DGI:Postexpositionsprophylaxe/HIV/Abstract: Difference between revisions

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imported>Maximilian.schons@uk-koeln.de
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<nowiki>}}</nowiki><span class="mw-editsection" style="box-sizing: inherit; user-select: none; font-size: 12px; font-weight: normal; margin-left: 1em; vertical-align: baseline; line-height: 1em; display: inline-block; white-space: nowrap; unicode-bidi: isolate; visibility: hidden; opacity: 0; transition: visibility 0s ease 0s, opacity 0.5s linear 0s;"><span class="mw-editsection-bracket" style="box-sizing: inherit; margin-right: 0.25em; color: rgb(84, 89, 93);"></span><span class="mw-editsection-divider" style="box-sizing: inherit; color: rgb(84, 89, 93);"></span><span class="mw-editsection-bracket" style="box-sizing: inherit; margin-left: 0.25em; color: rgb(84, 89, 93);"></span></span><span class="mw-editsection" style="box-sizing: inherit; user-select: none; font-size: 12px; font-weight: normal; margin-left: 1em; vertical-align: baseline; line-height: 1em; display: inline-block; white-space: nowrap; unicode-bidi: isolate; visibility: hidden; opacity: 0; transition: visibility 0s ease 0s, opacity 0.5s linear 0s;"><span class="mw-editsection-bracket" style="box-sizing: inherit; margin-right: 0.25em; color: rgb(84, 89, 93);"></span><span class="mw-editsection-divider" style="box-sizing: inherit; color: rgb(84, 89, 93);"></span><span class="mw-editsection-bracket" style="box-sizing: inherit; margin-left: 0.25em; color: rgb(84, 89, 93);"></span></span><span class="mw-editsection" style="box-sizing: inherit; user-select: none; font-size: 12px; font-weight: normal; margin-left: 1em; vertical-align: baseline; line-height: 1em; display: inline-block; white-space: nowrap; unicode-bidi: isolate; visibility: hidden; opacity: 0; transition: visibility 0s ease 0s, opacity 0.5s linear 0s;"><span class="mw-editsection-bracket" style="box-sizing: inherit; margin-right: 0.25em; color: rgb(84, 89, 93);"></span><span class="mw-editsection-divider" style="box-sizing: inherit; color: rgb(84, 89, 93);"></span><span class="mw-editsection-bracket" style="box-sizing: inherit; margin-left: 0.25em; color: rgb(84, 89, 93);"></span></span><span class="mw-editsection" style="box-sizing: inherit; user-select: none; font-size: 12px; font-weight: normal; margin-left: 1em; vertical-align: baseline; line-height: 1em; display: inline-block; white-space: nowrap; unicode-bidi: isolate; visibility: hidden; opacity: 0; transition: visibility 0s ease 0s, opacity 0.5s linear 0s;"><span class="mw-editsection-bracket" style="box-sizing: inherit; margin-right: 0.25em; color: rgb(84, 89, 93);"></span><span class="mw-editsection-divider" style="box-sizing: inherit; color: rgb(84, 89, 93);"></span><span class="mw-editsection-bracket" style="box-sizing: inherit; margin-left: 0.25em; color: rgb(84, 89, 93);"></span></span><span class="mw-editsection" style="box-sizing: inherit; user-select: none; font-size: 12px; font-weight: normal; margin-left: 1em; vertical-align: baseline; line-height: 1em; display: inline-block; white-space: nowrap; unicode-bidi: isolate; visibility: hidden; opacity: 0; transition: visibility 0s ease 0s, opacity 0.5s linear 0s;"><span class="mw-editsection-bracket" style="box-sizing: inherit; margin-right: 0.25em; color: rgb(84, 89, 93);"></span><span class="mw-editsection-divider" style="box-sizing: inherit; color: rgb(84, 89, 93);"></span><span class="mw-editsection-bracket" style="box-sizing: inherit; margin-left: 0.25em; color: rgb(84, 89, 93);"></span></span><span class="mw-editsection" style="box-sizing: inherit; user-select: none; font-size: 12px; font-weight: normal; margin-left: 1em; vertical-align: baseline; line-height: 1em; display: inline-block; white-space: nowrap; unicode-bidi: isolate; visibility: hidden; opacity: 0; transition: visibility 0s ease 0s, opacity 0.5s linear 0s;"><span class="mw-editsection-bracket" style="box-sizing: inherit; margin-right: 0.25em; color: rgb(84, 89, 93);"></span><span class="mw-editsection-divider" style="box-sizing: inherit; color: rgb(84, 89, 93);"></span><span class="mw-editsection-bracket" style="box-sizing: inherit; margin-left: 0.25em; color: rgb(84, 89, 93);"></span></span><br />
