An 8-month-old boy is brought to the emergency room due to fever and lethargy. The patient had been doing well at home until this morning, when he developed a fever of 38.6 C (101.5 F) and had several small episodes of nonbilious, nonbloody emesis. He was irritable but interactive and continued to drink fluids. The family suspected a viral illness but grew more concerned when the fever persisted and the patient became less responsive. Temperature is 39.4 C (103 F), blood pressure is 70/40 mm Hg, pulse is 130/min, and respirations are 29/min. A lumbar puncture reveals gram-negative diplococci in the cerebrospinal fluid. The patient is given empiric antibiotics and admitted to the pediatric intensive care unit. Which of the following isolation types is most appropriate for this patient's infection?

Question

An 8-month-old boy is brought to the emergency room due to fever and lethargy.  The patient had been doing well at home until this morning, when he developed a fever of 38.6 C (101.5 F) and had several small episodes of nonbilious, nonbloody emesis.  He was irritable but interactive and continued to drink fluids.  The family suspected a viral illness but grew more concerned when the fever persisted and the patient became less responsive.  Temperature is 39.4 C (103 F), blood pressure is 70/40 mm Hg, pulse is 130/min, and respirations are 29/min.  A lumbar puncture reveals gram-negative diplococci in the cerebrospinal fluid.  The patient is given empiric antibiotics and admitted to the pediatric intensive care unit.  Which of the following isolation types is most appropriate for this patient's infection?

Quizplus · Accepted Answer

Explanation: 11ec25c8_d6c6_27f1_bc81_a79197a5b65d_MD0003_00 Isolation precautions are widely used for infection prevention. The precaution chosen is based on the characteristics of the suspected infectious disease, including its ability to form aerosolized respiratory particles, the size of the particles, and the length of time particles remain viable on surfaces outside the body (eg, fomites). When aerosolized particles are ≥5 microns (considered relatively large), they cannot stay suspended in the air for long periods and are associated with transmission within only 3-6 feet of the source. Droplet precautions require the use of surgical masks within this range. When aerosolized particles are <5 microns, they stay suspended in the air for prolonged periods. Such cases require airborne precautions (ie, negative-pressure rooms, respiratory masks with a minimum 95% filtering capacity [eg, N95 masks]) to prevent inhalation (Choice A). This patient's presentation is due to Neisseria meningitidis, gram-negative diplococci that can cause a potentially fatal meningitis characterized by rapid progression and hemodynamic compromise. N meningitidis reproduces primarily in the nasopharynx, and infectious particles are readily aerosolized through coughing and respiratory procedures (eg, intubation). The organism is transmitted through relatively large respiratory particles that do not retain infectivity well on surfaces outside the body. Therefore, droplet precautions are indicated for possible cases of N meningitidis. These measures are typically implemented until the patient has been treated with 24 hours of antibiotic therapy (eg, ceftriaxone). (Choice B) Infections that spread through direct physical contact of infected materials or on fomites (eg, skin and enteric infections) merit the use of contact precautions with providers wearing both gown and gloves in patient rooms. Many respiratory viruses transmit via both direct contact and respiratory droplets, requiring both contact and droplet precautions. (Choice D) Neutropenic precautions provide protection for patients at risk for infection due to profound immunosuppression. The goal is to prevent exposure of the patient rather than the health care worker; therefore, no specific protective gear is required unless contact with bodily fluids is anticipated. Common neutropenic precautions include strict hand hygiene, private rooms with high-efficiency air filtration, no live plants or animals, and avoidance of intrusive probes (eg, rectal thermometers, enemas). (Choice E) Standard precautions (previously universal precautions) should be followed in the care of all patients. They include hand hygiene before and after contact, use of safety gear when there is possible contact with bodily fluids, respiratory hygiene/cough etiquette, and safe injection practices. Standard precautions are included within all other precautions. Educational objective: Neisseria meningitidis reproduces primarily in the nasopharynx, and infectious particles are readily aerosolized through coughing and respiratory procedures. Droplet precautions should be ordered for all potentially infected patients until they have been treated with antibiotics for 24 hours. References: 2007 guideline for isolation precautions: preventing transmission of infectious agents in health care settings. (http://www.ncbi.nlm.nih.gov/pubmed/18068815)

An 8-Month-Old Boy Is Brought to the Emergency Room Due