Assessing and upgrading the cleanliness of the emergency department brief title: upgrading the emergency room's cleanliness.

Objective: To upgrade cleaning and disinfection of patient rooms in a crowded emergency department (ED).

Setting: Tertiary referral hospital.

Design: Prospective, 3-component, before-and-after intervention study.

[EFFECTIVENESS OF SERIAL C-REACTIVE PROTEIN (CRP) MEASUREMENTS IN HOSPITALIZED PATIENTS WITH BLOOD STREAM INFECTION].

Background: C-reactive protein (CRP) is increasingly being used as an inflammatory marker in sepsis. Its main use is for diagnosis, less for prognosis, while it is increasingly used for serial monitoring of response to treatment - with little evidence to support this practice.

Objectives: Assessment of the effectiveness of serial measurements of CRP in the management of patients with blood stream infection (BSI).

How effective are monthly departmental tracer surveys? A 5-year retrospective study of 138 surveys in 96 departments.

Background: Repeat department-wide surveys are commonly employed for infection control. There remains debate concerning their cost-effectivess. The aim of the study was to measure the impact of repeat department-wide surveys in major in-patient departments (IPDs) and ambulatory facilities (AFs) in a tertiary care hospital.

The use of a diversion tube to reduce blood culture contamination: A "real-life" quality improvement intervention study.

Background: Blood culture contamination is associated with health care costs and potential patient harm. Diversion of the initial blood specimen reduces blood culture contamination. We report results of the "real-life" clinical implementation of this technique.

Rate and Risk Factors for Carbapenem Resistant Acinetobacter baumannii Clinical Infections in Colonized Patients.

Background: Carbapenem-resistant Acinetobacter baumannii (CRAB) is an important cause of nosocomial infections. Active surveillance for CRAB carriage to identify and isolate colonized patients is used to reduce transmission.

Objectives: To assess the rate and risks of clinical infection among CRAB-carrier and non-carrier patients.

Mixed effect of increasing outflow of medical patients from an emergency department.

Background And Aim: Since 2014, the annual number of patients entering our emergency department (ED) has increased significantly. These were primarily Internal Medicine (IM) patients, and of these, 25-30% were admitted. The present governmental policy presents a deterrent to adding IM beds for these patients, and Emergency and IM departments cope with ever-increasing number of IM patients.

The Timing of Limb Amputation in Nontraumatic Patients: Impact on Mortality and Postoperative Complication Rates.

Diabetes and peripheral vascular diseases are accompanied frequently by lower limb ischemia and in minority, need for amputation, as a treatment of last resort. Even after a decision has been made regarding amputation, the procedures are often repeatedly postponed due to more urgent surgeries and lack of operating room availability. This study assessed the possible relationship between the duration of time inpatients wait for semiurgent amputations and the incidence of postamputation complications.

Availability, timeliness, documentation and quality of consultations among hospital departments: a prospective, comparative study.

Background: Many in-patients require care from practitioners in various disciplines. Consultations most probably have significant implications for hospitalization outcomes.

Purpose: To determine key aspects of consultations provided by various departments to formulate an optimal policy.

Characteristics and outcome of elderly patients admitted for acute Cholecystitis to medical or surgical wards.

Background: Elderly patients admitted because of acute cholecystitis are usually not operated during their initial admission and receive conservative treatment. To help formulate a new admission policy regarding elderly patients with acute cholecystitis we compared the demographic and clinical characteristics and outcome of patients > 65 with acute cholecystitis admitted to medical or surgical wards.

Methods: This retrospective study included all patients > 65 years admitted for acute cholecystitis between January, 2009 and September, 2016.

Prospective Audit of Empirical Antibiotic Therapy for Septic Patients.

Background: Antibiotic stewardship programs are necessary to test the appropriateness of local guidelines for empirical antibiotic treatment by audits.

Objectives: To assess whether compliance to local guidelines achieved a higher rate of appropriate antibiotic treatment and reduced morbidity and mortality, and whether infectious disease counseling improved the rate of appropriate treatment.

Methods: Our cohort comprised 294 patients with proven bacteremia.

Bacterial contamination of surgical scrubs in the operating theater.

Background: Measures for the prevention of postsurgical infections include issuing special scrubs for the operating room (OR) and prohibiting walking out of the OR complex wearing these scrubs. The aim of this study was to provide further data on bacterial contamination of surgical scrubs.

Methods: Specimens were collected at the entrance to the OR from surgical scrubs worn by surgeons.

Mechanical ventilation in medical departments: a necessary evil, or a blessing in bad disguise?

In most countries there is a mismatch between demand for intensive care unit (ICU) beds and ICU bed availability. Because of a policy of low ICU-bed reimbursement this mismatch is much more profound in Israel, which arguably has the lowest number of ICU beds/1000 population of OECD countries. Increasing demand for mechanical ventilation has led to an ever-rising presence of ventilated patients in medical departments, which may reach up to 15% or more of medical beds, especially during winter months, posing serious challenges such as: delivery of adequate treatment, guaranteeing patient safety, nosocomial infections, emergence and spread of resistant organisms, dissatisfaction among family members and medical and nursing staff, as well as enormous direct and indirect expenses.

