# A nurse is caring for a patient with Clostridium difficile-associated diarrhea (CDAD) in a medical unit. Which nursing intervention is the MOST important to prevent transmission of this infection to other patients? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=543668 > language: ko > subject: Next Gen NCLEX ## 문제 A nurse is caring for a patient with Clostridium difficile-associated diarrhea (CDAD) in a medical unit. Which nursing intervention is the MOST important to prevent transmission of this infection to other patients? ## 보기 1. Use alcohol-based hand sanitizer before and after patient contact 2. Place the patient in droplet precautions with a surgical mask 3. Implement standard precautions with gloves and gown only 4. Use soap and water for hand hygiene and implement contact precautions **✔ 정답** **정답: 4** ## 해설 Soap and water hand hygiene with contact precautions is most important for C. difficile, as alcohol-based sanitizers are ineffective against spores. Other options like droplet precautions or standard precautions alone are inadequate. ## 심화 해설 Correct Answer: 4. Use soap and water for hand hygiene and implement contact precautions This is the most critical intervention for preventing the transmission of Clostridioides difficile (C. difficile) in a healthcare setting. The rationale is rooted in the unique microbiology of the organism and the fundamental principles of infection control. Why Soap and Water is Non-Negotiable The primary reason alcohol-based hand sanitizers are insufficient lies in the ability of C. difficile to form spores. When environmental conditions are unfavorable, the bacteria convert into a dormant, highly resilient spore form. The lipid envelope of many other bacteria and viruses is readily disrupted by alcohol, leading to their inactivation. However, alcohol does not reliably kill C. difficile spores. The mechanical friction and rinsing action of soap and water is essential to physically remove these spores from the hands of healthcare personnel (HCP). This is a cornerstone of horizontal infection prevention, as transmission to patients often occurs via transiently contaminated hands of HCP [1]. The Role of Contact Precautions Because environmental surfaces contaminated with multidrug-resistant organisms (MDROs) like C. difficile from infected patients represent a significant source of HCP hand contamination, contact precautions are mandated [1]. This creates a dual-barrier system: - Gown and Gloves: These are donned upon room entry to create a physical barrier, preventing the contamination of HCP clothing and hands with spores from the patient's environment or body substances. - Hand Hygiene with Soap and Water: This is performed after removing gloves and before exiting the room to remove any spores that may have been transferred during the doffing process. Analysis of Incorrect Options - Option 1: Recommending an alcohol-based hand sanitizer is directly contraindicated because it is ineffective against C. difficile spores. This practice would leave viable spores on the hands, facilitating transmission to the next patient or surface touched. - Option 2: Placing the patient in droplet precautions with a surgical mask is incorrect. C. difficile is transmitted via the fecal-oral route through contact with contaminated surfaces or hands, not through large respiratory droplets that travel short distances. The appropriate transmission-based precaution is contact, not droplet. - Option 3: Implementing standard precautions with gloves and gown only is a critical failure. While standard precautions form the base of all patient care, they are insufficient for a patient with active C. difficile infection (CDI). Transmission-based contact precautions must be added. Furthermore, this option omits the most crucial element of hand hygiene for this specific pathogen: soap and water. The increasing prevalence of CDI as a leading cause of hospital-acquired diarrhea makes strict adherence to these evidence-based prevention bundles, including proper hand hygiene and barrier precautions, a fundamental nursing responsibility to break the chain of infection .References (research sources) - [1]Hand and environmental hygiene: respective roles for MRSA, multi-resistant gram negatives, Clostridioides difficile, and Candida spp.Research articleBoyce JM. (2024) · DOI: 10.1186/s13756-024-01461-x ## 임상 시나리오 C. difficile Infection ControlPreventing Spore Transmission For C. difficile, alcohol-based hand sanitizer is ineffective against spores. Only soap and water with mechanical friction physically removes spores from hands. Implement Contact Precautions: private room, gown and gloves donned upon entry. This prevents hand contamination from environmental surfaces which are a known reservoir. CautionDo not rely on standard precautions or alcohol rubs. Continue precautions until diarrhea ceases, as spore shedding persists while the patient is symptomatic. ## 핵심 개념 - **C. difficile spores** — A dormant, highly resilient form of the bacteria resistant to alcohol, requiring mechanical removal with soap and water. - **Contact Precautions** — Infection control practices including private room, gown, and gloves used to prevent transmission of epidemiologically important organisms spread by direct or indirect contact. - **Horizontal Infection Prevention** — Strategies aimed at reducing the spread of pathogens across a patient population by targeting common transmission pathways like hand contamination. ## 같은 주제 문제 - [A nurse is caring for a patient with methicillin-resistant Staphylococcus aureus (MRSA) pn…](https://mymerci.kr/pages/nclex_q.php?qn_id=543660) - [A nurse is caring for multiple patients on a medical-surgical unit. 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