CCRN · Multisystem · 7 min read
Infection Prevention, Transplant and Organ Donation
- Apply evidence-based infection prevention bundles and isolation precautions to reduce critical care healthcare-associated infections.
- Recognize signs of solid organ allograft rejection and monitor for adverse effects of immunosuppressive therapies.
- Support the qualified clinician’s evaluation for death by neurologic criteria, coordinate ethical donation processes with the organ procurement organization, and implement ordered donor-management goals.
Isolation Precautions and Healthcare-Associated Infection Prevention Bundles
Infection prevention in the intensive care unit relies on transmission-based precautions and meticulous bundle adherence. Contact precautions require healthcare personnel to wear a clean gown and gloves upon entering the room of a patient colonized or infected with multidrug-resistant organisms. Droplet precautions require wearing a surgical mask upon entering the room of a patient with infections such as influenza or meningococcal disease. Airborne infection isolation requires a negative-pressure room relative to adjacent areas with at least six air changes per hour in existing facilities or 12 air changes per hour in newly constructed or renovated rooms. Staff caring for patients under airborne precautions must don a fit-tested N95 respirator or powered air-purifying respirator prior to entering the room.
Doffing personal protective equipment requires a deliberate sequence to prevent self-contamination. Healthcare personnel must remove gloves and gown before leaving the patient room or designated anteroom. Eye protection is removed next, followed by the mask or respirator at the location specified by isolation policy, and hand hygiene must be performed immediately after equipment removal. When caring for a patient with Clostridioides difficile, alcohol-based hand rubs do not reliably inactivate spores. Nurses must wash hands with soap and water when hands are visibly soiled or during an outbreak, and follow facility policy.
Device-associated infection bundles require standardized bedside execution. Central line-associated bloodstream infection prevention bundles mandate maximal sterile barrier precautions during catheter insertion and chlorhexidine skin antisepsis with adequate drying time. The femoral vein site carries a higher risk of catheter-related infection and deep vein thrombosis and should be avoided in adult patients whenever possible. Catheter-associated urinary tract infection bundles focus on prompt catheter removal, maintaining uninterrupted dependent closed drainage, and keeping the collection bag below the level of the bladder.
Pulmonary and surgical care bundles limit further hospital-acquired complications. Ventilator-associated pneumonia prevention bundles include maintaining the head of the bed elevated between 30 and 45 degrees unless medically contraindicated. Subglottic secretion drainage endotracheal tubes decrease the accumulation of secretions above the cuff, reducing the incidence of ventilator-associated pneumonia. Furthermore, pairing daily sedation interruption with spontaneous breathing trials when safe shortens mechanical ventilation duration and may reduce ventilator-associated pneumonia. To prevent surgical site infections, staff should clip hair only when removal is necessary, maintain perioperative normothermia, and manage blood glucose to avoid hyperglycemia without causing hypoglycemia.
| Precaution Type | Room Airflow Criteria | Personal Protective Equipment Required on Entry |
|---|---|---|
| Contact Precautions | Standard room ventilation | Clean gown and gloves |
| Droplet Precautions | Standard room ventilation | Surgical mask |
| Airborne Precautions | Negative pressure; ≥6 air changes/hr (existing) or 12 (new/renovated) | Fit-tested N95 respirator or powered air-purifying respirator (PAPR) |
Common mistakes
- Using alcohol-based hand rub instead of soap and water after caring for a patient with Clostridioides difficile when hands are visibly soiled or during an outbreak.
- Administering atropine as the primary treatment for symptomatic bradycardia in a denervated transplanted heart instead of preparing for pacing or direct-acting chronotropes.
- Approaching a grieving family to request organ donation without coordinating with the organ procurement organization and designated requestors.
- Assuming every potential organ donor requires routine thyroid hormone or combined hormonal replacement therapy rather than evaluating individual donor hemodynamic indications.
Key points
- Isolation guidelines require negative pressure with 6 (existing) or 12 (new/renovated) air changes per hour for airborne precautions, clean gown and gloves on entry for contact precautions, and soap and water hand hygiene for Clostridioides difficile during outbreaks or when hands are soiled.
- Evidence-based bundles reduce hospital-acquired infections via subglottic suctioning, elevating head of bed 30 to 45 degrees, avoiding femoral central lines, maintaining dependent urinary drainage, and clipping hair only when necessary.
- Hyperacute rejection can occur within minutes to hours because of preformed antibodies; acute cellular rejection commonly occurs in days to months and is generally confirmed by biopsy; chronic rejection causes progressive, organ-specific graft injury over months to years.
- Cardiac allograft denervation typically raises resting heart rate, may make atropine ineffective for bradycardia, and can mask angina from ischemia; rejection may instead present as graft dysfunction.
- Immunosuppressants require diligent surveillance: calcineurin inhibitors risk nephrotoxicity, neurotoxicity, and diabetes, while antimetabolites can cause leukopenia, thrombocytopenia, and anemia.
- Brain death determination requires established prerequisites and a complete neurologic examination and apnea test when these can be performed; an appropriate ancillary test may be required when a component cannot be completed or interpreted.
- Organ donor resuscitation targets a MAP of 65 to 100 mmHg, urine output of 1 to 3 mL/kg/h, core temperature between 36 and 37.5°C, and lung-protective ventilation at 6 to 8 mL/kg of predicted body weight.
Practice this section
Explained CCRN Multisystem questions, no account needed. CCRN Multisystem practice test
The full lesson continues with 3 more sections with exam tips, audio in English and Spanish, 5 Check yourself questions and 20 flashcards.
- 1 month
$58.99$29.49 - 3 months
$173.99$86.99 - Lifetime
$350.99$175.49
One payment, no subscription.
See CCRN plansAlready a member? Log in
Sample lesson: Sepsis Recognition and the Sepsis Bundle25 practice questions on this exam
Each CCRN practice test has 25 original questions with the answers explained. No account needed.
Open the CCRN practice testsOriginal lesson written for CCRN practice · updated October 31, 2026. Exam names are trademarks of their owners; tests.global is not affiliated with them.