護理師正在照顧一位有困難梭狀芽孢桿菌（C. difficile）病史且正經歷頻繁水瀉的病人。為防止病原體傳播，護理師應採取的最關鍵行動為何？
A nurse is caring for a client with a history of Clostridioides difficile infection who is experiencing frequent liquid stools. Which action is most critical for the nurse to perform to prevent the spread of the pathogen?
- AEnsure the client is in a room with positive pressure確保病人住在正壓病房
- BUse an alcohol-based hand sanitizer before exiting the room離開病房前使用酒精性乾洗手
- CWear a N95 respirator when entering the room進入病房時佩戴 N95 呼吸器
- DWash hands with soap and water after providing care✓ 正解提供照護後用肥皂和水洗手
針對困難梭狀芽孢桿菌（C. diff）的感染控制，核心概念在於「孢子（Spores）」的物理性移除。C. diff 會產生具有高度抵抗力的孢子，一般的酒精性洗手液（Alcohol-based hand sanitizer）無法破壞其外殼。因此，唯一有效的方法是透過肥皂和流動的水進行物理性搓洗，將孢子從皮膚表面沖走。這是感染控制中的標準接觸預防措施（Contact Precautions Plus）。護理師必須理解，雖然酒精對大多數細菌有效，但在面對孢子型病原體時，物理性清潔是不可替代的安全防線。若未落實此步驟，孢子可能透過護理師的手傳播給其他易感病人，導致院內集體感染。此外，這類病人應安置在私人物室，並落實接觸隔離。
Infection control for Clostridioides difficile (C. diff) centers on the physical removal of spores. C. diff produces highly resistant spores that ordinary alcohol-based hand sanitizers cannot destroy. The only effective method is mechanical washing with soap and running water, which physically removes spores from the skin surface. This is the standard contact precaution measure (Contact Precautions Plus) for infection control. The nurse must understand that, although alcohol is effective against most bacteria, physical cleansing is irreplaceable when dealing with spore-forming pathogens. Failure to perform this step may transmit spores via the nurse's hands to other susceptible clients, leading to nosocomial outbreaks. In addition, these clients should be placed in a private room with contact isolation enforced.
在美國，NCLEX 高度強調 C. diff 必須使用 soap and water，這是必考點。台灣臨床上雖然也強調濕洗手，但在某些醫院的感控指引中，若非爆發流行期，有時會混淆酒精乾洗手的適用性。美國規範較為嚴格且統一。