# A nurse is caring for a patient with Clostridium difficile-associated diarrhea (CDAD) in a medical unit. Which nursing intervention is the MOST important to prevent transmission of this infection to other patients?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=319485  
> language: ko  
> subject: Next Gen NCLEX

## 문제

A nurse is caring for a patient with Clostridium difficile-associated diarrhea (CDAD) in a medical unit. Which nursing intervention is the MOST important to prevent transmission of this infection to other patients?

## 보기

1. Use alcohol-based hand sanitizer before and after patient contact
2. Place the patient in droplet precautions with a surgical mask
3. Implement standard precautions with gloves and gown only
4. Use soap and water for hand hygiene and implement contact precautions **✔ 정답**

**정답: 4**

## 해설

Soap and water hand hygiene with contact precautions is most important for C. difficile, as alcohol-based sanitizers are ineffective against spores. Other options like droplet precautions or standard precautions alone are inadequate.

## 심화 해설

Core Nursing Explanation
This question tests the critical knowledge of infection control measures specific to Clostridium difficile (C. diff). The core concept is understanding the organism's unique characteristics and how they dictate the required nursing interventions to prevent transmission.

**Key Concept Analysis**
The question asks for the **most important** intervention to prevent transmission of Clostridium difficile-associated diarrhea (CDAD). C. diff is a spore-forming bacterium. The spores are highly resistant to environmental disinfection and, crucially, **are not killed by alcohol-based hand sanitizers (ABHR)**. Transmission occurs via the fecal-oral route through contact with contaminated surfaces, equipment, or the hands of healthcare workers. Therefore, the infection control strategy must address both sporicidal hand hygiene and environmental containment.

**Answer Rationale**
Key Point! The correct answer combines two essential, evidence-based actions:
1.  Hand hygiene with soap and water: The mechanical friction of washing with soap and water is required to physically remove the hardy C. diff spores from hands. Alcohol-based sanitizers are ineffective against these spores.
2.  Contact Precautions: This is a Transmission-Based Precautions category used in addition to Standard Precautions. It requires the use of a gown and gloves upon entry to the patient's room to prevent contamination of clothing and skin. This directly interrupts the contact transmission route.

**Distractor Analysis**
Watch out for confusion!

- **Option 1 (Use alcohol-based hand sanitizer)**: This is a critical error. While ABHR is the gold standard for hand hygiene for most pathogens, it is **contraindicated** in a known or suspected C. diff setting because it does not kill or remove spores. Relying on it can actually promote spread.

- **Option 2 (Droplet precautions with a surgical mask)**: This applies to pathogens spread by large respiratory droplets (e.g., influenza, pertussis). C. diff is not transmitted through the respiratory tract, so this intervention is irrelevant and would not prevent transmission.

- **Option 3 (Standard precautions with gloves and gown only)**: This is incomplete. Standard Precautions are used for all patients. However, for a patient with known C. diff, **Contact Precautions** must be *added* to Standard Precautions. The phrasing "with gloves and gown only" suggests a casual use, not the formal, consistent implementation required upon every room entry for Contact Precautions.

**Related Concepts**
Understanding this requires knowledge of the hierarchy of infection control: Standard Precautions (for all patients) + Transmission-Based Precautions (added for specific pathogens: Contact, Droplet, Airborne). For C. diff, environmental cleaning with a **sporicidal agent** (like bleach) is also a cornerstone of prevention, as spores can persist on surfaces for months.

Concept Summary

| Concept | Key Points for C. difficile |
| --- | --- |
| Organism | Spore-forming bacterium, causes antibiotic-associated diarrhea/colitis. |
| Transmission | Fecal-oral route (Contact). |
| Critical Hand Hygiene | Soap and water only. Alcohol-based sanitizer is ineffective. |
| Isolation Precautions | Contact Precautions (gown & gloves) in addition to Standard Precautions. |
| Environmental Control | Cleaning with a sporicidal disinfectant (e.g., diluted bleach). |

Side-by-Side Comparison!

| Precaution Type | Used For | Key Interventions | Example Pathogens |
| --- | --- | --- | --- |
| Contact Precautions | Diseases spread by direct/indirect contact. | Gown & gloves. Soap/water for C. diff. Private room or cohort. | C. difficile, MRSA, VRE, RSV, Scabies |
| Droplet Precautions | Diseases spread by large respiratory droplets (>5μm). | Surgical mask within 3 feet/1 meter. Private room or cohort. | Influenza, Pertussis, Meningitis (N. meningitidis), Group A Strep (pharyngitis) |
| Airborne Precautions | Diseases spread by small airborne particles (

## 임상 시나리오

Nursing Clinical Practice Guide
**Clinical Scenario**
You are assigned to Mr. Johnson, a 72-year-old patient admitted with pneumonia who developed severe, watery diarrhea on day 3 of intravenous (IV) ceftriaxone. The stool has a characteristic foul odor. A C. difficile toxin test is ordered and comes back positive.

**Nursing Intervention Strategy**

- **Immediate Action (Assessment & Isolation):**

- Don gloves and a gown immediately upon entering the room for the first time after suspicion/confirmation.

- Place a **Contact Precautions** sign on the door.

- If possible, assign the patient to a private room. If not, cohort with another confirmed C. diff patient.

- Educate the patient: "Mr. Johnson, to keep everyone safe, we'll be wearing these gowns and gloves. It's also very important for you to wash your hands with soap and water after using the bathroom."

