A nurse is caring for a patient with active pulmonary tuberculosis. Which isolation precaution should the nurse implement?

A nurse is admitting a 45-year-old patient with a persistent productive cough, night sweats, and weight loss. A chest X-ray reveals apical infiltrates, and sputum AFB smear is positive. Active pulmonary tuberculosis is diagnosed. The patient is being transferred from the emergency department to a medical-surgical unit.

• Isolation Initiation: Immediately place the patient in a negative pressure airborne infection isolation room (AIIR) with the door kept closed. Ensure the room has 6-12 air exchanges per hour and air is exhausted directly outside or through HEPA filters.
• Respiratory Protection: All healthcare personnel entering the room must wear a fit-tested N95 respirator. A surgical mask is inadequate. The patient must wear a surgical mask if transport outside the AIIR is medically necessary.
• Additional Precautions: Standard precautions for blood and body fluids apply. Contact or droplet precautions are not indicated as primary strategies. Limit the use of procedures that induce coughing, such as sputum induction, unless absolutely necessary and performed in an enclosed booth.
• Patient Education: Teach the patient to cover their mouth and nose with a tissue when coughing or sneezing and to dispose of tissues in a designated container. Explain the rationale for the isolation room and mask requirements to reduce anxiety and promote adherence.
• Discontinuation Criteria: Airborne precautions can be discontinued when the patient has been on effective antituberculosis therapy for at least 2-3 weeks, demonstrates clinical improvement, and has three consecutive negative AFB sputum smears collected 8-24 hours apart.