Question

The nurse is caring for a client with tuberculosis. Which of the following is not a part of the client's care? A. Keeping the client's door closed at all times B. Wearing an N95 mask only when providing direct care C. Maintaining the client in a room with at least six exchanges of fresh air per hour D. Providing phototherapy with a source of ultraviolet light

Short answer

A) Keeping the client's door closed at all times B) Wearing an N95 mask only when providing direct care C) Maintaining the client in a room with at least six exchanges of fresh air per hour D) Providing phototherapy with a source of ultraviolet light Answer: B) Wearing an N95 mask only when providing direct care

Step-by-step solution

Analyze Option A - Keeping the client's door closed at all times

To prevent the spread of tuberculosis bacteria in the air and protect others in the hospital environment, it is essential to keep the client's door closed as much as possible. Therefore, option A is a part of the client's care.

Analyze Option B - Wearing an N95 mask only when providing direct care

Tuberculosis is an airborne infection, and healthcare providers should wear personal protective equipment (PPE) to minimize the risk of transmission. An N95 mask is required when providing direct care, but it should also be worn whenever entering the patient's room, regardless of the interaction. This means option B is not a part of the client's care and is likely the correct answer.

Analyze Option C - Maintaining the client in a room with at least six exchanges of fresh air per hour

Ensuring adequate ventilation is a crucial infection control measure for tuberculosis patients. A room with a minimum of six air exchanges per hour helps dilute and remove the infectious particles in the air. Therefore, option C is a part of the client's care.

Analyze Option D - Providing phototherapy with a source of ultraviolet light

Ultraviolet germicidal irradiation (UVGI) has been shown to be effective against airborne infections such as tuberculosis. However, it is generally used as an additional infection control measure to supplement other interventions, such as ventilation and respiratory protection. Therefore, option D is a part of the client's care.

Identify the correct answer

Given the analysis of each option, we can conclude that the correct answer is option B: Wearing an N95 mask only when providing direct care is not a part of the client's care, as healthcare providers should wear an N95 mask whenever entering the patient's room.

Key concepts

Infection Control Measures

Ensuring the safety of both patients and healthcare workers is paramount when dealing with infectious diseases like tuberculosis (TB). Infection control measures are practices and procedures that help prevent the spread of infection in healthcare settings. For TB patients, these measures are highly critical due to the contagious nature of the bacterium causing TB, which can become airborne and inhaled by others.

Among these measures, isolating the infected individual in a well-ventilated room plays a key role. It is recommended that the room has at least six air exchanges per hour to minimize the concentration of infectious airborne particles. Additionally, keeping the patient’s door closed helps contain the bacteria within the room. Another important protocol is the use of personal protective equipment (PPE), particularly for health workers who should preferably wear protective masks even if not providing direct care. Adhering to hand hygiene and sterilizing equipment regularly are also fundamental practices in infection control.

Healthcare facilities often implement training for staff to ensure they understand and comply with these measures, which not only protect the staff but also other patients and visitors.

Airborne Precautions

Airborne precautions are specific infection control practices used to prevent the transmission of diseases that are spread through the air over long distances when an infected person talks, coughs, or sneezes. Tuberculosis is a prime example of an illness that requires airborne precautions because TB bacteria can become airborne quite easily.

These precautions include a combination of measures such as the use of high-efficiency particulate air (HEPA) filtration systems, which help remove TB bacteria from the air, and directing this air to the outside or through filters if recirculation is necessary. The placement of the patient in a negative pressure room, which prevents contaminated air from flowing out of the room and into other areas, is also a critical component of airborne precautions.

Understanding Negative Pressure Environments

These rooms are designed to maintain lower air pressure inside the room than in the surrounding areas; this means that when the door is opened, air flows into the room rather than out of it, keeping potentially infectious particles contained. Only those necessary should enter, and always with proper protection such as an N95 mask.

N95 Mask Usage

An N95 respirator mask is a type of PPE that is designed to achieve a very close facial fit and provide efficient filtration of airborne particles. The 'N95' designation means that the mask filters out at least 95% of very small (0.3 micron) test particles. When dealing with diseases like TB, wearing an N95 mask is essential for healthcare workers to protect themselves from inhaling the airborne pathogens.

It is important to undergo a fit test to ensure the mask forms a seal around the nose and mouth. This fit test should be done annually to consider any changes in the user’s facial structure and to train on the proper method to don and doff the mask. Beyond direct patient care, healthcare workers are recommended to wear the N95 mask even when they are just entering the patient's room, as transmission can occur without close contact.

Proper Usage and Disposal

After using an N95 mask, it should be properly disposed of or, if reusable, decontaminated according to the facility’s guidelines. Remember that the mask's effectiveness diminishes once it becomes soiled or damp, emphasizing the need for regular replacement or maintenance.