一位55歲男性因今日高達8次水瀉，疑似感染艱難梭菌 (C. difficile) 入院。病房內散發出一股獨特的惡臭。其生命徵象為心跳 105次/分，血壓 102/65 mmHg，體溫 37.8°C。在脫下沾染髒污的手套與隔離衣後，護理師離開病房前強制必須執行的手部衛生程序為何？
A 55-year-old male is admitted with suspected Clostridium difficile (C. difficile) infection after reporting eight episodes of watery diarrhea today. The room emits a distinctive foul odor. His vital signs are HR 105 bpm, BP 102/65 mmHg, and Temp 37.8°C (100.0°F). After removing heavily soiled gloves and an isolation gown, what is the mandatory hand hygiene procedure the nurse must perform before exiting the room?
- AUse an alcohol-based hand rub vigorously for at least 15 seconds.用力使用酒精性搓手液至少15秒
- BDon a new pair of clean gloves immediately to prevent touching environmental surfaces.立即戴上新的乾淨手套以防止接觸環境表面
- CWipe hands using a facility-approved chlorhexidine gluconate (CHG) wipe.使用機構核准的葡萄糖酸氯己定（CHG）濕巾擦拭雙手
- DWash hands with antimicrobial soap and warm running water.✓ 正解使用抗菌肥皂和溫流水洗手
本題測驗最基礎卻最致命的感染控制：艱難梭菌 (C. diff) 的手部衛生規定。根據美國疾病管制與預防中心 (CDC) 指引，C. diff 會產生難以消滅的細菌休眠體——孢子 (Spores)。坊間醫院普遍使用的含酒精乾洗手液 (Alcohol-based hand rubs) 並不具備殺滅孢子的能力（選項A錯誤）；同樣地，含有洗必泰 (CHG) 的濕巾也無法完全去除孢子（選項C錯誤）。唯一有效預防 C. diff 散播的方法是：在每次接觸病患或脫下手套後，利用「肥皂與流動溫水」透過搓揉的物理摩擦力將皮膚表面的孢子沖刷掉入水槽（選項D正確）。選項B戴上新手套不能取代手部清潔，若手未洗就拿新手套，已將污染擴散。
Clostridium difficile produces spores that are resistant to alcohol-based hand rubs and chlorhexidine wipes. The most effective method to remove these spores is washing hands with antimicrobial soap and warm running water, which uses mechanical friction to physically rinse them away. This is critical after contact with a patient or contaminated environment to prevent transmission.
台灣指引與美國 CDC 安全標準一致。在台灣許多醫學中心，面對 C. diff 病患也會強制掛上「必須用肥皂洗手洗」(Wash hands with soap and water)的特殊告示牌，而非單純的接觸防護。