Suspected Infection Control Breach During a Wound Care Round
You are observing a colleague perform a dressing change on a patient with a chronic sacral wound colonized with MRSA. The nurse dons gloves but not a gown, places the dressing tray on the bed, cleans the wound from clean to dirty but returns to a previously cleaned area, and then uses the same gloves to touch the IV pump keypad and the patient's call light. The patient's roommate is on contact precautions for C. difficile. The unit is at 100% occupancy and the supply room is out of gowns until the afternoon delivery.
1. Identify the breaches and rank them by infection risk.
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Breaches: (1) no gown for a wound with MRSA, risking contamination of clothing and transmission; (2) clean-to-dirty sequence violated, recontaminating the wound bed; (3) gloved hands touching the IV pump and call light, spreading organisms to high-touch surfaces; (4) tray placed on the bed, a contaminated surface.
Ranking: gloved contact with shared equipment is the highest cross-transmission risk; the gown omission is next; wound-sequence error risks the patient's own wound; tray placement is lower but still a break.
Rationale: transmission risk depends on contact with shared surfaces and PPE integrity; the sequence error mainly threatens the patient's wound.
2. Gowns are unavailable. What do you do, and how do you escalate?
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Do not proceed without appropriate PPE for a known MRSA wound. Options: borrow gowns from an adjacent unit or central supply, use an alternative barrier per policy if approved, or defer the non-urgent dressing until supplies arrive while ensuring the wound is covered and the patient is comfortable. Escalate to the charge nurse and infection prevention immediately; document the supply gap and the delay.
Rationale: improvising PPE compromises both patients and staff; the correct response is to escalate the system failure, not to accept it silently.
3. How do you address the colleague and the roommate risk?
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Address the colleague privately, factually, and without blame: describe what you observed, the specific risk, and the correct practice, and offer to review policy together. If unsafe practice continues, escalate to the manager or infection prevention.
For the roommate: verify C. difficile contact precautions, ensure dedicated equipment, hand hygiene with soap and water for C. difficile (alcohol does not kill spores), and separate supplies. Document actions and report the supply shortage.