Nursing Field Notes / Nursing Core · Med-Surg Course
Isolation Precautions 🧼
Contact · droplet · airborne · protective · and the ones that are not isolation
NG-406
Nursing Core
ADHD-friendly visual edition
Three transmission-based categories, one protective category, and a handful of “precautions” that are not isolation at all. Getting the room and the mask right is most of the mark.
AirborneNegative pressure room · N95 · MTV — Measles, TB, Varicella
DropletPrivate room · surgical mask within 1 meter
ContactGown and gloves · C. diff needs SOAP AND WATER
ProtectiveSHE is protected · positive pressure · no fresh flowers
🧨 What starts it
The four categories
- Contact — spread by touching her or her surroundings. Gown and gloves on entry, private room or cohort, dedicated equipment. MRSA, VRE, C. difficile, scabies, RSV, draining wounds, impetigo.
- Droplet — large droplets that fall within about a meter. Surgical mask, private room, mask on the patient for transport. Influenza, pertussis, mumps, rubella, Neisseria meningitidis, group A strep pharyngitis.
- Airborne — tiny particles that stay suspended. Negative-pressure room with the door closed, and an N95 respirator (fit-tested). Measles, Tuberculosis, Varicella — and disseminated zoster.
- Protective (neutropenic) — this one protects her. Positive-pressure room, no sick visitors, no fresh flowers, no standing water, no raw fruit or vegetables. For severe neutropenia and transplant patients.
Negative or positive pressure?
- Negative pressure pulls air into the room so nothing escapes — for airborne infection. Door stays closed.
- Positive pressure pushes air out so nothing contaminated comes in — for the neutropenic patient.
- Remember it by who you are protecting: negative protects everyone else, positive protects her.
The two hand-hygiene exceptions
Alcohol gel does not kill spores. C. difficile and anthrax require soap and water, physically washing the spores off. Alcohol gel is fine for everything else and is preferred when hands are not visibly soiled.
🔎 What you will see
Putting it on and taking it off
On, in this order: gown → mask or respirator → goggles → gloves. The gloves go over the gown cuffs.
Off, in this order: gloves → goggles → gown → mask. Then hand hygiene.
- Gloves come off first because they are the most contaminated.
- The mask comes off last, and outside the room for airborne precautions.
- Remove the mask by its ties or elastics, never the front.
- Peel the gown away from the neck and shoulders, turning it inside out, and roll it.
- Hand hygiene after everything, every time.
Transport and equipment
- Leave the room only when necessary.
- Droplet or airborne: the patient wears a surgical mask — not an N95 — during transport.
- Contact: cover the wound or the affected area, and clean hands before leaving.
- Dedicated stethoscope, thermometer and blood pressure cuff kept in the room. Disinfect anything shared.
- Warn the receiving department before she arrives.
Which mask, and when
- Surgical mask — droplet precautions, and on the patient during transport.
- N95 respirator — airborne precautions, on the staff. It must be fit-tested, and a seal check is done every time.
- Facial hair breaks the seal.
- A patient with active TB in a negative-pressure room does not need staff in an N95 once she is on effective treatment and non-infectious — but until that is confirmed, it stays.
🩺 What you do
The other “precautions” — which are not isolation
- Bleeding precautions (low platelets, anticoagulated): soft toothbrush, electric razor, no rectal temperatures or suppositories, no intramuscular injections if avoidable, pressure to sites, no NSAIDs or aspirin, watch for bruising and black stools.
- Aspiration precautions: upright at 90° for meals and for 30 to 60 minutes after, chin tuck, small bites, thickened fluids if prescribed, suction available, no straws for a dysphagic patient.
- Seizure precautions: padded rails up, bed low, suction and oxygen at the bedside, IV access, nothing in the mouth.
- Hip precautions after a total hip: no bending past 90°, no crossing the legs, no internal rotation. Abduction pillow, raised toilet seat, no low chairs.
- Latex precautions: latex-free room and equipment, schedule her first on the list, ask about banana, avocado and kiwi allergy.
Psychosocial cost
- Isolation causes sensory deprivation, loneliness and depression, and staff go in less often.
- Go in for reasons other than tasks. Sit down. Explain why the precautions exist and when they will end.
- Encourage visitors with the right equipment; arrange video calls.
- Clock, calendar, window, television and phone within reach.
The ones examiners love
- Measles, TB, Varicella — airborne. Remember MTV.
- C. difficile — contact, and soap and water, not gel.
- Neutropenic — positive pressure, no fresh flowers or raw produce.
- Meningococcal meningitis — droplet, for the first 24 hours of antibiotics.
- A private negative-pressure room is the priority admission when beds are short.
⚡ Quick recall
AirborneNegative pressure room · N95 · MTV — Measles, TB, Varicella
DropletPrivate room · surgical mask within 1 meter
ContactGown and gloves · C. diff needs SOAP AND WATER
ProtectiveSHE is protected · positive pressure · no fresh flowers
Which three infections need airborne precautions?
Measles, tuberculosis and varicella. MTV.
Why does C. difficile need soap and water?
Alcohol gel does not kill the spores. They have to be washed off.
Negative or positive pressure for a neutropenic patient?
Positive. It keeps contaminated air out.
In what order does PPE come off?
Gloves, goggles, gown, mask — then hand hygiene.
Which mask does a patient wear during transport on airborne precautions?
A surgical mask. The N95 is for staff.
Three things a neutropenic patient does not get?
Fresh flowers, standing water, and raw fruit or vegetables.