護理師準備進入一位感染困難梭狀芽孢桿菌（C. diff）病人的病房。下列哪項措施是感控的首要優先事項？
A nurse is preparing to enter the room of a client with Clostridioides difficile (C. diff) infection. Which of the following actions is the priority for infection control?
- AApplying an alcohol-based hand sanitizer before putting on gloves戴手套前使用酒精性乾洗手
- BPerforming hand hygiene with soap and water after contact✓ 正解接觸後用肥皂和水進行手部清潔
- CDonning a mask and eye protection戴上口罩和眼部防護
- DEnsuring the client is in a room with positive pressure airflow確保病人處於正壓氣流的房間內
針對困難梭狀芽孢桿菌（C. diff）的感染控制，核心概念在於該細菌會產生芽孢，而酒精性乾洗手液無法有效殺滅芽孢。因此，物理性地透過肥皂與流動清水洗手，利用摩擦力將芽孢從皮膚表面移除，是預防傳播最關鍵的步驟。此題考驗基礎的接觸傳染防護（Contact Precautions）與 C. diff 的特殊性。正確答案為 B，因為在接觸受污染環境或病人後，必須使用肥皂洗手。A 選項在 C. diff 案例中無效；C 選項的防護具（口罩與眼罩）並非接觸傳染的標準配備，除非預期有噴濺風險；D 選項的正壓病房適用於保護性隔離（如骨髓移植病人），而非 C. diff 病人（通常需要單人房或同病種隔離）。
The key to infection control of Clostridioides difficile (C. diff) is that the organism produces spores, and alcohol-based hand sanitizers cannot effectively kill these spores. Therefore, physically washing the hands with soap and running water, using the friction to mechanically remove the spores from the skin, is the most critical step in preventing transmission. This item tests basic Contact Precautions and the special features of C. diff. The correct answer is B because, after contact with a contaminated environment or client, soap and water handwashing is required. Option A is ineffective in C. diff cases; the personal protective equipment in option C (mask and eye protection) is not standard for contact transmission unless splashing is expected; and option D, a positive pressure room, is used for protective isolation (for example, for bone marrow transplant patients) rather than for clients with C. diff (who typically require a private room or cohorting).
在美國 NCLEX 考題中，C. diff 必選肥皂洗手是極為經典的考點，強調 OSHA 的標準預防。台灣臨床實務中，雖然同樣強調肥皂洗手，但有時會因洗手台設置位置不便而增加酒精乾洗手的依賴，但在國考與評鑑標準上，兩者對於芽孢菌的處理準則完全一致。