Never give live virus vaccines (MMR, varicella) during pregnancy; advise avoiding pregnancy for 4 weeks after.
Before you read
Test yourself first: 3 questions
Question 1 of 3
A nurse is teaching a nursing student about the most important measure to prevent the spread of health-care-associated infections. Which statement by the student indicates correct understanding?
Answer: B. Hand hygiene is the single most effective measure to prevent the transmission of health-care-associated infections. It should be performed before and after every client contact.
Question 2 of 3
A client with AIDS is admitted with Pneumocystis jirovecii pneumonia (PCP). Which medication should the nurse anticipate as first-line treatment?
Answer: B. Trimethoprim-sulfamethoxazole (TMP-SMX) is the first-line treatment and prophylaxis for Pneumocystis jirovecii pneumonia. Isoniazid treats tuberculosis, acyclovir treats herpesviruses, and amphotericin B treats systemic fungal infections such as cryptococcosis, not PCP first-line.
Question 3 of 3
Which client is appropriate for the charge nurse to assign to the same room (cohort) as a client who has scabies?
Answer: B. Scabies requires contact precautions, so a client may be cohorted with another client who has the same active infection with the same organism. Cohorting an uninfected, immunocompromised, or differently-infected client risks cross-transmission. Matching identical infections is the principle behind safe cohorting when private rooms are limited.
Keep the streak going with more questions like these, each with a full rationale.
What is torch infections?
The acronym stands for Toxoplasmosis, Other (syphilis, varicella, parvovirus B19, hepatitis, HIV, Zika), Rubella, Cytomegalovirus (CMV), and Herpes simplex virus. Prevention and early maternal screening are key because many infections are asymptomatic in the mother but devastating to the fetus.
Key points to remember
- Toxoplasmosis is acquired from cat litter and raw/undercooked meat and can cause hydrocephalus, chorioretinitis, and intracranial calcifications.
- Rubella (first-trimester) causes cataracts, deafness, and cardiac defects; the MMR vaccine is contraindicated during pregnancy because it is a live vaccine.
- Cytomegalovirus is the most common congenital viral infection and a leading cause of congenital hearing loss.
- Active genital herpes lesions at delivery require cesarean birth to prevent neonatal HSV.
- Many TORCH infections are subclinical in the mother but cause IUGR, microcephaly, rash, jaundice, or hearing/vision loss in the neonate.
- Untreated maternal syphilis can cause stillbirth and congenital syphilis; it is treated with penicillin.
Signs & symptoms
- IUGR, microcephaly, hearing loss
- Rash, cataracts, hepatosplenomegaly
Nursing priorities
- Reinforce prevention: avoid cat litter and undercooked meat, practice hand hygiene, and screen for immunity.
- Administer rubella vaccine postpartum (not during pregnancy) to nonimmune mothers.
- Identify active herpes lesions at admission and notify the provider for possible cesarean delivery.
- Implement appropriate isolation and standard precautions for infected neonates and report cases as required.
- Ensure pregnant clients avoid live vaccines during pregnancy.
Labs & values
Patient teaching
- Pregnant women should not change cat litter and should cook meat thoroughly.
- Wash hands frequently, especially around young children, to reduce CMV exposure.
- Get rubella immunity checked before or early in pregnancy and vaccinate after delivery if nonimmune.
Red flags: report now
- Never give live virus vaccines (MMR, varicella) during pregnancy; advise avoiding pregnancy for 4 weeks after.
- Active genital herpes lesions in labor: never proceed with vaginal birth; report for cesarean.
- Report neonatal signs of congenital infection (microcephaly, rash, jaundice, seizures, poor feeding).
References
Clinical references for this topic
