Hygiene in the Kenntnisprüfung

A patient with open pulmonary tuberculosis has to be taken to X-ray. Which protective measures are correct?

• The patient wears an FFP2 mask with an exhalation valve, the accompanying staff wear a surgical mask (Mund-Nasen-Schutz)
• The patient wears a surgical mask (Mund-Nasen-Schutz), the staff wear an FFP2 mask; the X-ray department is informed in advance
• Transport is not allowed until the isolation ends; the X-ray is done as a bedside X-ray in the room
• Masks are needed in the isolation room; in the corridor it is enough if the patient holds a hand in front of the mouth when coughing

Explanation: Tuberculosis is transmitted through the air (aerogen): the staff protect themselves with an FFP2 mask; outside the room the patient wears a surgical mask, which reduces the release of infectious droplets and aerosols. A mask with an exhalation valve on the patient is wrong, because the exhaled air escapes unfiltered. Necessary examinations outside the room are possible with these measures and with the receiving department informed in advance.

After taking blood from a patient who is HIV- and hepatitis-C-positive, you prick yourself on the used needle. What do you do?

• Squeeze the wound hard and rinse it with water, finish the shift and see your general practitioner the next day
• Disinfect and dress the wound; seeing a doctor is necessary if fever or other symptoms appear in the next weeks
• Encourage bleeding, disinfect, immediately see the D-Arzt (accident insurance doctor) or occupational physician (Betriebsarzt) about a possible HIV-PEP, report it as a work accident
• Encourage bleeding and disinfect; an HIV-PEP is worthwhile for deep pricks and can still be started after one week

Explanation: After a needlestick injury, bleeding is encouraged and the site is treated with antiseptic; then you must immediately see a D-Arzt or the occupational physician, because an HIV-PEP should be started as early as possible – ideally within a few hours. For hepatitis C there is no PEP, but close follow-up checks. Waiting until the end of the shift or until symptoms appear wastes the time window; reporting it as a work accident (Arbeitsunfall) secures your claims against the accident insurance (Unfallversicherung).