C. difficile, a Roommate, and a Soiled Linen Bag
Mrs. Okafor, 70, has a Clostridioides difficile infection and three episodes of watery stool in the last two hours. She wears briefs and is on contact precautions with a sign on the door. Her roommate, Mrs. Lin, 88, has an indwelling urinary catheter and is finishing treatment for a wound infection. Housekeeping has just left the room carrying a bag of soiled linen pressed against her uniform, and the room door is propped open with a chair. The gown and glove cart is down the hall; an alcohol-based hand rub dispenser is mounted just outside the door. You have been asked to clean Mrs. Okafor and change her bed.
1. What is your PPE and hand hygiene sequence before and after entering, and why is the alcohol rub by the door not enough?
Read the worked answer
Before entering:
- Perform hand hygiene, then put on a gown and gloves at the door - even though the cart is down the hall, gather supplies first so you are not going in and out contaminated.
- Take in only what you need: briefs, wipes, a linen bag, and dedicated equipment for her room.
After care:
- Remove gloves and gown inside the room, turning them inside out, and discard them in the room's waste.
- Then wash hands with soap and water.
Why soap and water, not the alcohol rub: C. difficile forms spores that alcohol does not kill. Mechanical washing with soap and running water removes spores; alcohol rub leaves them on your hands to be carried to Mrs. Lin and the rest of the unit. The rub is fine for many organisms but it is the wrong choice here.
Also: do not prop the door open - it invites traffic and airborne/contact spread through a shared unit. Close it and keep the precaution sign visible. Keep a dedicated thermometer and stethoscope in the room.
2. What do you do about the propped door and the housekeeping aide holding linen against her uniform?
Read the worked answer
Handle it as a safety correction, not a reprimand.
- Close the door or ask the aide to close it, and explain briefly that the room is on contact precautions.
- Tell the aide directly and kindly: 'That bag is against your uniform - let's get you a clean set of scrubs and put the linen in the soiled utility room.' Linen should be held away from the body and never pressed against clothing, because stool from a C. diff resident can transfer to her uniform, then to every surface she touches.
- Report it to the nurse and to infection prevention so the aide's assignment and the linen procedure can be reviewed - one correction does not fix a pattern.
- Do not shame her in front of the resident or visitors.
Reasoning: the highest-risk object in that room is not the toilet - it is whatever leaves the room. The linen bag and a contaminated uniform are both ways C. diff spores travel to Mrs. Lin, who is elderly, catheterized, and has a healing wound - three risk factors at once.
3. You must clean Mrs. Okafor and change her bed. Where is the cross-contamination risk in that task, and how do you control it?
Read the worked answer
Sequence and control points:
- Keep Mrs. Lin's side of the room out of the work zone; do not set clean supplies on her bed or use shared equipment between the two residents.
- Put on fresh gloves for cleaning; contain stool in a bedpan or brief and dispose of it without splashing. Splash and aerosol spread spores onto surfaces.
- Use the facility's sporicidal (bleach-based) disinfectant on the bedpan, bed rails, call light, and overbed table. Alcohol wipes are not enough for C. diff.
- Handle linen without shaking or hugging it to your body; place it directly into the bag in the room, then to soiled utility.
- Remove PPE inside the room, then wash hands with soap and water.
- Do not carry the soiled linen bag through the hallway against your uniform or set it on the floor at the nurses' station.
Key judgment: the brief change itself is easy. The risk lives in the surfaces and the objects that leave the room, and in skipping handwashing because gloves were worn.