- **Ongoing Care (Implementation):**

- **Hand Hygiene:** Perform **hand hygiene with soap and water** for at least 40-60 seconds *immediately after* removing gloves and gown, before touching anything outside the patient's environment.

- **PPE:** Use a fresh gown and gloves for every entry into the room. Remove them properly before exit.

- **Environmental Cleaning:** Ensure daily and terminal cleaning is done with an EPA-registered sporicidal disinfectant (often a bleach solution). Pay special attention to high-touch surfaces: bed rails, call light, toilet, sink handles.

- **Dedicated Equipment:** Use a dedicated stethoscope, blood pressure cuff, and thermometer for this patient only.

- **Monitoring & Evaluation:**

- Monitor stool frequency, consistency, and volume. Assess for signs of severe colitis: abdominal pain, distension, fever, leukocytosis.

- Evaluate the effectiveness of isolation: Are other patients on the unit developing diarrhea? Are healthcare staff compliant with Contact Precautions and soap/water hand hygiene?

**Patient Safety and Precautions**

- **Contraindication:** **Never** use alcohol-based hand rub as the primary method after caring for a C. diff patient. It provides a false sense of security.

- **Medication Caution:** Discontinue the inciting antibiotic if possible, per physician order. Administer the prescribed anti-C. diff antibiotic (e.g., oral vancomycin) as scheduled. Note that IV metronidazole is no longer a first-line therapy.

- **Key Monitoring:** Watch for signs of Toxic megacolon (severe abdominal distension, pain, decreased bowel sounds, fever, tachycardia) – a surgical emergency.

Nursing Procedure & Medication Flow
**Procedure: Implementing Contact Precautions for C. difficile**
1.  **Gather:** Gown, gloves, soap, paper towels.
2.  **Perform:** Hand hygiene with soap and water before donning PPE if hands are visibly soiled.
3.  **Don:** Gown first, then gloves. Ensure gown ties securely and gloves cover gown cuffs.
4.  **Provide Care.**
5.  **Remove:** Gloves first, then gown. Discard in room trash.
6.  **Exit:** Leave the room.
7.  **Final Hand Hygiene:** **Mandatory** hand hygiene with soap and water immediately outside the room.

**Medication: Oral Vancomycin Administration**

- **Action:** Bactericidal against C. diff in the GI tract (poor systemic absorption).

- **Nursing Points:** Administer orally as directed (capsules or liquid). For liquid, shake well. It is **very expensive**; ensure it is not wasted. Monitor for resolution of diarrhea.

A Word from Your Senior Nurse
"C. diff is a formidable opponent on any medical unit. It's not just about the patient in isolation; it's about protecting the entire community of patients on your floor. Remembering the 'soap and water' rule is non-negotiable. In clinical practice, you'll be the one ensuring compliance, educating new staff and visitors, and advocating for proper environmental cleaning. On the NCLEX, they test this heavily because it's a fundamental patient safety issue. When you see 'C. difficile,' let your brain automatically flash: **Contact Precautions + Soap & Water.** That reflexive knowledge will keep your future patients safe and help you ace these questions!"

## 핵심 개념

- **Clostridium difficile (C. diff)** — A spore-forming, gram-positive bacterium that causes antibiotic-associated diarrhea and colitis. Its spores are resistant to alcohol and many disinfectants.
- **Contact Precautions** — A type of Transmission-Based Precautions used for diseases spread by direct or indirect contact. Requires use of gown and gloves. Essential for C. diff, MRSA, VRE.
- **Sporicidal Agent** — A disinfectant capable of destroying bacterial spores. Bleach (sodium hypochlorite) is a common sporicidal agent used for environmental cleaning in C. diff isolation rooms.
- **Fecal-oral Route** — The transmission route where infectious agents from feces are ingested through the mouth. This is the primary mode of transmission for C. difficile, often via contaminated hands or surfaces.
- **Pseudomembranous Colitis** — A severe inflammation of the colon characterized by the formation of pseudomembranes (plaques of inflammatory cells and debris) on the mucosal surface. It is a classic, severe manifestation of C. difficile infection.

## 같은 주제 문제

- [A nurse is caring for a patient with methicillin-resistant Staphylococcus aureus (MRSA) pn…](https://mymerci.kr/pages/nclex_q.php?qn_id=319484)
- [A nurse is caring for a patient with methicillin-resistant Staphylococcus aureus (MRSA) pn…](https://mymerci.kr/pages/nclex_q.php?qn_id=319486)
- [A nurse is caring for a patient with a central venous catheter (CVC) who develops signs of…](https://mymerci.kr/pages/nclex_q.php?qn_id=319487)
- [A nurse is caring for a patient with methicillin-resistant Staphylococcus aureus (MRSA) pn…](https://mymerci.kr/pages/nclex_q.php?qn_id=319488)
- [A nurse is caring for multiple patients in a medical-surgical unit. Which situation requir…](https://mymerci.kr/pages/nclex_q.php?qn_id=319489)
- [A nurse is caring for multiple patients in a medical-surgical unit. Which action by the nu…](https://mymerci.kr/pages/nclex_q.php?qn_id=319490)
- [A nurse is caring for a patient with Clostridioides difficile (C. diff) infection. Which i…](https://mymerci.kr/pages/nclex_q.php?qn_id=319491)
- [A nurse is caring for multiple patients on a medical-surgical unit. Which action by the nu…](https://mymerci.kr/pages/nclex_q.php?qn_id=319492)

---

More free questions: [기출문제](https://mymerci.kr/)

_학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._