produced by coughing, sneezing, talking, or suctioning. These droplets travel approximately 3-6 feet and fall to surfaces — they do not remain suspended in the air for long periods. Pathogens requiring droplet precautions: - Influenza A and B - COVID-19 (both droplet and contact — many facilities use enhanced respiratory precautions) - Respiratory Syncytial Virus (RSV) - Pertussis (whooping cough) - Meningococcal disease - Mumps, rubella Droplet precaution requirements: - Single room preferred (door may remain open) - Surgical mask: Wear when within 3-6 feet of the resident; don before entering room - Eye protection (goggles or face shield): Wear when splashing of secretions is possible - Gloves and gown: Not required for droplet precautions alone, but standard precautions apply (use gloves if touching body fluids) - Place a surgical mask on the resident if they must be transported Droplet precautions differ from airborne precautions (which require N95 respirators and negative-pressure rooms) because the droplets are larger and travel shorter distances. Knowing the difference is important for selecting the correct PPE.

Question 3: In what order should personal protective equipment (PPE) be put on (donned) before entering a contact precaution room?

Gown first, then mask (if needed), then eye protection, then gloves last (Correct answer)
Gloves first, then gown, then mask, then eye protection
Mask first, then eye protection, then gown, then gloves
The order does not matter as long as all PPE is worn

Correct answer: Gown first, then mask (if needed), then eye protection, then gloves last

The standard PPE donning sequence is: gown first (provides body coverage), then mask/respirator, then eye protection, then gloves last (gloves go over gown cuffs to prevent gaps).

Proper donning (putting on) and doffing (taking off) order is critical for infection prevention. The CDC-recommended donning sequence: 1. Gown: Fully cover the torso from neck to knees and arms to wrist. Secure at the neck and waist. The gown protects the largest body surface first. 2. Mask or respirator: Secure ties or earloops. Mold the nose piece to fit. For N95: perform a seal check. 3. Eye protection (goggles or face shield): Place over the face and eyes. Adjust for a comfortable, secure fit. 4. Gloves: Don after the gown and extend gloves over the gown cuffs to prevent skin exposure at the wrist gap. The logic: the gown goes on first to protect clothing. The mask and eye protection go on next because touching the face after gowning (but before gloving) is still relatively safe. Gloves go on last because they are the most contaminated barrier during care — wearing them last minimizes self-contamination. Doffing (removal) is the reverse order and is even more critical because contamination risk is highest during removal: gloves off first → eye protection → gown → mask last. Hand hygiene is performed after removing each piece of PPE. The mask is removed last because the face coverings protect the respiratory mucous membranes even while handling contaminated gown and gloves.

Question 4: Tuberculosis (TB) requires airborne precautions. What type of room is needed for a resident with active TB?

Airborne Infection Isolation Room (AIIR) with negative air pressure (Correct answer)
A regular private room with the door closed
A room shared with other residents who also have TB
No special room is needed if staff wear N95 masks

Correct answer: Airborne Infection Isolation Room (AIIR) with negative air pressure

Active TB requires an Airborne Infection Isolation Room (AIIR) with negative pressure — air is drawn in from the hallway and exhausted outside or filtered, preventing TB bacilli from spreading to other areas of the facility.

Airborne precautions are the most rigorous transmission-based precautions. They are used for pathogens that spread through tiny droplet nuclei (<5 microns) that remain suspended in the air for extended periods and travel long distances. Pathogens requiring airborne precautions: - Mycobacterium tuberculosis (TB) - Measles (rubeola) - Varicella (chickenpox) - Disseminated zoster (shingles) - Smallpox Airborne precaution requirements: - AIIR (Airborne Infection Isolation Room): A specially ventilated single room with negative air pressure. Negative pressure means air flows from the hallway INTO the room, and contaminated air is exhausted to the outside (or through HEPA filtration) — not back into the hallway. The door must remain CLOSED at all times. - N95 respirator (or higher): Staff must wear a fit-tested N95 particulate respirator (not a surgical mask) when entering the AIIR. The N95 filters at least 95% of airborne particles. - Limit transport: Resident should leave the room only for essential procedures. Place a surgical mask on the resident if transport is unavoidable. If an AIIR is not available in the facility, the resident with suspected or confirmed airborne infection must be transferred to a hospital equipped with appropriate isolation facilities.

