In triage, which client requires the most rapid action to protect other ED clients from infection?

• A. 3-year-old with paroxysmal coughing and a sibling with pertussis
• B. 5-year-old with a new pruritic rash and possible chickenpox
• C. 62-year-old with MRSA abdominal wound infection
• D. 74-year-old exposed to TB during international travel

Answer: (B)

When triage is about protecting other clients from infection, the priority is to implement precautions based on how easily a disease spreads and by what route. Chickenpox (varicella) is highly contagious through airborne as well as contact routes and is contagious from 1–2 days before the rash until all lesions crust over. A child with a new pruritic vesicular rash compatible with varicella should be placed in airborne isolation immediately (negative-pressure room if available) with staff using an N95 respirator and appropriate PPE. Requiring airborne precautions right away minimizes the risk of widespread transmission to other ED patients, especially those who are unvaccinated or immunocompromised.

Pertussis is spread by droplets, so droplet precautions are important, but the airborne nature of varicella makes its isolation the most urgent action. MRSA is typically a direct-contact risk, which is important but not as rapidly transmissible in the ED as airborne varicella. TB exposure is a concern, but isolation decisions depend on whether active disease is suspected; without symptoms, it is not as immediately infectious as suspected varicella.