C. diff, a Shared Bathroom, and Three Boxes of Gloves
Mrs. Okafor is 68 and has just been placed on contact precautions. Overnight she had four loose stools, and this morning the nurse tells you her stool tested positive for C. difficile. She shares a room and a bathroom with Mrs. Lin, who has lived there for six years. The two women share a television remote, a bedside table, and a water pitcher. It is 0800. The isolation cart outside the door holds gowns and gloves, and the supply room has three boxes of gloves left with no delivery expected before the afternoon. Mrs. Okafor tells you she wants to go to the dining room for breakfast because it is bingo day and she always sits with Mrs. Lin.
1. How do you handle Mrs. Okafor's request to go to the dining room, knowing you cannot make that decision yourself?
Read the worked answer
Contact precautions plus active diarrhea means the nurse decides whether she leaves the room - not you, and not the resident's preference alone.
What you can do:
- Do not say yes and do not simply say no. Tell her honestly that you need to check with the nurse because of the diarrhea, and then actually do it promptly so she is not left waiting and guessing.
- Explain without shaming and without disclosing her diagnosis to anyone who does not need it. Something like: "While your stools are still loose, the nurse wants you to eat in your room so the other residents don't pick up the same bug. I know bingo matters to you - let me see what we can do."
- Offer real alternatives: a tray in her room, sitting with her while she eats, bringing the bingo card to her room, or a phone call with Mrs. Lin afterward. Only promise what you can actually deliver.
- Never tell Mrs. Lin or her family the test result. If Mrs. Lin asks why the cart is at the door, refer her to the nurse.
C. diff spores are spread by hands and contaminated surfaces, and a shared dining table is exactly the setting they travel in.
2. Walk through what you do for her incontinence care and when you leave the room. Include what you would and would not change because gloves are running low.
Read the worked answer
Before entering: gown and gloves on, dedicated equipment (thermometer, BP cuff, bedpan) kept in the room and not carried to other residents.
During care:
- Keep gloved hands off clean surfaces - don't answer the phone, touch the door handle, or adjust the remote with contaminated gloves.
- Clean the perineum from front to back, change linens that are soiled, and bag waste and linen inside the room per policy.
- Once gloves are contaminated, they are contaminated; there is no "rinsing and continuing."
On exit: remove gloves, then gown, without letting the outer surfaces touch your clothing or skin, and discard both inside the room or at the door as policy directs.
Hand hygiene: soap and water, not alcohol rub. C. difficile forms spores that alcohol does not reliably kill; friction and running water are what remove them.
Do not change technique because of the glove shortage. Hand hygiene is the actual intervention; gloves are a barrier, not a substitute. Report the low supply to the nurse or charge nurse so it is addressed - rationing by skipping PPE is not a CNA's workaround.
3. What do you do about the shared bathroom, remote, pitcher, and bedside table with Mrs. Lin? What can you decide and what must go to someone else?
Read the worked answer
You can act on surfaces and items; you cannot rearrange the room.
What you can do:
- Move Mrs. Okafor's pitcher, cup, and personal items onto her own space and keep the shared items separated, or set up a dedicated remote and pitcher for her.
- Clean high-touch shared items such as the remote and the bathroom grab bars and light switch with the facility's approved disinfectant - and use one that is labeled effective against C. diff spores, not a general wipe.
- Ensure hand hygiene is available inside or at the door of the shared bathroom, and remind both residents without embarrassing either one.
What you must hand off:
- Room assignment, cohorting, and whether a move is needed is the nurse's and infection preventionist's call. Report the shared bathroom and the shared items as a concern - that is your job, not solving it unilaterally.
- Mrs. Lin's own risk should be raised with the nurse; she has been exposed and may need monitoring, but her evaluation belongs to the clinical team.
- Never discuss Mrs. Okafor's results with Mrs. Lin or her family. Redirect to the nurse.
Document what you did - cleaning, item separation, who you notified and when.