An 86-year-old woman is hospitalized for a urinary tract infection due to Escherichia coli and is being treated with ceftriaxone. She has a history of advanced dementia, coronary artery disease, and congestive heart failure. On the fifth day of hospitalization, she seems agitated. The nurse also reports that the patient had 3 episodes of diarrhea the previous night. Her temperature is 38.3 C (101 F). In addition to appropriate hand hygiene, which of the following equipment is necessary before examining this patient?

Question

An 86-year-old woman is hospitalized for a urinary tract infection due to Escherichia coli and is being treated with ceftriaxone.  She has a history of advanced dementia, coronary artery disease, and congestive heart failure.  On the fifth day of hospitalization, she seems agitated.  The nurse also reports that the patient had 3 episodes of diarrhea the previous night.  Her temperature is 38.3 C (101 F).  In addition to appropriate hand hygiene, which of the following equipment is necessary before examining this patient?

Quizplus · Accepted Answer

11ec160b_381a_bb36_9249_d5b6b4cde091_MD0001_00 This hospitalized patient's fever and diarrhea a few days after antibiotic initiation are concerning for Clostridium difficile infection. All hospitalized patients require standard precautions, including handwashing before and after patient contact, proper disposal of cleaning instruments and linens, and occasional use of gowns and gloves as required (eg, contact with body fluids). However, cases of suspected or proven C difficile infection require additional contact precautions, including handwashing with soap and water (alcohol-based hand sanitizers do not kill the spores), gown for any patient contact, and nonsterile gloves that should be changed after contact with contaminated secretions. Gloves alone would not be sufficient (Choice D). In addition, a dedicated stethoscope and blood pressure cuff should be left in the patient's room. (Choice A) Certain pathogens are transmitted by droplets (>5 microns) that remain suspended in air for limited periods only (eg, Neisseria meningitides, influenza, Bordetella pertussis, Mycoplasma pneumoniae, respiratory syncytial virus). In such cases, healthcare workers need to wear a simple facemask when within 6-10 feet of affected patients (droplet precautions). Gloves and gowns are not required. (Choice B) Airborne precautions include an isolated room with negative pressure ventilation and a respirator mask with filtering capacity (eg, N95 mask) to avoid potential exposure to aerosolized particles (<5 microns) that can remain suspended in air for extended periods. Gloves and gowns are not needed. Airborne precautions are required for certain bacteria (eg, tuberculosis) and viruses (eg, varicella), but not for C difficile. (Choices E and F) Sterile gloves generally are used for minor procedures or surgeries but are not required in patients with contact precautions. Educational objective: Clostridium difficile requires additional contact precautions, including handwashing with soap and water, a gown for any patient contact, and nonsterile gloves that should be changed after contact with contaminated secretions. Alcohol-based hand sanitizers do not kill the bacterial spores. __________ References: Environmental interventions to control Clostridium difficile. (http://www.ncbi.nlm.nih.gov/pubmed/25573675)

An 86-Year-Old Woman Is Hospitalized for a Urinary Tract Infection