Diarrhea, Spores, and a Visitor
Mrs. Pruitt has had four episodes of watery diarrhea since breakfast and is on contact precautions for Clostridioides difficile. She shares a room with Mrs. Okafor, who has an indwelling urinary catheter and eats independently. Mrs. Pruitt uses a walker and wears a gait belt. At 1:40 p.m. you are to take her to radiology for a chest X-ray, and on your way in her daughter arrives and asks to use the bathroom in her mother's room. You are the only aide on the hall and the linen cart is down to its last two gowns.
1. What PPE do you put on to enter the room, how do you take it off, and what hand hygiene do you use? Explain why.
Read the worked answer
Gown and gloves, removed inside the room, followed by soap and water.
- Put on a gown and gloves before entering; add a mask and eye protection if there is any risk of splashing during cleanup.
- Do not wear them in the hallway or at the nurses' station.
- Remove gloves first, then the gown, peeling it away from your body so the contaminated outside folds inward, both while still at the doorway inside the room.
- Wash hands with soap and water, not alcohol gel.
Reasoning: C. difficile forms spores that alcohol does not reliably kill; friction and running water physically remove them. Keeping PPE inside the room stops you from painting the hallway, door handles, and cart with spores. Use the room's dedicated equipment and do not carry a shared blood pressure cuff from her room to another resident.
2. Walk through how you get Mrs. Pruitt to radiology without spreading contamination.
Read the worked answer
Contain the contamination in the room, then hand off cleanly.
- Before leaving, provide peri-care and a fresh brief, and put on a clean gown.
- Gather what she needs so you do not have to come back.
- Remove your contaminated PPE inside the room and wash your hands.
- Put on clean gloves to apply the gait belt and assist her; if she may soil the chair or chair, line it with a washable pad.
- Do not stop at the desk, lean on walls, or handle shared items with soiled gloves.
- Tell the radiology staff on arrival that she is on contact precautions so they can prepare.
- Remove gloves and wash hands after handing her over.
Reasoning: the diarrhea is the source; the trip is the risk window. Dignity matters too - she should not be wheeled through the hall soiled or uncovered. If she has another episode en route, stop, clean up, and change gloves rather than continuing.
3. The daughter wants to use her mother's bathroom, and Mrs. Okafor's daughter later asks to borrow her mother's roommate's lotion. How do you respond?
Read the worked answer
Say no to both, kindly, and explain why.
The bathroom and everything in it are contaminated with C. difficile spores. Direct the daughter to the public restroom, and ask her to wash with soap and water before she leaves the unit and before she eats. Do not let her use her mother's towel or sit on the bed.
Mrs. Okafor's daughter should not share lotions, towels, washcloths, or equipment across the room - that is how spores and other organisms travel. Items that belong to Mrs. Pruitt stay with her.
Reasoning: contact precautions are about the environment as much as the person. The roommate is at real risk because she has a urinary catheter, which is a direct path for organisms. Also watch Mrs. Okafor for diarrhea and report any change to the nurse, since exposure may already have happened before precautions started.