A nurse is caring for a client newly admitted with active Clostridioides difficile infection presenting with watery diarrhea. Which infection prevention actions should the nurse implement? Select all that apply.
Select All That Apply
Choose your responses, then check the answer.
Explanation
C. difficile is transmitted by spores via the fecal-oral route through contact. Contact precautions require gown and gloves. The spores are resistant to alcohol; only soap and water mechanically remove them. Negative-pressure airborne rooms and N95 respirators are reserved for true airborne pathogens (TB, measles, varicella). Equipment must be dedicated to the client to prevent spore transmission.
Clinical Judgment C. diff is a contact precaution organism with one critical exception: soap and water for hand hygiene because alcohol-based sanitizer does not kill spores. Bleach-based wipes (1:10 sodium hypochlorite) for surface disinfection. Dedicated equipment per client.
Memory Tip C. diff = Contact + soap and water (not alcohol)
KR vs US CDC and Korean infection control guidelines align: contact precautions plus soap-and-water hand hygiene for C. diff. Both jurisdictions discourage routine alcohol use after C. diff care. Korean tertiary hospitals use bleach wipes per CDC EPA-registered list.
Clinical Practice GuideCDC contact precautions for C. difficile:- Private room or cohort with other C. diff clients- Gown and gloves for all room entries- Soap and water hand hygiene (not alcohol)- Bleach-based surface disinfection (1:10 sodium hypochlorite or EPA-registered sporicidal)- Dedicated equipment until 48 hours after diarrhea resolves- Maintain precautions throughout symptomatic period; some institutions extend 48 hours after last loose stool
Treatment:- First-line: oral fidaxomicin 200 mg BID x 10 days- Alternative: oral vancomycin 125 mg QID x 10 days- Severe/fulminant: oral vanco + IV metronidazole + surgical consult- Stop the inciting antibiotic if possible
CautionAvoid antimotility agents (loperamide, diphenoxylate) during active C. diff — risk of toxic megacolon. Recurrence rate is 20-25%; consider fecal microbiota transplant for repeated episodes.
Clostridioides difficile — Spore-forming gram-positive anaerobic bacterium. Causes pseudomembranous colitis after antibiotic disruption of gut flora. Spores survive on surfaces for months. Transmitted fecal-oral by contact. Severe outcomes: toxic megacolon, sepsis, death.
Soap and water hand hygiene — Mechanical hand washing required for C. diff exposure because alcohol-based hand sanitizer does not kill C. diff spores. Lather soap with friction over all hand surfaces for at least 20 seconds. Dry with single-use paper towel. Required throughout the symptomatic period.
Contact precautions — CDC transmission-based precaution category for organisms spread by direct or indirect contact. Required for MDROs (MRSA, VRE), C. difficile, scabies, RSV, and norovirus. PPE: gown and gloves on entry. Private room or cohorting preferred.