<nowiki>}}</nowiki><span class="mw-editsection" style="box-sizing: inherit; user-select: none; font-size: 12px; font-weight: normal; margin-left: 1em; vertical-align: baseline; line-height: 1em; display: inline-block; white-space: nowrap; unicode-bidi: isolate; visibility: hidden; opacity: 0; transition: visibility 0s ease 0s, opacity 0.5s linear 0s;"><span class="mw-editsection-bracket" style="box-sizing: inherit; margin-right: 0.25em; color: rgb(84, 89, 93);"></span><span class="mw-editsection-divider" style="box-sizing: inherit; color: rgb(84, 89, 93);"></span><span class="mw-editsection-bracket" style="box-sizing: inherit; margin-left: 0.25em; color: rgb(84, 89, 93);"></span></span><span class="mw-editsection" style="box-sizing: inherit; user-select: none; font-size: 12px; font-weight: normal; margin-left: 1em; vertical-align: baseline; line-height: 1em; display: inline-block; white-space: nowrap; unicode-bidi: isolate; visibility: hidden; opacity: 0; transition: visibility 0s ease 0s, opacity 0.5s linear 0s;"><span class="mw-editsection-bracket" style="box-sizing: inherit; margin-right: 0.25em; color: rgb(84, 89, 93);"></span><span class="mw-editsection-divider" style="box-sizing: inherit; color: rgb(84, 89, 93);"></span><span class="mw-editsection-bracket" style="box-sizing: inherit; margin-left: 0.25em; color: rgb(84, 89, 93);"></span></span><span class="mw-editsection" style="box-sizing: inherit; user-select: none; font-size: 12px; font-weight: normal; margin-left: 1em; vertical-align: baseline; line-height: 1em; display: inline-block; white-space: nowrap; unicode-bidi: isolate; visibility: hidden; opacity: 0; transition: visibility 0s ease 0s, opacity 0.5s linear 0s;"><span class="mw-editsection-bracket" style="box-sizing: inherit; margin-right: 0.25em; color: rgb(84, 89, 93);"></span><span class="mw-editsection-divider" style="box-sizing: inherit; color: rgb(84, 89, 93);"></span><span class="mw-editsection-bracket" style="box-sizing: inherit; margin-left: 0.25em; color: rgb(84, 89, 93);"></span></span><span class="mw-editsection" style="box-sizing: inherit; user-select: none; font-size: 12px; font-weight: normal; margin-left: 1em; vertical-align: baseline; line-height: 1em; display: inline-block; white-space: nowrap; unicode-bidi: isolate; visibility: hidden; opacity: 0; transition: visibility 0s ease 0s, opacity 0.5s linear 0s;"><span class="mw-editsection-bracket" style="box-sizing: inherit; margin-right: 0.25em; color: rgb(84, 89, 93);"></span><span class="mw-editsection-divider" style="box-sizing: inherit; color: rgb(84, 89, 93);"></span><span class="mw-editsection-bracket" style="box-sizing: inherit; margin-left: 0.25em; color: rgb(84, 89, 93);"></span></span><span class="mw-editsection" style="box-sizing: inherit; user-select: none; font-size: 12px; font-weight: normal; margin-left: 1em; vertical-align: baseline; line-height: 1em; display: inline-block; white-space: nowrap; unicode-bidi: isolate; visibility: hidden; opacity: 0; transition: visibility 0s ease 0s, opacity 0.5s linear 0s;"><span class="mw-editsection-bracket" style="box-sizing: inherit; margin-right: 0.25em; color: rgb(84, 89, 93);"></span><span class="mw-editsection-divider" style="box-sizing: inherit; color: rgb(84, 89, 93);"></span><span class="mw-editsection-bracket" style="box-sizing: inherit; margin-left: 0.25em; color: rgb(84, 89, 93);"></span></span><span class="mw-editsection" style="box-sizing: inherit; user-select: none; font-size: 12px; font-weight: normal; margin-left: 1em; vertical-align: baseline; line-height: 1em; display: inline-block; white-space: nowrap; unicode-bidi: isolate; visibility: hidden; opacity: 0; transition: visibility 0s ease 0s, opacity 0.5s linear 0s;"><span class="mw-editsection-bracket" style="box-sizing: inherit; margin-right: 0.25em; color: rgb(84, 89, 93);"></span><span class="mw-editsection-divider" style="box-sizing: inherit; color: rgb(84, 89, 93);"></span><span class="mw-editsection-bracket" style="box-sizing: inherit; margin-left: 0.25em; color: rgb(84, 89, 93);"></span></span><br />
====<span class="mw-headline" id="Basis-_und_Kontrolluntersuchungen" style="box-sizing: inherit;">Basis- und Kontrolluntersuchungen</span>====
{| class="wikitable"
|+
! class="col-blue-dark-bg" |
! class="col-blue-dark-bg" |Indexperson^0
! colspan="4" class="col-blue-dark-bg" |Exponierte Persono
|-
| class="col-blue-dark-bg" |
| class="col-blue-dark-bg" |
| class="col-blue-dark-bg" |Ausgangsuntersuchung
| class="col-blue-dark-bg" |2 Wochen
| class="col-blue-dark-bg" |6 Wochen/nach PEP: 10 Wochen [122]
| class="col-blue-dark-bg" |12 Wochen nach PEP: 16 Wochen
|-
|HIV-Antikörper
|X
|X
|
|X
|X
|-
|HBsAg^
|X
|X
|
|
|
|-
|Anti HBc- und Anti HBs-Antikörper^
|
|X
|
|X*
|X*
|-
|HCV-Antikörper^^
|X
|X
|
|X*
|X*
|-
|HCV-RNA^^
|(X)
|
|X
|X
|
|-
|ärztliche Untersuchung
|
|X
|X**
|X
|
|-
|Medikamentenanamnese**
|X^1
|X^2
|X^2
|
|
|-
|Blutbild**
|
|X
|X
|
|
|-
|Transaminasen
|
|X
|X
|
|X^^
|-
|Kreatinin/Harnstoff**
|
|X
|X
|
|
|-
|'''Bei sexuellem Risiko'''
|
|
|
|
|
|-
