# A nurse is caring for a patient with suspected Clostridium difficile infection. Which transmission-based precaution should be implemented immediately? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=541833 > language: ko > subject: Infectious Diseases ## 문제 A nurse is caring for a patient with suspected Clostridium difficile infection. Which transmission-based precaution should be implemented immediately? ## 보기 1. Standard precautions with hand hygiene using alcohol-based sanitizer 2. Contact precautions with soap and water hand hygiene **✔ 정답** 3. Droplet precautions with surgical mask 4. Airborne precautions with N95 respirator **정답: 2** ## 해설 Contact precautions with soap and water hand hygiene are essential for C. difficile because alcohol-based sanitizers are ineffective against spores. Other options represent precautions for different transmission modes. ## 심화 해설 Understanding the Pathogen and Transmission The correct answer is 2. When Clostridioides difficile infection (CDI) is suspected, Contact precautions must be implemented immediately. This organism forms highly resilient spores that are the primary vehicle for transmission in healthcare settings. These spores are not effectively killed by alcohol, which is a critical point for nursing practice. The multifaceted approach to prevention, as highlighted in the literature, explicitly emphasizes the role of hand hygiene, contact precautions, and environmental cleaning as core interventions [1]. Rationale for Hand Hygiene Method The specific requirement for soap and water hand hygiene over an alcohol-based sanitizer is grounded in the sporulating nature of C. difficile. Alcohol-based hand rubs have poor activity against the spore form of the bacterium. Mechanical friction with soap and water is necessary to physically remove spores from the hands of healthcare workers. This practice is a cornerstone of the isolation bundle designed to interrupt transmission. Adherence to this complete bundle, which includes prompt isolation and correct hand hygiene, is a key metric for infection prevention and control teams when monitoring and responding to CDI cases [2]. Why Other Precautions Are Incorrect The other options are inappropriate for this pathogen's transmission route. - Option 1 (Standard precautions with alcohol-based sanitizer) is insufficient because it fails to address the need for a private room or cohorting (Contact precautions) and specifies an ineffective hand hygiene agent against spores. - Option 3 (Droplet precautions) is used for pathogens transmitted via large respiratory droplets, such as influenza. C. difficile is transmitted via the fecal-oral route through contact with contaminated surfaces or hands, not through coughing or sneezing. - Option 4 (Airborne precautions) is reserved for pathogens with very small airborne droplet nuclei, like tuberculosis or measles, and requires an N95 respirator and negative pressure room, which are not indicated for CDI. Clinical Application and Diagnostic Stewardship In practice, a nurse must initiate these precautions based on clinical suspicion—typically unexplained, new-onset diarrhea—without waiting for laboratory confirmation. This immediate action is vital to prevent environmental contamination and transmission. The emphasis on diagnostic stewardship in current literature supports this approach, as using optimized testing algorithms and electronic alerts helps ensure that only symptomatic patients are tested, reducing false positives from colonization and preventing unnecessary isolation, while ensuring true infections are rapidly identified and managed [1,2]. The goal is to shorten the time-to-action, a process shown to improve when electronic surveillance systems assist infection control teams in detecting suspected cases promptly and auditing compliance with the isolation bundle [2].References (research sources) - [1]Prevention and Control of Clostridioides difficile Infection for the Infectious Diseases Clinician.Research articleMonday L, Krishna A, Chopra T. (2026) · DOI: 10.1016/j.idc.2026.02.009 - [2]Electronic surveillance system shortens time-to-action and improves adherence to the isolation bundle for patients with Clostridioides difficile infection: an interrupted time series at a French university hospital.Research articleFaivre V, Lizon J, Colas A, Demoré B, Florentin A, Baudet A. (2026) · DOI: 10.1016/j.jhin.2026.07.003 ## 임상 시나리오 C. difficile Infection Control BundleImmediate Implementation for Suspected Cases Initiate Contact Precautions immediately upon suspicion of CDI. Place patient in a private room with dedicated equipment. Perform hand hygiene with soap and water before and after patient contact. Alcohol-based hand rubs are ineffective against C. difficile spores. Don gown and gloves upon room entry. Ensure gloves are removed and hand hygiene is performed immediately before exiting the room. CautionContinue Contact Precautions until 48 hours after diarrhea resolves. Use a sporicidal agent for environmental cleaning; standard disinfectants do not eradicate spores. ## 핵심 개념 - **Clostridioides difficile** — A spore-forming, gram-positive anaerobic bacillus causing antibiotic-associated diarrhea and colitis, transmitted via the fecal-oral route. - **Contact Precautions** — Transmission-based precautions used for pathogens spread by direct or indirect contact, requiring gown and gloves for all room entry. - **Spores** — A dormant, tough, and non-reproductive structure produced by certain bacteria, including C. difficile, resistant to alcohol and many disinfectants. ## 같은 주제 문제 - [A nurse is working in an emergency department. Which patient requires airborne precautions…](https://mymerci.kr/pages/nclex_q.php?qn_id=541830) - [A nurse is caring for multiple patients with different infectious diseases. Which patient …](https://mymerci.kr/pages/nclex_q.php?qn_id=541831) - [A nurse is assessing patients in an emergency department. 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