護理師正在照護一位感染困難梭狀芽孢桿菌（C. diff）的病人。為了防止感染擴散，護理師最應優先執行的措施是？
A nurse is caring for a client with Clostridioides difficile (C. diff) infection. Which action is most important for the nurse to perform to prevent the spread of infection?
- AWash hands with soap and water after providing care✓ 正解提供照護後以肥皂和水洗手
- BWear a mask and goggles when entering the room進入房間時佩戴口罩和護目鏡
- CPerform hand hygiene with alcohol-based hand rub使用含酒精的搓手液進行手部衛生
- DKeep the client’s door closed at all times保持病人房門始終關閉
本題核心概念在於困難梭狀芽孢桿菌（C. diff）的孢子特性。C. diff 是一種產孢細菌，其孢子對酒精（Alcohol-based hand rub）具有高度抵抗力，無法被酒精殺滅。因此，接觸隔離預防措施中，機械性的摩擦與流動水沖洗是移除孢子的唯一有效物理方式。當照護此類病人時，肥皂與清水洗手是防止交叉感染的最重要環節。雖然酒精洗手液在一般情況下（如標準預防措施）非常有效，但在面對孢子型病原體時無效。選項 B 和 D 分別屬於飛沫隔離與空氣隔離的要求，對 C. diff 這種接觸傳染路徑並非首選。護理臨床思維應先鎖定病原傳播途徑，再選擇對應且有效的清潔技術。
The core concept of this item is the spore-forming nature of Clostridioides difficile (C. diff). C. diff is a spore-forming bacterium, and its spores are highly resistant to alcohol-based hand rubs, which cannot kill them. Therefore, within contact isolation precautions, mechanical friction and rinsing with running water are the only effective physical means to remove the spores. When caring for such clients, handwashing with soap and water is the most important link in preventing cross-infection. Although alcohol-based hand rubs are very effective in general (such as for standard precautions), they are ineffective against spore-forming pathogens. Options B and D belong to droplet and airborne precautions respectively and are not the first-line choices for the contact transmission route of C. diff. Nursing clinical reasoning should first identify the pathogen's transmission route, then choose the corresponding and effective cleansing technique.
在美國 NCLEX 考試中，C. diff 必須使用 soap and water 是絕對考點。台灣臨床雖然也強調此點，但有時在非爆發期間，部分醫護可能會過度依賴乾洗手，但在認證醫院（JCI）中，洗手台的設置與標示會比台灣一般診所更嚴格要求在病房內完成肥皂洗手。