# A patient is admitted with confirmed Clostridioides difficile (C. diff) infection — profuse watery diarrhea, abdominal pain, and a positive stool toxin assay. Which infection prevention measures should the nurse implement? Select all that apply.

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> language: en  
> subject: Safety and Infection Prevention and Control  
> category: SIPC

## Question

A patient is admitted with confirmed Clostridioides difficile (C. diff) infection — profuse watery diarrhea, abdominal pain, and a positive stool toxin assay. Which infection prevention measures should the nurse implement? Select all that apply.

1

Place the patient on contact precautions in a private room (or cohort with another C. diff patient) for the duration of the illness plus 48 hours after diarrhea resolves.

2

Use sporicidal agents (such as bleach-based products) for environmental cleaning and dedicated patient-care equipment.

3

Use alcohol-based hand rub before and after patient contact since it is faster and equally effective against C. diff.

4

Wash hands with soap and water (NOT alcohol-based hand rub) before and after every patient contact and after PPE removal — alcohol does not kill C. diff spores.

5

Wear gown and gloves on every entry; remove PPE before leaving the room.

## Explanation

C. difficile precautions: contact isolation in private room (or cohort), soap and water hand hygiene (alcohol does NOT kill spores), sporicidal cleaning agents (bleach), gown and gloves on entry. Choice 3 is wrong — alcohol-based hand rubs are NOT effective against C. diff spores; soap and water are required. Continue isolation through 48 hours after diarrhea resolves.

## In-depth explanation

C. diff is the most-tested NCLEX hand hygiene exception: ALCOHOL DOES NOT KILL C. DIFF SPORES. Soap and water mechanically remove spores. Norovirus also requires soap and water. Other spore-formers (Bacillus anthracis) and visibly soiled hands are also exceptions. Memorize: SOAP for C. diff/Noro/dirty hands; alcohol fine for everything else.

## Clinical scenario

**Adult admitted with confirmed C. difficile infection** — profuse watery diarrhea, abdominal pain, fever, positive stool toxin assay, WBC 18,000. The unit follows CDC C. diff isolation protocols.

## Key concepts

- **Clostridioides difficile (C. diff)** — Toxin-producing spore-forming bacterium causing antibiotic-associated colitis; alcohol-resistant spores; transmitted by fecal-oral route.
- **Soap and water for C. diff** — Mechanical removal of spores via friction; alcohol-based rub does NOT kill spores; required for C. diff and Norovirus.
- **Sporicidal cleaning** — Bleach-based agents (1:10 dilution) required for room cleaning; quaternary ammonium and standard disinfectants do not kill spores.

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