# 一名護理師照顧因活動性Clostridioides difficile感染合併水樣性腹瀉而新入院的病人。下列何者為應採取的感控措施?(複選)

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

## 題目

一名護理師照顧因活動性Clostridioides difficile感染合併水樣性腹瀉而新入院的病人。下列何者為應採取的感控措施?(複選)

1

照護後以肥皂與清水洗手,而非酒精乾洗手液

2

進入病房前穿戴隔離衣與手套

3

進入病房時佩戴N95口罩

4

將病人安置於負壓空氣傳染隔離病房

5

與病房其他病人共用血壓計等器材

## 解析

C. difficile為芽孢形成菌,經糞口接觸傳播。接觸隔離需穿戴隔離衣與手套。芽孢對酒精具抵抗性,僅能以肥皂與清水機械去除。負壓空氣隔離室與N95僅用於真正空氣傳染病原(結核、麻疹、水痘)。器材應專用以避免芽孢傳播。

## 深入解析

臨床判斷
C. diff為接觸隔離菌但有一關鍵例外: 手部衛生需用肥皂與清水 — 酒精乾洗液無法殺死芽孢。表面消毒採漂白劑擦拭(1:10次氯酸鈉)。專屬器材每位病人。

記憶口訣
C. diff = 接觸+肥皂清水(非酒精)

韓 vs 美
CDC與臺灣感控指引一致: C. diff採接觸隔離+肥皂清水洗手。兩地皆不建議C. diff照護後例行用酒精。臺灣醫學中心使用CDC EPA登錄之漂白劑擦拭巾。

## 臨床情境

臨床指引
CDC C. difficile接觸隔離:
- 單人房或與其他C. diff病人同房
- 入室皆穿隔離衣與手套
- 肥皂與清水洗手(非酒精)
- 漂白劑表面消毒(1:10次氯酸鈉或EPA登錄殺孢產品)
- 腹瀉緩解後48小時內維持專屬器材
- 症狀期間維持隔離;部分機構最後一次稀便後再延長48小時

治療:
- 第一線: 口服fidaxomicin 200 mg BID 10天
- 替代: 口服vancomycin 125 mg QID 10天
- 重症/猛爆: 口服vanco+IV metronidazole+外科會診
- 可行則停誘發抗生素

注意
活動性C. diff時避用止瀉藥(loperamide、diphenoxylate) — 巨結腸風險。復發率20-25%;反覆者考慮糞便菌叢移植。

## 重要概念

- **Clostridioides difficile** — 芽孢形成之革蘭氏陽性厭氧菌。抗生素破壞腸道菌叢後造成偽膜性大腸炎。芽孢於表面可存活數月。經糞口接觸傳播。嚴重後果: 巨結腸、敗血症、死亡。
- **肥皂清水洗手** — C. diff暴露時必須機械洗手,因酒精乾洗液無法殺死芽孢。以肥皂搓泡覆蓋手部全表面摩擦至少20秒。以單次使用紙巾擦乾。症狀期間必行。
- **接觸隔離** — CDC按傳播途徑分類之隔離措施,適用於直接或間接接觸傳播之病原。MDRO(MRSA、VRE)、C. difficile、疥瘡、RSV、諾羅病毒皆需。PPE: 入室穿戴隔離衣與手套。優先單人房或同房收治。

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