[PRINCIPLES OF APPROPRIATE ANTIBIOTIC USAGE IN ISRAELBY THE ISRAELI SOCIETY FOR INFECTIOUS DISEASES: TO WHOM ARE THEY DIRECTED?].

In this issue of Harefuah Nesher and Strahilevitz discuss the principles of appropriate antibiotic guidelines based on a position paper by the Israeli Society for Infectious Diseases (ISID). This editiorial discusses for whom this position paper was intended. The first and most obvious target would be the Infectious Disease (ID) physicians themselves.

[SELECTING A SPECIALTY BY INTERNS IN A CHANGING PERIOD: A MULTI-YEAR AND SINGLE-CENTER EXPERIENCE].

Aims: To collect data on the expectations of interns at the onset of their internship regarding their professional future and the actual realization of these expectations of medical graduates who completed their internship in one medical center during the years 2010-2015.

Background: The internship year may have great importance in the decision-making process regarding selection of future residency. Previous research conducted 10-20 years ago involved graduates of Israeli medical schools.

[PREVALENCE OF AND POSSIBLE RISK FACTORS FOR PROLONGED HOSPITAL STAY IN DEPARTMENTS OF INTERNAL MEDICINE].

Background: Prolonged hospitalization (PH) is associated with increasing rates of complications and cost.

Objectives: To detect and quantify causes and predictors for PH in current practice.

Methods: PH was defined as higher than the 70th percentile of the mean hospitalization duration for each department (two medical departments and one acute geriatric ward).

[AN EDUCATIONAL INTERVENTION TO REDUCE THE RATE OF CONTAMINANTS IN BLOOD CULTURES AND IMPROVE APPROPRIATE ANTIBIOTIC TREATMENT].

Blood cultures' contamination (BCC) is associated with unnecessary processing of cultures, higher cost, and occasionally, unjustified antibiotic treatment. We aimed to reduce the rate of BCC by educational intervention. In parallel, we also strove to expand the use of aminoglycosides (AMG) and reduce the utilization of beta-lactam antibiotics.

Spondylodiskitis and endocarditis due to Streptococcus gordonii.

Background: Streptococcus gordonii is an infrequent cause of infective endocarditis (IE); associated spondylodiskitis has not yet been described in the literature.

Purpose: We describe 2 patients who presented with new-onset, severe back pain; blood cultures revealed S. gordonii bacteremia, which led to the diagnosis of spondylodiskitis and IE.

Clinical manifestations, risk factors and prognosis of patients with Morganella morganii sepsis.

Background: There are few studies of Morganella bacteremia. We evaluated risk factors and outcome of patients with Morganella bacteremia.

Methods: Medical records of patients with Morganella bacteremia were reviewed (1997-2014).

[MONITORING UNITS IN DEPARTMENTS OF INTERNAL MEDICINE: FREQUENCY, IMPACT AND SATISFACTION].

Background: Due to increasing numbers of elderly, seriously ill patients and shortage of ICU beds, many hospitals have established monitoring units (MU) in their medical departments.

Objectives: (1) To assess the national prevalence of MUs in medical departments; (2) to determine the outcome of consecutively admitted MU patients; (3) to evaluate patient/ family satisfaction with care.

Methods: The case control study included all 123 patients hospitalized in the MU during a 5-month period, compared with two control groups: (1) 123 patients admitted to medical departments, matched at a ratio of 1:1 by gender, age±10 years and mechanical ventilation; (2) all 52 medical patients treated in the ICU.

Can Procalcitonin Contribute to the Diagnosis of Clostridium difficile Colitis?

Background: It is a challenge to diagnosis Clostridium difficile colitis.

Objectives: To determine, among patients who developed nosocomial diarrhea, whether serum procalcitonin (PCT) can distinguish between C. difficile toxin (CDT)-positive and CDT-negative patients.

Assessment and Improvement of Medical Histories: Impact of Focused Feedback.

Background: Medical history-taking is an essential component of medical care.

Objectives: To assess and improve history taking, physical examination and management plan for hospitalized patients.

Methods: The study consisted of two phases, pre- and post- intervention.

Operating a Monitoring Unit in the Geriatric Department: Effects on Outcomes.

Objectives: To compare the effect of a five-bed geriatric monitoring unit (MU) on in-hospital mortality and length of stay with the effect of usual care in a geriatric hospital department and a medical MU.

Design: Prospective, case-control, noninterventional study.

Participants: All individuals hospitalized for 24 hours or longer in the geriatric MU (n = 89, aged 53-101, mean age 82.

Mortality due to blaKPC Klebsiella pneumoniae bacteraemia.

Objectives: To determine the mortality rate secondary to blaKPC Klebsiella pneumoniae (KPC/Kp) bacteraemia, compared with that from ESBL-producing K. pneumoniae (ESBL/Kp) bacteraemia, and to determine associated risk factors.

Methods: This was a retrospective case-control study of all 68 KPC/Kp bacteraemia patients diagnosed since 2006, matched by year of isolation, gender and age, at a ratio of 1:2, to 136 ESBL/Kp bacteraemia patients.