Infection Control in a Client with Clostridioides difficile
Mrs. Lee, an 80-year-old female, is admitted with a 3-day history of watery diarrhea (8-10 times per day), abdominal cramping, and fever (38.3°C). She recently completed a course of broad-spectrum antibiotics for a urinary tract infection. Stool testing confirms Clostridioides difficile infection. She is placed in a private room with contact precautions. The LPN is assigned to care for her and another client with a fresh surgical wound. The LPN must plan care to prevent transmission.
1. What infection control measures should the LPN implement for Mrs. Lee? Explain the rationale for each.
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Infection control measures:
- Contact precautions: Wear gloves and a gown when entering the room. Remove PPE before leaving the room. Perform hand hygiene with soap and water (alcohol-based hand rub is not effective against C. difficile spores).
- Private room: Keep the door closed if possible. Dedicate equipment (e.g., stethoscope, thermometer, BP cuff) to the room.
- Environmental cleaning: Use a chlorine-based disinfectant or EPA-approved sporicidal agent for surfaces and equipment. C. difficile spores are resistant to alcohol.
- Hand hygiene: Emphasize soap and water handwashing for staff, visitors, and the client after bathroom use.
- Visitor education: Instruct visitors to wear PPE and perform hand hygiene. Limit visitors if necessary.
- Client teaching: Teach the client to wash hands thoroughly after using the bathroom and before eating. Keep the bathroom door closed.
- Waste management: Dispose of stool in the toilet carefully to avoid splashing. Use a dedicated bedpan or toilet if possible.
- Avoid sharing items: Do not share utensils, towels, or other personal items.
Rationale: C. difficile spores are highly contagious and resistant to many disinfectants. Contact precautions and sporicidal cleaning are essential to prevent spread, especially to vulnerable clients like the one with a surgical wound.
2. How should the LPN manage the assignment to protect the other client with a surgical wound? What additional precautions are needed when caring for both clients?
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Assignment management:
- If possible, the LPN should request a reassignment so that she does not care for both clients during the same shift, or care for the surgical client first before entering Mrs. Lee's room.
- If reassignment is not possible, the LPN must perform care for the surgical client first, before any contact with Mrs. Lee, to minimize the risk of transferring spores.
- After caring for Mrs. Lee, the LPN must remove PPE and perform hand hygiene with soap and water before entering the surgical client's room.
- The LPN should not carry equipment between rooms. Use dedicated equipment for each client.
Additional precautions:
- Strict adherence to contact precautions for Mrs. Lee.
- For the surgical client, ensure that the wound dressing is intact and dry. Monitor for signs of infection.
- Educate the surgical client about the importance of hand hygiene and avoiding contact with the infected client.
- Clean and disinfect any shared equipment (e.g., blood pressure cuff) between clients.
- Report any breaches in protocol to the infection control team.