E N D
1. HIV??????????? ????????
????? ????? ???
2. ?????????? ????
????
????
????????
???(??)??
?????
3. ??????? ??????
??
????!
4. ??????? ?????
SARS
5. ???????(??=5µm) ??
?????????????
????????
A??????
?????
??
????
???
???
????
6. ??????? ????????
B?????
C?????
??
????
??
??????
???
??????
7. ????????—??? ??????????????????????????????,??????????????????,?????
??,??????????,??????????????,???????????????????
?????,?????,??????????????????????????????????????????,??????????????????,?????
??,??????????,??????????????,???????????????????
?????,?????,????????????
8. ????????—???? ?????????
???????????????
????????
????????
?????? ???????????,?:
?????????
?????
?????????
????????
????????,?????
????????????
???????????????????,??????????????,??????,?????????,????????,?????????,?????????,???????!
???????????,?:
?????????
?????
?????????
????????
????????,?????
????????????
???????????????????,??????????????,??????,?????????,????????,?????????,?????????,???????!
9. ????????—???? ???????---900/1,000
????????---3/1,000
???????????????---6.7/1,000
???????????,???
?????1.34?
??: 1/150
??3-5?:1/30-50
???3-5?,?????????????????100%
?????????????????? ???????????,?:
?????????
?????
?????????
????????
????????,?????
????????????
???????????????????,??????????????,??????,?????????,????????,?????????,?????????,???????!
???????????,?:
?????????
?????
?????????
????????
????????,?????
????????????
???????????????????,??????????????,??????,?????????,????????,?????????,?????????,???????!
10. ????????— ?????? ???????????,??????,??????????????,??????????,????????,
????????HIV???????????????,??????,??????????????,??????????,????????,
????????HIV????
11. ????????— ?????? ??:25-40%
??:60-75%
??:15-25% ???????????,??????,??????????????,??????????,????????,
????????HIV???????????????,??????,??????????????,??????????,????????,
????????HIV????
12. CDC, MMWR1987;36;2S ?????? ???? CDC?1987????????????(Universal Precaution)??,???????????,?????????????,??????????
??????,?????????????????HIV?B??????C?????????
13. HIV????? ???????????
HIV????????:????
Percutaneous injury
Mucous membrane or non-intact skin
Infectious body fluids (???????):
Blood or body fluids containing blood
Semen, vaginal secretion, CSF, synovial fluid, pleural fluid, peritoneal fluid, amniotic fluid
14. ????????????????????
15. ????????? B?????(HBV) : 20-40% (30%)
C?????(HCV) : 1-10% (3%)
????????(HIV)?? : 0.1-0.4% (0.3%)
HIV????????:?????????????? ?????????????
?HBsAg?anti-HBs?????????????????HBV????
16. ??????????????? ???????????????
??????????
????,?????????????
???????????????
??????,???????????
???????????0.3%
???????????0.09%
17. ?HIV?????? ???????
?????????????
????????
???????
????????????????
?????????????
?????????????
??????????????
??????????????????
???????????
18. ??????HIV????? ?????? (odds ratio [OR] 15)
?????????? (OR 6.2)
??????????????? (OR 4.3)
?????????? (OR 5.6)
Type of needle (hollow bore or solid)
Size of needle
Source patient’s viral load
Amount of blood
Duration of exposure
Immune status of HCW
19. ???????? ????????
????????
?????????????(alcohol-based hand hygiene agent)????
??????
????????
????
????????
21. Management of Exposures Follow-up of HIV:
Source anti-HIV (+):
Testing for anti-HIV at 6 weeks, 3 months, and 6 months (1 year for HCV sero-conversion)
Testing for anti-HIV if illness compatible with an acute retroviral illness occurs.
Source anti-HIV (-) and no evidence of AIDS and acute HIV infection:
No indication of follow-up testing
22. ?????????
23. ???????? Universal Precaution (?????)
???????????
(?????????)
?????????!
24. ??????????? ??????????????
25. ?????????Post-Exposure Prophylaxis (PEP) ???????,?????????????????????
??????????????????????: HIV, HBV, HCV, ??
?????????????????:
HIV?????????,??????????????90%
HBV???,???????????7?
HCV????????????????????,?????????
26. PEP for HIV Exposures Role of pathogenesis in considering PEP
Not immediately systemic infection
Brief window to modify / prevent
Studies of S (simian) IV:
First 24 hours: local dendritic-like cells
Subsequent 24~ 48 hours: to regional LN
SIV in peripheral blood within 5 days
28. PEP for HIV Exposures Efficacy of PEP in Animal Studies:
Viral inoculum, dose of PEP, duration of PEP, time lag to initiate PEP
Tenofovir study for SIV:
4 weeks, initiated within 48 hours: success
3 ~ 10 days or initiated 48 ~ 72 hours: incomplete prevention
29. PEP for HIV Exposures Efficacy of PEP in Human Studies:
Retrospective case-control study of HCP:
ZDV associated with a 85% reduction in the risk of HIV infection
ZDV for HIV-infected pregnant women:
Used during pregnancy, labor, delivery and to infant
67% reduction of HIV transmission to infant
30. PEP for HIV Exposures Reports of Failure of PEP:
At least 21 instances
16 cases, use ZDV only
2 cases, use ZDV and DDI
3 cases, use more than 3 drugs
Potential causes:
Resistance of HIV, delayed initiation = 48hrs, inadequate drug / dosage, larger inocula
31. PEP??? ??????????,???????24?????????,??100%??????????
?24~48????????5???
~ Tsai C-C et al. J Virol 1998;72:4265-73.
??????28??
????????????????,?????,??????????
33. ??HIV?????? ???????:???????????(<1500 c/mL) ?CD4+?????
???????:????????????????CD4+?????
?????
????:????????
????:??????????
??????
??:????????????????????????????
????:????????
36. ??????????? ????HIV??,??????????????
?????????????????????
???????,???7??????????
??????,?????AZT????????,?????
????????
?????????????????
?????????????????????? ?????
????????????????
37. How To Reduce Risk? Number of procedures
Double gloves (?)
Gowns, facemasks, goggles.
Care during procedures where splattering of blood is anticipated
Use of impervious needle-disposal containers
Transport of samples in sealed containers
38. ?????????????????? ?????6~12???,????????????:
??????????,????????
??????
?????:
?????: ???6??3?6?9???????????
???????
???????????
39. HBV???? ??????????????????????
????B?????,???????95%
?????????????10 IU/ml?B???????
HBV ?PEP:
HBIG (hepatitis B Immune Globulin)
B????????????????????
???????????
40. http://www.cmesh.org.tw/????????????????-950820.pdf B?????????????
41. HCV???? HCV???????????1.8%
??????????????HIV????
????????????PEP??
?????????????,?????????????????,???????????????
42. C????????????? ??????????
????????HCV?RNA???,?????
?HIV?????,HCV???????????
43. ??????????-EPINet????????????????(93/1~95/5) EPINet????????????????(93/1~95/5)
44. ??????????-EPINet????????????????(93/1~95/5) ???????????
45. ??????????-EPINet????????????????(93/1~95/5)
46. ????????????????????? ????CDC?1922??,?????????????????????????,?????1922?? (??)?
??????????????????,??????,??????????????
??????????????????????,?????????,??????????????
????????:0800-888-995
47. ?????????? ???????????????,?????????????????,???????,???????????
????????????????96??1????? (5/22??) :
????????????????????,????????????????,??????????,?????????????