Question 5: Standard precautions should be used:

With every resident, regardless of their diagnosis or infection status (Correct answer)
Only when a resident has a known communicable disease
Only when the resident has blood visible on their skin
Only in ICU settings where resident acuity is highest

Correct answer: With every resident, regardless of their diagnosis or infection status

Standard precautions are the baseline infection prevention practices applied with all residents in all settings, regardless of whether a resident has a known infectious disease, because blood and body fluids may harbor undiagnosed pathogens.

Standard precautions (formerly 'universal precautions') are based on the principle that all blood, body fluids, secretions, excretions (except sweat), non-intact skin, and mucous membranes may contain transmissible infectious agents. They are applied to every resident encounter, regardless of diagnosis. Components of standard precautions: 1. Hand hygiene: The single most important infection control practice. Wash with soap and water or use alcohol-based hand rub before and after resident contact, after removing gloves, and after touching potentially contaminated surfaces. 2. PPE: Gloves when touching blood, body fluids, secretions, excretions, non-intact skin, or mucous membranes. Gown, mask, and eye protection when splashing is anticipated. 3. Safe injection practices (nursing responsibility). 4. Respiratory hygiene/cough etiquette: Teach residents, staff, and visitors to cover coughs and sneezes. 5. Safe handling of sharps (nursing responsibility). 6. Environmental cleaning and disinfection. 7. Proper handling of soiled linen. Transmission-based precautions (contact, droplet, airborne) are applied IN ADDITION to standard precautions — never instead of them. Consistently applying standard precautions with every resident protects staff, residents, and visitors from infection.

Question 6: When removing (doffing) contaminated gloves, what is the correct technique to prevent self-contamination?

Peel the first glove off by grasping the outside and pulling it inside out, then slide fingers under the second glove and peel it off inside out (Correct answer)
Pull both gloves off at the same time by grabbing each at the fingertip
Use scissors to cut the gloves off at the wrist
Remove gloves by pulling from the forearm area downward

Correct answer: Peel the first glove off by grasping the outside and pulling it inside out, then slide fingers under the second glove and peel it off inside out

Gloves are removed by peeling the first glove inside out over the fingers, holding it in the still-gloved hand, then sliding ungloved fingers under the cuff of the second glove and peeling it off inside out over the first glove — keeping contaminated surfaces contained inside.

The correct glove removal technique prevents the contaminated outer surfaces from touching bare skin: Step 1: With the dominant hand, grasp the outside (palm) of the opposite (non-dominant) glove. Do NOT touch the bare skin of the wrist. Step 2: Peel the glove off inside-out, turning it inside out as you pull it from the hand. Hold this inside-out glove in your still-gloved (dominant) hand. Step 3: Slide the fingers of the now-bare (non-dominant) hand UNDER the cuff of the remaining (dominant) glove at the wrist. Touch only the inside surface — not the contaminated outside. Step 4: Peel the second glove off inside-out over your fingers and over the balled-up first glove, enclosing both gloves together inside-out. Step 5: Dispose of both gloves (now inside-out, contaminated surfaces contained) in the appropriate waste receptacle. Step 6: Perform hand hygiene immediately after glove removal. This technique is sometimes summarized as 'glove in glove' or 'beak technique.' Practicing proper glove removal prevents self-inoculation — one of the most common ways healthcare workers accidentally expose themselves to pathogens during patient care.

CNA Isolation Precautions 2

A resident is diagnosed with MRSA (Methicillin-resistant Staphylococcus aureus) in a wound.
Which type of isolation precautions is required?