C. diff and the Bingo Game
Mr. Kowalski, 70, has Clostridioides difficile infection and has had six episodes of watery diarrhea since midnight. Contact precautions are posted on his door. You are also assigned to a resident with a fresh surgical wound and to two residents on the rehab hall. The alcohol-based hand rub is mounted outside his door; the sink is inside the room by the bathroom. At 1:50 p.m. he says, 'Bingo is at two. I've been in this room for three days and I'm going.' His gown and the bed linen are soiled again.
1. What PPE and hand hygiene do you use for this episode of care, and why the specifics?
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Before entry: gown and gloves, per contact precautions. Gather everything first so you don't leave mid-care.
During care:
- Do not touch clean surfaces, door handles, or your face with gloved hands.
- Use dedicated equipment for him - thermometer, blood pressure cuff, stethoscope - and do not carry them to your other residents.
- Bag soiled linen at the bedside; do not shake it or carry it against your body.
On the way out:
- Remove gloves and gown inside the room, then wash hands with soap and water at the sink before leaving.
- Why not the alcohol rub: alcohol does not reliably kill C. difficile spores; friction and soap and water physically remove them. This is the one organism where the hand rub is not enough.
- Why the wound resident matters: you go to that resident only after hand hygiene and with clean equipment, or better, after finishing this room.
2. He wants to go to bingo. How do you respond?
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He has a real reason to be angry, and 'no' by itself will escalate him.
- Be honest about the reason: he is on contact precautions because of an infection that spreads easily, and shared activities are restricted per facility policy until it clears.
- Do not just shut the door. Offer what is possible: bingo in his room, a private activity with an activity aide, a call to his family, a book or radio, or a walk in the hallway at an off-peak time if policy allows and he is clean and contained.
- Get the nurse involved if he is insisting - the nurse can explain the expected duration and the criteria for ending precautions.
- Do not give him a vague 'maybe later' to end the conversation; that damages trust and he will try again with someone else.
- Do not let him go to the dining room. If he leaves the room, notify the nurse; you do not physically restrain or block a resident.
- Document what he asked for and what was offered.
3. What are your environmental and linen responsibilities, and what about his roommate?
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Spores live on surfaces, so cleaning is treatment, not housekeeping.
- Linen: roll soiled linen inward, bag it at the bedside in the designated bag, tie it, and transport it in a way that does not touch your uniform or the hallway walls.
- Never shake linen - that launches spores into the air and onto your clothes.
- Surfaces: clean the bathroom, bed rails, call light, and bedside table with the facility-approved disinfectant for C. difficile - the nurse or housekeeping can confirm which product meets sporicidal requirements.
- Dedicated items stay in the room and are cleaned before reuse.
- Roommate: confirm with the nurse whether he has a roommate and whether that person has symptoms. Do not share equipment, towels, or toiletries between them, and report any new diarrhea in the roommate immediately.
- Report any breaches you catch yourself making - a missed handwash is a reportable event, not a secret.