|Weiteres STDs (Syphilis, Gonorrhö, Chlamydien)
|X*
|X*<br />
|X*<br />
|X*<br />
|
|-
|(bei MSM) Kontrolle des HAV- Impfstatus^^^
|X
|X
|
|
|
|}
<small>° falls Person bekannt, aber Infektionsstatus unklar, Einwilligung erforderlich, ggf. Einsatz eines Schnelltestes</small>
<small>^ bei ausreichendem Impfschutz des Verletzten (Anti HBs>100 IE/ml innerhalb der letzten 10 Jahre) ist eine Testung der Indexperson auf HBsAg nicht erforderlich – bei fehlender Impfanamnese und bestehender Impfindikation Impfung empfehlen (siehe Impfempfehlung der STIKO: [https://www.rki.de/DE/Content/Infekt/EpidBull/Archiv/2013/Ausgaben/34_13.pdf?__blob=publicationFile <span style="font-family:&quot;Calibri&quot;,sans-serif;mso-bidi-font-family:&quot;Times New Roman&quot;">https://www.rki.de/DE/Content/Infekt/EpidBull/Archiv/2013/Ausgaben/34_13.pdf?__blob=publicationFile</span>] , S.341-342)</small>
<small>^^ HCV-RNA-Bestimmung bei der Indexperson falls diese anti-HCV positiv ist; nach beruflicher Exposition (z.B. NSV) Vorgehen bzgl. HCV gemäß S3-Leitlinie (<nowiki>http://www.awmf.org/leitlinien/detail/ll/021-012.html</nowiki>). HCV-RNA-Bestimmung bei der verletzten (exponierten) Person bei relevantem HCV-Übertragungsrisiko<span style="mso-spacerun:yes">  </span>und bekannter oder möglicher HCV-Infektion der Indexperson) nach 2-4 und falls negativ 6 – 8 Wochen nach Exposition. Abschlusskontrolle (HCV-Antikörper und Transaminasen) nach HCV-Exposition nach 6 Monaten.</small>
<small>^^^ falls nicht gegen Hepatitis A geimpft, Hepatitis A-oder Hep.A/B –Kombinationsimpfung empfehlen</small>
<small>* falls indiziert/ falls Exposition vorlag</small>
<small>** falls PEP genommen wird</small>
<small>1 Behandlungsanamnese mit antiretroviralen Medikamenten (Abschätzung der Resistenzsituation)</small>
<small>2 Einnahme anderer Medikamente? (cave! Wechselwirkungen) Verträglichkeit der PEP?</small>
<br /><span class="mw-editsection" style="box-sizing: inherit; user-select: none; font-size: 12px; font-weight: normal; margin-left: 1em; vertical-align: baseline; line-height: 1em; display: inline-block; white-space: nowrap; unicode-bidi: isolate; visibility: hidden; opacity: 0; transition: visibility 0s ease 0s, opacity 0.5s linear 0s;"><span class="mw-editsection-bracket" style="box-sizing: inherit; margin-right: 0.25em; color: rgb(84, 89, 93);"></span><span class="mw-editsection-divider" style="box-sizing: inherit; color: rgb(84, 89, 93);"></span><span class="mw-editsection-bracket" style="box-sizing: inherit; margin-left: 0.25em; color: rgb(84, 89, 93);"></span></span><span class="mw-editsection" style="box-sizing: inherit; user-select: none; font-size: 12px; font-weight: normal; margin-left: 1em; vertical-align: baseline; line-height: 1em; display: inline-block; white-space: nowrap; unicode-bidi: isolate; visibility: hidden; opacity: 0; transition: visibility 0s ease 0s, opacity 0.5s linear 0s;"><span class="mw-editsection-bracket" style="box-sizing: inherit; margin-right: 0.25em; color: rgb(84, 89, 93);"></span><span class="mw-editsection-divider" style="box-sizing: inherit; color: rgb(84, 89, 93);"></span><span class="mw-editsection-bracket" style="box-sizing: inherit; margin-left: 0.25em; color: rgb(84, 89, 93);"></span></span><span class="mw-editsection" style="box-sizing: inherit; user-select: none; font-size: 12px; font-weight: normal; margin-left: 1em; vertical-align: baseline; line-height: 1em; display: inline-block; white-space: nowrap; unicode-bidi: isolate; visibility: hidden; opacity: 0; transition: visibility 0s ease 0s, opacity 0.5s linear 0s;"><span class="mw-editsection-bracket" style="box-sizing: inherit; margin-right: 0.25em; color: rgb(84, 89, 93);"></span><span class="mw-editsection-divider" style="box-sizing: inherit; color: rgb(84, 89, 93);"></span><span class="mw-editsection-bracket" style="box-sizing: inherit; margin-left: 0.25em; color: rgb(84, 89, 93);"></span></span><span id="Abklärung_akuter_HIV-Infektion" style="box-sizing: inherit;"></span><span class="mw-editsection" style="box-sizing: inherit; user-select: none; font-size: 12px; font-weight: normal; margin-left: 1em; vertical-align: baseline; line-height: 1em; display: inline-block; white-space: nowrap; unicode-bidi: isolate; visibility: hidden; opacity: 0; transition: visibility 0s ease 0s, opacity 0.5s linear 0s;"><span class="mw-editsection-bracket" style="box-sizing: inherit; margin-right: 0.25em; color: rgb(84, 89, 93);"></span><span class="mw-editsection-divider" style="box-sizing: inherit; color: rgb(84, 89, 93);"></span><span class="mw-editsection-bracket" style="box-sizing: inherit; margin-left: 0.25em; color: rgb(84, 89, 93);"></span></span><br />

