A 65-year-old hospitalized client develops severe Clostridioides difficile colitis with watery diarrhea, fever, and WBC 18,000. The prescriber orders vancomycin 125 mg PO every 6 hours for 10 days. Which nursing instruction is most appropriate?

Severe C. difficile infection (CDI) is treated with oral or rectal vancomycin 125 mg every 6 hours for 10 days, OR fidaxomicin 200 mg every 12 hours, per current IDSA/SHEA and ACG guidelines. Important pharmacokinetic point: oral vancomycin is poorly absorbed from the GI tract and remains in the colonic lumen, which is exactly where C. difficile lives. IV vancomycin reaches systemic tissues but does not enter the colonic lumen at therapeutic concentrations and is therefore not effective for CDI; conversely IV vanco is for systemic gram-positive infections like MRSA and is not useful for CDI. Important nursing actions for CDI: (1) administer oral vancomycin per order; (2) implement contact (enteric) precautions and a private room or cohort with another CDI patient; (3) hand hygiene with soap and water — alcohol-based hand rubs do not kill C. difficile spores; (4) review antibiotic therapy and stop or narrow agents that perpetuate dysbiosis (FQs, clindamycin, broad cephalosporins) when possible; (5) avoid antimotility agents such as loperamide in severe disease because they can worsen toxic megacolon; (6) monitor for fulminant CDI signs — hypotension, ileus, megacolon, requires surgical evaluation; (7) educate household and visitors. Switching to IV, mixing with milk, or discharging on severe CDI are unsafe.

Oral vancomycin is the only vancomycin route that treats CDI. Soap and water for hands; alcohol does not kill spores. Contact precautions and private room are part of the standard.