Tier by tier
Assign all eleven, then press Check the tiers.
The three tiers in one line each. Contact — direct skin-to-skin or indirect through contaminated hands, equipment and surfaces; gown and gloves before entering. Droplet — large respiratory particles that travel roughly 3 to 6 feet and fall, so they do not remain suspended; surgical mask on entry. Airborne — small particle nuclei 5 micrometres or less that remain suspended and travel on air currents; fit-tested N95 and a negative-pressure room with the door closed.
Some conditions need more than one tier. Chickenpox and disseminated herpes zoster require airborne and contact precautions, and many respiratory viruses require droplet and contact. Start precautions on suspicion, before the laboratory confirms anything. For C. difficile add soap-and-water hand hygiene and an EPA-registered sporicidal agent such as 1:10 sodium hypochlorite for the room — alcohol does not kill spores and a standard disinfectant does not remove them from surfaces.
The patient behind the sign. Patients in isolation receive fewer provider visits, report more depression and anxiety, and experience more non-infectious adverse events than comparable patients who are not isolated. Counter it deliberately: explain in plain language what the organism is, how it travels, why the gown and mask are worn and what has to happen before precautions end; teach visitors the same PPE sequence you use; cluster care so you reduce the number of entries without reducing the amount of contact; enter for reasons other than tasks; and sit down when you are in there. Never let the sign on the door become a reason to stand in the hallway and talk loudly through the doorway.
When may anyone go in?
Set the time, the air changes and the target, then press
Calculate.
At 12 air changes per hour, 99 percent removal takes about 23 minutes and 99.9 percent about 35 minutes. At 6 air changes per hour those figures are about 46 and 69 minutes.
Post the time the room was vacated so everyone is working from the same clock. Environmental services should not enter before the interval elapses, and neither should you. Measles particles remain infectious in the air for up to 2 hours after the patient leaves.
Airflow direction
Decide each patient, then press Check.
A respirator only works if it seals. Fit testing is required annually and whenever facial features change. A user seal check is required every single time you put one on: cover the respirator with both hands, inhale sharply and feel it collapse slightly toward the face, then exhale and feel for leakage around the edges and at the nose. Facial hair crossing the seal makes an N95 ineffective, and a surgical mask is never a substitute for a respirator. A patient in an airborne room wears a surgical mask during transport — never an N95 — because a respirator has never been fit-tested to that patient’s face, it adds work of breathing to someone already ill, and an exhalation valve would vent unfiltered air and give no source control at all. Keep the two purposes separate: the patient’s surgical mask contains what they exhale; your fit-tested respirator filters what you inhale.