CNA Isolation Precautions 3 — Questions and Answers
Question 1: A resident with localized herpes zoster (shingles) is immunocompetent. The lesions are on their torso and are completely covered by a dressing and their clothing. What is the minimum level of precaution a CNA should use when providing personal care?
- Airborne and Contact Precautions
- Droplet Precautions
- Standard Precautions (Correct answer)
- Contact Precautions
Correct answer: Standard Precautions
For an immunocompetent resident with localized shingles where the lesions can be fully covered and contained, Standard Precautions are sufficient. The virus spreads by direct contact with the fluid from the blisters. If the lesions are covered, the risk of transmission is effectively managed.
Question 2: A CNA is assigned to a resident who is in Contact Precautions for C. difficile and also on Protective (Reverse) Isolation due to being severely immunocompromised. Which of the following actions is most appropriate?
- Wear the same PPE for all residents to conserve supplies, as long as hands are washed.
- Care for the immunocompromised resident first, then care for other residents on the unit.
- Follow Contact Precautions only, as they are more stringent than Protective Isolation.
- Strictly adhere to both sets of precautions, including meticulous handwashing with soap and water and proper PPE sequencing. (Correct answer)
Correct answer: Strictly adhere to both sets of precautions, including meticulous handwashing with soap and water and proper PPE sequencing.
This complex scenario requires adhering to both sets of precautions to protect the resident from outside pathogens (Protective Isolation) and to protect staff and other residents from C. difficile (Contact Precautions). This involves a strict sequence of donning and doffing PPE and emphasizes handwashing with soap and water, as alcohol-based sanitizers do not kill C. difficile spores.
Question 3: When transporting a resident on Droplet Precautions to another department for a medical test, which action is essential for the CNA to perform?
- Have the resident wear an N95 respirator during transport.
- Wear a gown and gloves during the entire transport process.
- Notify the receiving department of the patient's isolation status. (Correct answer)
- Ensure the hallway is completely clear of all other people before transport.
Correct answer: Notify the receiving department of the patient's isolation status.
While placing a surgical mask on the patient is the primary measure to contain droplets, it is crucial to notify the receiving department beforehand. This allows their staff to prepare, maintain precautions, and ensure the safety of other patients and personnel in their area.
Question 4: A resident is on Contact Precautions. A family member brings them a stack of personal mail. What is the correct procedure for handling the mail?
- Refuse the mail as nothing can be brought into an isolation room.
- Place the mail in a plastic bag for 24 hours before giving it to the resident.
- Allow the family member to give the mail directly to the resident.
- Wear gloves to receive the mail and give it to the resident, then perform hand hygiene. (Correct answer)
Correct answer: Wear gloves to receive the mail and give it to the resident, then perform hand hygiene.
Personal items like mail can be brought into an isolation room. The CNA should follow facility policy, which generally involves using standard or contact precautions as appropriate. The key is to handle the items safely (e.g., with gloves if contact with contaminated surfaces is likely) and always perform hand hygiene after the interaction to prevent cross-contamination.
Question 5: Which of the following is a key difference in the environmental cleaning required for C. difficile compared to norovirus?
- Alcohol-based disinfectants are effective against norovirus but not C. difficile.
- C. difficile requires a sporicidal agent like bleach, while norovirus is inactivated by standard disinfectants. (Correct answer)
- Terminal cleaning for norovirus must include steam cleaning, which is optional for C. difficile.
- Cleaning for C. difficile focuses on high-touch surfaces, while norovirus cleaning focuses on floors.
Correct answer: C. difficile requires a sporicidal agent like bleach, while norovirus is inactivated by standard disinfectants.
C. difficile forms spores that are resistant to many standard hospital disinfectants and alcohol-based hand rubs. Therefore, environmental cleaning requires the use of an EPA-registered sporicidal disinfectant, most commonly a bleach-based product. While norovirus is also resilient, some standard disinfectants are effective, though bleach is often recommended for outbreaks.
Question 6: A CNA is preparing to exit the room of a resident on Airborne and Contact precautions. What is the last piece of Personal Protective Equipment (PPE) they should remove?
- Gown
- Respirator (N95 mask) (Correct answer)
- Gloves
- Goggles/Face Shield
Correct answer: Respirator (N95 mask)
When on Airborne Precautions, the respirator (N95 mask) should be removed after exiting the patient's room and closing the door. Gloves, goggles, and gown are removed inside the room at the doorway. This sequence prevents the inhalation of airborne particles that may be in the room's air.
CNA Isolation Precautions 3
A resident with localized herpes zoster (shingles) is immunocompetent.
The lesions are on their torso and are completely covered by a dressing and their clothing.
What is the minimum level of precaution a CNA should use when providing personal care?