Six Loose Stools and a Shared Blood Pressure Cuff
Mr. Alvarez, 82, has had six loose, watery stools since 6 a.m. and is on contact precautions for Clostridioides difficile. His gown, his sheets, and the bed rail are soiled. Alcohol-based hand rub is mounted on the wall outside his door; there is one box of gloves in the room and a working sink. His roommate, Mr. Bell, uses the same blood pressure cuff and the same walker that were left at Mr. Alvarez's bedside last night. The nurse asks you to clean Mr. Alvarez up and then go straight to helping Mr. Bell with breakfast before the meal trays are collected.
1. Which PPE do you put on before entering the room, and exactly when and where does each item come off?
Read the worked answer
Before entering: hand hygiene, then gown and gloves at the doorway. Add a mask with eye protection only if splashing is likely (for example, emptying a full bedpan or a stool that may spray).
Order of removal - all inside the room:
- Gloves first. They are the most contaminated item; peel them off without snapping them.
- Gown second. Untie in front, pull it off touching only the inside, roll it inward, and put it in the room's waste container.
- Hand hygiene after leaving - soap and water, not the alcohol rub (see next task).
Reasoning: the whole point of the gown and gloves is to leave the contamination in the room. A gloved hand that touches the door handle or the hand-rub dispenser has just moved C. difficile spores into the hallway. Never wear PPE into the hall or into Mr. Bell's room, and never carry soiled linen against your body.
2. When you finish cleaning Mr. Alvarez, which hand hygiene method do you use and why? What if your hands are visibly soiled?
Read the worked answer
Soap and water for at least 20 seconds, with friction - palms, backs of hands, between fingers, under nails - then dry with paper towels and use the towel to turn off the faucet.
Why not the alcohol rub: alcohol does not reliably kill C. difficile spores. The mechanical action of washing and rinsing removes them; alcohol leaves them on your skin. This is one of the few organisms where the alcohol rub is the wrong choice.
Visibly soiled hands: always soap and water, no exceptions, regardless of organism.
Timing: wash after removing the gown and gloves and before you leave the room, then again before you touch Mr. Bell or his tray. Follow facility policy on whether the wash must happen at the sink inside the room - many facilities require it for C. diff.
3. What do you do about the shared blood pressure cuff and walker before you care for Mr. Bell?
Read the worked answer
Do not carry them out of the room. They were at the bedside of a resident with an active C. diff infection and are contaminated.
Steps:
- Tell the nurse that equipment was shared and needs to be addressed - this is a reportable infection-control problem, not something to quietly fix.
- Ask for a dedicated cuff to stay in Mr. Alvarez's room, or a disposable one.
- Clean and disinfect the shared cuff with the facility-approved agent for C. diff (usually a bleach-based product) and let it sit for the full wet contact time before anyone else uses it. If you are not trained or the product is not available, give it to the nurse; do not guess.
- Get Mr. Bell a different walker now. Do not clean-and-hand-off a walker while he is waiting to walk.
Reasoning: this is indirect contact transmission through a contaminated object. The reason it matters here is the pairing of a diarrhea illness with equipment that crosses between two residents - the highest-yield way to spread C. diff on a unit.