Assign the Precaution: Twelve Patients, One Column Each
An assignment board with four open trays labeled STANDARD ONLY, CONTACT, DROPLET, AIRBORNE, a fifth tray set apart and taped down labeled PROTECTIVE ENVIRONMENT with its air arrow reversed outward, and twelve patient cards feeding in from the left, two of them forking into two trays.
| # | Condition | Category | PPE required | Room | Hand hygiene agent |
|---|---|---|---|---|---|
| 1 | Adult with new watery diarrhea after antibiotics | Contact | Gown and gloves on entry | Single room, dedicated equipment, sporicidal surface agent | Soap and water |
| 2 | Wound colonized with a resistant organism, drainage not contained | Contact | Gown and gloves on entry | Single room preferred, cohorting permitted with the same organism | Alcohol rub, or soap and water if soiled |
| 3 | Confirmed pulmonary tuberculosis | Airborne | Fit-tested respirator, seal checked | Airborne infection isolation room, door closed | Alcohol rub |
| 4 | Rubeola (measles) | Airborne | Fit-tested respirator; only personnel with evidence of immunity assigned | Airborne infection isolation room, door closed | Alcohol rub |
| 5 | Varicella (chickenpox) | Airborne plus contact | Respirator, gown, gloves | Airborne infection isolation room, door closed | Alcohol rub |
| 6 | Disseminated zoster | Airborne plus contact | Respirator, gown, gloves | Airborne infection isolation room, door closed | Alcohol rub |
| 7 | Pertussis | Droplet | Surgical mask on entry | Single room preferred, door may stay open | Alcohol rub |
| 8 | Meningococcal meningitis | Droplet | Surgical mask on before entry | Single room, door may stay open | Alcohol rub |
| 9 | Seasonal influenza | Droplet | Surgical mask on entry | Single room preferred, cohorting permitted | Alcohol rub |
| 10 | Infant with respiratory syncytial virus bronchiolitis | Contact | Gown and gloves on entry | Single room or cohort | Alcohol rub |
| 11 | Allogeneic transplant recipient | Protective environment | No added PPE for the healthy visitor or nurse; the room is the intervention | Positive pressure to the corridor, high-efficiency filtered incoming air, sealed room, no dried or fresh flowers | Alcohol rub |
| 12 | Bioterrorism tier | Pneumonic plague: droplet for the guideline's stated duration of effective therapy. Smallpox: airborne plus contact. Anthrax: standard precautions, not transmitted person to person | Per category above | Per category above | Soap and water after anthrax contact, because the agent is a spore-former |
Localized zoster with covered lesions in an immunocompetent host stays on standard precautions. That exception is tested more often than the disseminated case.
Memory hookFour that float, everything else falls.
Watch outStrip 11 is the only room in this book where air must not be pulled in. Setting a transplant recipient's room to negative pressure removes the one barrier protecting the patient.
Margin noteAlcohol does not kill spores.
TakeawayThe exam rarely asks for a category alone. It asks for the category plus the one detail that changes the room or the hand hygiene agent.
Verify at reprint: all twelve assignments, including PPE, room, door state, and duration, against the current CDC/HICPAC isolation precautions guideline and its appendix of infections and required precautions. Verify the protective environment specification against current CDC guidance for hematopoietic stem cell transplant recipients. Daily care of the neutropenic patient belongs to → BOOK 11 · P9.