Question

A client with cancer has been having severe diarrhea and tested positive for clostridium difficile. Which infection-control measure should the nurse take? ? A. Continue to follow standard precautions ? B. Prepare to place the client on contact precautions ? C. Contact environmental services to mop the floor ? D. Use hand hygiene prior to client contact

Short answer

Answer: The most appropriate infection-control measure in this situation is to prepare to place the client on contact precautions. This provides an additional level of protection beyond standard precautions to prevent the infection's transmission to other patients or healthcare providers since Clostridium difficile infection can spread through direct or indirect contact.

Step-by-step solution

Understanding the Choices

First, we need to understand what each choice entails: A. Standard precautions are the minimum infection control practices that healthcare providers should follow when dealing with all patients, regardless of their infection status. B. Contact precautions are additional infection control measures taken when dealing with patients who have an infection that can spread through direct or indirect contact with the patient or their environment. C. Contacting environmental services to mop the floor is a cleaning procedure that may or may not be part of the necessary infection control measures. D. Hand hygiene is a basic infection control practice and is always essential before and after contacting any patient.

Analyzing the Situation

Given the situation, we're dealing with a cancer client who has severe diarrhea and tested positive for Clostridium difficile. This means that the infection can spread through direct or indirect contact, and the nurse should implement additional infection control measures.

Selecting the Appropriate Measure

Based on the analysis in Step 2, the most appropriate infection-control measure is one that takes into account the specifics of the situation. In this case, the answer is: B. Prepare to place the client on contact precautions

Explaining the Chosen Measure

The reason behind choosing 'contact precautions' is that it provides an additional level of protection beyond standard precautions. Since the client has cancer and Clostridium difficile infection, which could spread through contact, it's essential to follow contact precautions to prevent the infection's transmission to other patients or healthcare providers.

Key concepts

Clostridium difficile

Clostridium difficile, often abbreviated as *C. difficile* or *C. diff*, is a bacterium that can cause serious infections in the digestive tract.
It's particularly known for causing diarrhea and inflammation of the colon, especially in hospitalized patients or those who have been exposed to antibiotics. The bacterium releases toxins that lead to the symptoms of infection. Understanding *C. difficile* is important for implementing effective infection control measures. Since it's highly contagious, it can spread through spores that are difficult to eradicate and can live on surfaces for extended periods. Because of this, specific actions, like implementing contact precautions, become essential in healthcare settings.

Contact Precautions

Contact precautions are special measures used to prevent the spread of infections that can be transmitted by direct contact with a patient or indirectly via surfaces in their environment.
These precautions are vital for infections like *C. difficile*, which are highly transmissible. When healthcare personnel use contact precautions, it typically involves:

• Wearing gloves and gowns before entering the patient's room.
• Using disposable or dedicated equipment wherever possible.
• Disinfecting surfaces and medical equipment thoroughly between uses.
• Limiting patient movement within the healthcare facility to prevent cross-contamination.

By adhering to contact precautions, healthcare workers can effectively control the spread of *C. difficile* and protect both themselves and other patients from infection.

Hand Hygiene

Hand hygiene is one of the simplest yet most effective infection control measures to combat the spread of infections like *C. difficile*.
Proper hand hygiene involves washing hands with soap and water for at least 20 seconds or using hand sanitizer that contains at least 60% alcohol. Given that *C. difficile* spores are resistant to alcohol, washing hands with soap and water is recommended in cases of *C. difficile* infection. This physical washing helps in removing the spores from the hands effectively. Hand hygiene is crucial not only before and after patient contact but also after contact with potentially contaminated environments. Encouraging this practice can dramatically reduce infection rates and improve overall hygiene in healthcare settings.

Standard Precautions

Standard precautions are a set of infection control practices adopted universally in healthcare settings to prevent the transmission of diseases.
They establish the baseline for infection control, ensuring safety for both healthcare providers and patients. These precautions include:

• Proper hand hygiene.
• Using personal protective equipment (PPE) like gloves and masks when necessary.
• Safely handling sharps and waste.
• Using respiratory and cough etiquette.

While standard precautions are effective for general infection control, additional measures are often required for specific infections like *C. difficile*. Therefore, in cases of known infection risks, such as *C. difficile*, contact precautions are employed alongside standard precautions for enhanced safety.