Revision as of 06:02, 15 June 2021

Sofortmaßnahmen bei beruflicher Exposition

ABBILDUNG MIT MERMAID MACHEN 


 
 {{#mermaid:sequenceDiagram
  participant Alice
  participant Bob
    Alice->John: Hello John, how are you?
    loop Healthcheck
         John->John: Fight against hypochondria
    end
    Note right of John: Rational thoughts <br/>prevail...
      John-->Alice: Great!
      John->Bob: How about you?
      Bob-->John: Jolly good!
  }}


{{#mermaid:graph TD; graph TD

A[Stich- oder Schnittverletzung, Kontamination geschädigter Haut]

B["Kontamination (Auge oder Mundhöhle)"]

A-->C[Spülung mit Wasser und Seife bzw. einem Antiseptikum, welches begrenzt viruzide Wirksamkeit aufweist]

B-->D[Spülung mit Wasser von Auge und Mundhöhle]

C-->E[Entscheid über systematische, medikamentöse Postexpositionsprophylaxe*]

D-->E

E-->F["Unfalldokumentation (D-Arzt/Betriebsarzt)"]

F-->G[Ausgangsstatus HIV- und Hepatitis-Serologie]

style A fill:#ccc,stroke:#333

style B fill:#ccc,stroke:#333

style C fill:#fff,stroke:#333

style D fill:#fff,stroke:#333

style E fill:#fff,stroke:#333

style F fill:#fff,stroke:#333

style G fill:#fff,stroke:#333

}}

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