Six Loose Stools, One Shared Bathroom
Mr. B is 60 and has had six loose, watery stools since midnight. His chart is flagged 'contact precautions - C. difficile.' He is in a semi-private room, and his roommate Mr. J is two days post hip replacement and uses a walker. There is one bathroom in the room and it is shared. You put on gloves and a gown, clean Mr. B, bag the trash, then pull off your gloves in the doorway and use the alcohol-based hand rub in the hallway. You start toward Mr. J's buzzing call light. Another aide calls, 'I'll get him, I'm already gloved up from the flu room down the hall.' Two hours later Mr. B says he needs to go again and starts walking toward the shared bathroom on his own.
1. Critique what you just did with the PPE and your hands, and state exactly what you should have done.
Read the worked answer
Two errors, one of them the classic C. difficile mistake.
- Alcohol rub does not kill C. difficile spores. The only reliable step is soap and water handwashing with friction, long enough to physically remove spores. Using the alcohol rub after caring for Mr. B could carry spores to Mr. J's call light, tray, and walker.
- PPE was incomplete for the situation: gloves and gown were right, but for a resident with six watery stools, the gown should be removed inside the room and discarded there, and you should not be handling items outside the room before handwashing.
Correct sequence:
- Gather everything before entering (briefs, wipes, barrier bag) so you do not exit contaminated.
- Gloves and gown on entry; change gloves if they tear or become heavily soiled.
- Clean the resident, then clean and disinfect the commode/bathroom surfaces he used with a sporicidal bleach product per facility policy.
- Remove gown and gloves inside the room, discard into the room's waste, then exit and wash hands with soap and water.
- Leave the door closed, keep the precaution sign up, use dedicated equipment, and keep the roommate's items off shared surfaces.
Reasoning: C. difficile spreads by spores on hands and surfaces, not by air. Everything you touch on the way to the sink is a transmission route to a fresh hip replacement.
2. Mr. B gets up and starts walking toward the shared bathroom. What do you do, and what does that mean for Mr. J?
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Redirect the bathroom, not the person.
- Go with him and redirect - 'Mr. B, let's use the commode in your room, I'll help you.' Do not physically block or grab him; he has a right to move and he is continent enough to know he needs to go.
- Provide the alternative now: a bedside commode or a dedicated bathroom designated for his use, kept in his room and cleaned with a sporicidal product after each use. If nothing is available, that is a nurse/charge issue to solve this shift, not a reason to let him use the shared toilet.
- If he uses the shared bathroom anyway, it must be cleaned and disinfected before Mr. J uses it, and Mr. J must not be sent in behind him.
- Protect Mr. J: he is two days post hip replacement and a fall or an infection both threaten the repair. Keep his walker, over-bed table, and personal items out of the contaminated zone; assist him to void elsewhere if the nurse agrees.
- Report: that a resident on contact precautions is ambulating to a shared bathroom - this is a placement problem the nurse and administration need to fix (single room, dedicated commode, or cohorting).
Why: the precaution is only as good as the environment. Telling Mr. B 'you can't go' and walking away is not an option; giving him a safe place to go is.
3. Mr. J's call light is buzzing and the other aide offers to answer it while 'already gloved up' from the flu room. What do you do, and what do you report at the end of the shift?
Read the worked answer
Stop the cross-contamination before it happens.
- Do not send an aide who is in PPE from another room into Mr. J's space. Gloves and a gown worn for one resident are contaminated; carrying them into another resident's room, or into the hallway between rooms, moves organisms from the flu room to a post-op resident. PPE is removed at the doorway of the room where it was used, and hand hygiene happens before the next resident.
- Answer it yourself, correctly: wash your hands with soap and water (you just left a C. difficile room), then go to Mr. J with clean hands. If his request needs contact precautions for him personally, follow his own status - he is not on precautions, but he is a susceptible neighbor.
- Say it plainly to the other aide: 'Go wash up and change gloves first - I'll take Mr. J.' Frame it as protecting the next resident, not as a correction.
Report at end of shift:
- Mr. B's stool frequency, character, and any new symptoms (fever, cramping, blood, dizziness) - six watery stools in a few hours is a dehydration and skin-breakdown risk.
- Skin condition in the perineal area and what barrier product you used.
- That a resident on contact precautions is using a shared bathroom and a dedicated commode is needed.
- That another aide attempted to enter a non-precaution room in PPE from a different room, so the nurse can address it with staff.
- Mr. J's status - any loose stool, fever, or change - because he is now an exposed contact.