Two Rooms, One Supply Cart
Mr. Nowak, 74, has had six loose stools since 6:00 a.m. and has a documented C. difficile infection. He is on contact precautions. You are also assigned to Mrs. Liu in the next room, who has an indwelling urinary catheter and a wound colonized with MRSA. The two rooms share one supply cart in the hallway, stocked with alcohol-based hand gel, one box of gloves, and one box of gowns. A new aide asks you which hand sanitizer to use after leaving each room.
1. What do you use for hand hygiene after leaving Mr. Nowak's room, and why?
Read the worked answer
Soap and water, with friction, for at least 20 seconds.
C. difficile forms spores that alcohol does not reliably kill. Alcohol gel is fine for many organisms, and it is the right choice after leaving Mrs. Liu's room, but it is the wrong choice for C. diff. Wash hands, then dry with paper towels and use the towel to turn off the faucet and open the door.
Note that gloves are not a substitute for handwashing - spores can sit on gloved and ungloved hands. The soap-and-water rule applies after every contact with Mr. Nowak or his room, even a quick one.
2. Describe how you gown, glove, and exit the two rooms.
Read the worked answer
For either room: perform hand hygiene, gown first, then gloves with the cuffs over the gown wrists.
Exit: remove gloves and gown inside the room or in the doorway, without touching the outside of either with bare hands. Gloves off first, then gown by the shoulders, turning it inside out. Then leave and wash hands with soap and water.
Do not wear the same gown or gloves from one room into the next, and do not carry the shared cart into either room. Keep dedicated equipment (thermometer, blood pressure cuff, stethoscope) in each room when the facility provides it, and never bring an item from Mr. Nowak's room into Mrs. Liu's.
3. What is the problem with the shared cart, and what do you do about it?
Read the worked answer
Items that touch contaminated hands become contaminated items. If staff pull gloves from the same box after touching Mr. Nowak, the box and gel bottle become a way to move C. diff spores down the hallway to Mrs. Liu.
Fix it: keep the cart outside both rooms, do hand hygiene before reaching for supplies, and get a second box of gloves and a second gel bottle so each room's supplies stay outside its own door. Ask the nurse to make sure the cart is restocked with soap and paper towels too.
You do not need permission to point out a cross-contamination risk - report it to the nurse and the charge nurse, and say it plainly: one shared box is spreading germs between two rooms.