# 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.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=363996&lang=en  
> language: en  
> subject: Standard/Transmission-Based Precautions/Surgical Asepsis  
> category: SIPC

## Question

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.

1

Use soap and water for hand hygiene after providing care, not alcohol-based hand sanitizer

2

Wear gown and gloves before entering the room

3

Wear an N95 respirator when entering the room

4

Place the client in a negative-pressure airborne isolation room

5

Allow shared equipment such as the blood pressure cuff with other clients on the unit

## 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.

## In-depth explanation

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 scenario

Clinical Practice Guide
CDC 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

Caution
Avoid antimotility agents (loperamide, diphenoxylate) during active C. diff — risk of toxic megacolon. Recurrence rate is 20-25%; consider fecal microbiota transplant for repeated episodes.

## Key concepts

- **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.

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