fix(skill): infection-control Fork 4 — split contact isolation from airborne/negative-pressure - #111
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…inence) from airborne isolation Fork 4 grouped draining wound / fecal incontinence under Negative-pressure (AIIR), conflating Contact-precaution triggers with airborne triggers. AIIR is for airborne agents only (TB/measles/varicella/disseminated zoster); drainage and incontinence are Contact triggers needing a single room or cohort, not negative pressure. Added the agent-follows-route caveat (draining extrapulmonary TB / varicella / disseminated zoster still need airborne + contact) and a matching anti-pattern. Regenerated triage/INDEX/bundle. Stays draft. Domain-verified by MT; codex-reviewed APPROVE (web-checked vs CDC/HICPAC). Co-Authored-By: Claude Opus 4.8 <noreply@anthropic.com>
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| - **`infection-control-judgment` — Fork 4 clinical fix (stays `draft`)**: corrected a category conflation codex flagged during the PR #110 backfire-fix sweep — "หนองไหล/คุมอุจจาระไม่ได้" (draining wound / fecal incontinence) were grouped under **Negative-pressure (AIIR)**, conflating Contact-precaution triggers with airborne triggers. Now: AIIR reserved for airborne agents only (TB/หัด/สุกใส/disseminated zoster); drainage/incontinence reclassified as **Contact** → ห้องเดี่ยว (preferred)/cohort, no negative pressure. Added the reverse-trap caveat (agent-follows-route: draining extrapulmonary-TB / varicella / disseminated-zoster still need **airborne + contact**) + matching anti-pattern. Domain-verified by MT (repo owner); **codex-reviewed APPROVE, no MUST-FIX** (web-checked vs CDC/HICPAC Isolation Guideline; 2 of 3 NICE-TO-HAVE over-correction caveats applied). No A/B — error-removal on a knowledge-adjacent clinical fact, not a judgment-fork tune. |
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AGENTS.md says under “Discipline — do not skip” that every new/edited skill must get adversarial review plus an empirical A/B test on HARD cases before it is “done”; this new changelog entry explicitly records “No A/B”. Because this PR changes a clinical skill fork and then documents the fix as completed, the repo’s own validation gate is bypassed unless an A/B artifact covering the changed fork/anti-pattern is added or the change is not presented as done.
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| > **VERDICT: ความดันลบ = กันเชื้อ "ออก" (airborne) · ความดันบวก = กันเชื้อ "เข้า" (ภูมิคุ้มกันต่ำ). สลับ = หายนะ.** | ||
| - **Negative pressure (AIIR):** airborne/หนองไหล/คุมอุจจาระไม่ได้ → ดูดอากาศออก **กันเชื้อแพร่ออก** | ||
| - **Negative pressure (AIIR):** **เฉพาะ airborne** — TB/หัด/สุกใส/disseminated zoster (⚠️ สุกใส·zoster ต้อง **airborne + contact** คู่กัน ไม่ใช่ airborne อย่างเดียว) → ดูดอากาศออก **กันเชื้อแพร่ออก** — AIIR สงวนไว้สำหรับเชื้อที่ลอยในอากาศเท่านั้น | ||
| - ⚠️ **หนองไหลคุมไม่อยู่ / กลั้นอุจจาระไม่ได้ = Contact ไม่ใช่ airborne:** → **ห้องเดี่ยว (preferred) หรือ cohort** (ไม่ต้องความดันลบ) เพราะความเสี่ยงคือ *สัมผัส/สิ่งแวดล้อมปนเปื้อน* ไม่ใช่เชื้อลอยในอากาศ — **ยกเว้นตัวโรคเองเป็น airborne** (แผล/หนองจาก TB นอกปอด, ตุ่มสุกใส/zoster) → ต้อง **airborne + contact** · อย่าเอาเคส contact ล้วนไปเปลืองห้อง AIIR ที่มีจำกัด |
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This exception now treats any zoster vesicle as needing airborne + contact, but CDC Appendix A only requires Airborne+Contact for disseminated zoster, or localized zoster in an immunocompromised patient until dissemination is ruled out; localized zoster in an immunocompetent patient with coverable lesions is Standard. In that common covered-shingles scenario, the skill will still send a contact/standard case to AIIR, recreating the resource-waste problem this fork is trying to fix.
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What
Fixes a clinical category conflation in Fork 4 of
infection-control-judgmentthat codex flagged during the PR #110 backfire-fix sweep (left unfixed then under the clinical flag-only rule).Before:
Negative pressure (AIIR): airborne/หนองไหล/คุมอุจจาระไม่ได้— grouped draining wound / fecal incontinence (Contact-precaution triggers) under airborne/negative-pressure logic.After:
Verification
build_triage.pyin-sync ·validate_repo.pyOK ·pytest26 passed.Skill stays
draft(clinical; unchanged status).🤖 Generated with Claude Code