護理師準備進入一位確診感染困難梭狀芽孢桿菌（C. diff）病人的病房。下列哪項感染管制措施對護理師而言最為關鍵？
A nurse is preparing to enter the room of a client with a confirmed diagnosis of Clostridioides difficile (C. diff). Which infection control measure is most critical for the nurse to implement?
- AMaintain the client in a semi-private room with a roommate who has similar symptoms將病人安置在有類似症狀室友的半私人病房
- BPerform hand hygiene using an alcohol-based hand rub before exiting離開前使用酒精性乾洗手液進行手部衛生
- CWear an N95 respirator mask while providing direct care提供直接照護時佩戴 N95 呼吸防護口罩
- DWash hands with soap and water after removing gloves✓ 正解脫掉手套後用肥皂和水洗手
困難梭狀芽孢桿菌（C. diff）的感染管制核心在於其孢子特性。C. diff 會產生孢子，而酒精性乾洗手液無法有效殺滅這些孢子。因此，在接觸受污染的環境或病人後，必須使用肥皂和流動水進行物理性的沖洗，以去除手上的孢子。這是預防院內傳播最關鍵的步驟。臨床上，這類病人應採接觸傳染防護措施（Contact Precautions），包括穿戴手套與隔離衣。選項 B 錯誤，因為酒精對孢子無效；選項 C 錯誤，C. diff 透過接觸傳播而非空氣傳播，不需要 N95；選項 A 雖然在資源受限時可考慮同病相憐（cohorting），但並非「最關鍵」的措施，且優先序低於正確的手部衛生。護理師必須理解環境表面與手部清潔在 C. diff 控管中的決定性作用，以確保病人的安全與預防交叉感染。
Clostridioides difficile spores are resistant to alcohol-based hand sanitizers, making soap and water handwashing essential to physically remove spores from the hands. This measure is critical for preventing transmission, as contact precautions require strict adherence to proper hand hygiene after glove removal. Other methods, such as alcohol rubs or N95 respirators, are ineffective or unnecessary for this contact-spread pathogen.
在美國，CDC 強烈要求針對 C. diff 必須使用肥皂洗手，且醫院常設有特定的「接觸+」告示牌。台灣目前的感控實務亦遵循此原則，但部分基層單位可能過度依賴酒精，需透過醫院評鑑與感控查核來強化肥皂洗手的落實度。