每日一题_2022.08.31

A 68-year-old man undergoes exploratory laparotomy and bowel resection for colon cancer. On postoperative day six, he develops fever, tachycardia, and leukocytosis, and undergoes abdominal CT, which reveals a peritoneal abscess. He undergoes percutaneous drainage of the abscess and is started on IV vancomycin and IV piperacillin/tazobactam. On postoperative day 12, he develops diarrhea, recurrent fever to 38.8°C (101.8°F), and increased white blood cell count to 18,000/μL. Other laboratory findings include hemoglobin 9.7 g/dL, serum creatinine 1.8 mg/dL, and serum albumin 2.4 g/dL.

In addition to full-contact precautions, which of the following additional precautions is most appropriate for this patient?

A. Alcohol-based hand sanitizer before and after patient encounter

B. Soap hand washing before and after patient encounter

C. Chlorhexidine bath for patient

D. Reverse isolation room

答案解析：

该患者很可能患有艰难梭菌感染 (CDI)。 除了确认测试和开始治疗外，重要的是要制定适当的措施来防止 CDI 传播给同一患者护理单位的其他患者。 疾病控制和预防中心 (CDC) 建议所有确诊和疑似 CDI 的患者都采取接触隔离预防措施，包括单独的病房、所有患者接触的防护服和手套，以及个性化的患者护理物品和设备。 此外，疾病预防控制中心强调所有医疗保健提供者在接触患者之前和脱下手套后都要使用肥皂和水进行细致的手部卫生。 需要注意的是，在某些情况下，建议用肥皂和水洗手而不是酒精类产品，因为酒精类产品无法杀死梭状芽胞杆菌孢子。 洗必泰浴在 CDI 中没有明确的作用。

正确答案：A