護理師正在照護一位困難梭狀芽孢桿菌（C. diff）感染的病人。哪項感控措施是強制性的？
A nurse is caring for a client with Clostridioides difficile (C. diff) infection. Which infection control measure is mandatory for this client?
- AWearing an N95 respirator during client care在照護客戶期間佩戴 N95 呼吸器
- BUsing alcohol-based hand sanitizer after removing gloves脫下手套後使用酒精性免洗洗手液
- CPlacing the client in a room with negative pressure將客戶安置於負壓病房
- DWashing hands with soap and water after client contact✓ 正解接觸客戶後用肥皂和清水洗手
困難梭狀芽孢桿菌（C. diff）會產生孢子（spores），而酒精乾洗手液無法有效殺滅這些孢子。因此，在脫掉手套後，護理師必須使用肥皂和流動水進行物理性的刷洗，以移除手上的孢子，這是接觸傳染防護（Contact Plus Precautions）的關鍵。臨床思路應區別一般細菌與芽孢菌的清潔方式。選項 A 錯誤，C. diff 透過糞口接觸傳染，不需 N95；選項 B 錯誤，酒精對孢子無效；選項 C 錯誤，負壓病房適用於空氣傳染疾病（如結核病），C. diff 僅需單人房或同病種隔離。
Clostridioides difficile spores are resistant to alcohol-based hand sanitizers, making mechanical removal via soap and water essential for infection control. Contact precautions require a private room, but negative pressure is unnecessary as transmission is fecal-oral rather than airborne.
美國醫院在 C. diff 感控中非常強調「環境去污」，通常要求使用稀釋漂白水或專用滅孢劑清潔病房；台灣臨床亦遵循肥皂洗手原則，但在環境清潔上，有時會併用紫外線消毒燈作為輔助。