# A nurse is caring for a patient with confirmed Clostridioides difficile infection (CDI). Which nursing intervention should be the highest priority to prevent transmission to other patients?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=541879  
> language: ko  
> subject: Infectious Diseases

## 문제

A nurse is caring for a patient with confirmed Clostridioides difficile infection (CDI). Which nursing intervention should be the highest priority to prevent transmission to other patients?

## 보기

1. Implement contact precautions with dedicated equipment and perform hand hygiene with soap and water **✔ 정답**
2. Place the patient in airborne isolation and use alcohol-based hand sanitizer
3. Initiate droplet precautions and wear N95 respirator when entering the room
4. Use standard precautions only and clean hands with alcohol-based sanitizer

**정답: 1**

## 해설

Contact precautions with soap and water hand hygiene are essential for C. diff because alcohol-based sanitizers are ineffective against spores. Other options involve incorrect isolation types or ineffective hand hygiene methods.

## 심화 해설

Clinical Judgment
This question assesses infection control prioritization. The core transmission route for Clostridioides difficile infection is the fecal-oral route, and the **spores** produced by the bacteria are resistant to alcohol. Therefore, the top-priority intervention to prevent transmission is a method that effectively eliminates spores, namely contact precautions and handwashing with soap and water. Other isolation types (airborne, droplet) prevent respiratory transmission but do not apply to C. diff.

Memory Tip: **S**oap and **W**ater for **S**pores (SWS). C. diff spores are only removed with soap and water.

KR vs US
While contact precautions and hand hygiene are also important for C. diff infection in Korea, US NGN questions often emphasize 'priority setting' and 'tailored interventions for specific pathogens'. Rather than simply knowing 'to isolate,' they assess the ability to analyze 'why that isolation method is most effective for this pathogen' according to the CJMM (Clinical Judgment Measurement Model).

## 임상 시나리오

Clinical Practice Guide
When caring for patients with C. diff infection, implement contact precautions (wearing gown and gloves) and use dedicated blood pressure cuffs, stethoscopes, etc. for the patient. For environmental disinfection, use sodium hypochlorite (bleach)-based disinfectants.

Caution
In SATA (Select All That Apply) questions, if a question like "What is the correct intervention to prevent C. diff infection?" appears, 'using alcohol-based hand sanitizer' can never be the correct answer. Be sure to select 'hand washing with soap and water'.

## 핵심 개념

- **Clostridioides difficile Infection** — Gram-positive bacillus infection causing antibiotic-associated diarrhea or colitis. Produces toxins A and B and forms spores, allowing prolonged survival in the environment.
- **Contact Precautions** — Isolation method applied to infectious agents that can be transmitted through direct contact or contaminated environments/items. Wearing a gown and gloves is mandatory.
- **Spore** — A dormant structure formed by bacteria to survive in unfavorable environments. It is highly resistant to heat, dryness, and chemical disinfectants (especially alcohol).
- **Hand Hygiene with Soap and Water** — A hand hygiene method that physically removes contaminants, bacteria, and spores from the skin through the mechanical friction of water and the surfactants in soap. It is essential for removing C. diff spores.
- **Fecal-Oral Route** — Pathway where pathogens exit from the feces of an infected person and enter another person's mouth through contaminated hands, water, food, or objects. This is the main transmission route for C. diff.

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