Never use alcohol-based hand rub alone for C. difficile; alcohol does not kill spores.
Before you read
Test yourself first: 5 questions
Question 1 of 5
A client is on contact precautions for a vancomycin-resistant enterococcus (VRE) infection. A family member asks why everyone wears a gown and gloves. What is the nurse's best response?
Answer: B. VRE is spread by direct and indirect contact. Gowns and gloves prevent the organism from being carried on clothing and hands to other clients, which is the rationale for contact precautions.
Question 2 of 5
A client on contact precautions for Clostridioides difficile needs a stool sample collected. Which staff member is appropriate to perform this task, and why?
Answer: A. Collecting a stool specimen from a client on contact precautions is within UAP scope as long as the UAP is trained in the proper precautions, including hand hygiene with soap and water. The task does not require nursing judgment.
Question 3 of 5
When delegating client care, which task is appropriate for the nurse to assign to unlicensed assistive personnel (UAP) for a client on contact precautions?
Answer: B. UAP can perform stable, routine tasks within their scope, such as taking and recording vital signs while following contact precautions. Assessing wound infection, teaching about isolation, and evaluating the response to medication require nursing judgment and cannot be delegated. Delegation must match the task to the worker's scope and the client's stability.
Question 4 of 5
A client colonized with vancomycin-resistant enterococcus (VRE) requires which precaution?
Answer: B. VRE spreads by contact — use contact precautions (gown and gloves), dedicated equipment, and meticulous hand hygiene.
Question 5 of 5
A client with scabies is admitted to the unit. Which precaution should the nurse implement?
Answer: C. Scabies, caused by a mite that burrows into the skin, is spread by direct skin-to-skin contact and contaminated linens. Contact precautions with gown and gloves are required.
Keep the streak going with more questions like these, each with a full rationale.
What is contact precautions?
They are layered on top of Standard Precautions. Key PPE is a gown and gloves worn on room entry. Classic offenders: MRSA, VRE, C. difficile, RSV, scabies, and multidrug-resistant organisms.
Key points to remember
- Require gown and gloves for all interactions in the patient's room or environment.
- Place patient in a private room when possible; cohorting with the same organism is acceptable if private rooms are unavailable.
- Use dedicated single-patient equipment such as stethoscope and blood pressure cuff whenever feasible.
- C. difficile and norovirus spores resist alcohol, so soap-and-water handwashing is required, not alcohol rub.
- Doff PPE and perform hand hygiene before leaving the room to avoid carrying organisms out.
Nursing priorities
- Don gown and gloves before entering the room and remove them before exiting.
- Wash hands with soap and water for C. difficile and norovirus rather than alcohol-based rub.
- Keep stethoscope, thermometer, and cuff dedicated to the patient and disinfect shared items.
- Disinfect surfaces with a sporicidal agent such as bleach for C. difficile.
Patient teaching
- Visitors must wear a gown and gloves and perform hand hygiene on entering and leaving.
- Remind family that diligent handwashing prevents carrying the organism home.
Red flags: report now
- Never use alcohol-based hand rub alone for C. difficile; alcohol does not kill spores.
- Do not carry shared equipment between a contact-isolation patient and other patients without disinfection.
- Report a break in isolation or PPE failure so exposure follow-up can begin.
References
Clinical references for this topic
