護理師正在照護一位感染困難梭狀芽孢桿菌（C. diff）的病人。下列哪項措施是預防感染擴散的首要任務？
A nurse is caring for a client with Clostridioides difficile (C. diff) infection. Which action is the priority to prevent the spread of the infection?
- APerform hand hygiene with soap and water after care✓ 正解照護後使用肥皂和水進行手部衛生
- BUse alcohol-based hand rub before leaving the room離開房間前使用含酒精的免洗洗手液
- CWear a mask when entering the client's room進入病人房間時佩戴口罩
- DKeep the client's door closed at all times始終保持病人房門關閉
此題核心在於困難梭狀芽孢桿菌（C. diff）的感染控制。C. diff 會產生芽孢，而酒精洗手液無法殺滅芽孢，必須透過肥皂和流動清水洗手的物理摩擦力將芽孢移除。這是標準接觸隔離（Contact Precautions）在 C. diff 病例中的特殊要求。為什麼 B 是最優先？因為這直接阻斷了最常見的傳播途徑。A（酒精）無效；C（口罩）是針對飛沫或空氣隔離，對腸道傳染病非首選；D（關門）是空氣隔離（如結核病）的要求。臨床護理師必須記住：凡是『芽孢』類感染，酒精洗手液都是不夠的。
The key to this item is infection control of Clostridioides difficile (C. diff). C. diff produces spores, and alcohol-based hand rubs cannot kill spores; soap and running water must be used so that the physical action of friction removes the spores. This is a specific requirement of Contact Precautions when applied to C. diff cases. Why is B the priority? It directly interrupts the most common route of transmission. Option B (alcohol) is ineffective; option C (a mask) is for droplet or airborne precautions, not the first choice for an enteric pathogen; and option D (closing the door) is a requirement of airborne precautions (such as for tuberculosis). The clinical nurse must remember: for spore-forming infections, alcohol-based hand rubs are not enough.
美國 NCLEX 考題嚴格區分 Hand Rub 與 Soap/Water 的使用時機；台灣臨床上雖也推廣酒精洗手，但在腸道傳染病流行期間或特殊病房（如 ICU），對肥皂洗手的稽核與落實程度可能因醫院而異。