Israel Journal of Health Policy Research最新文献

{"title":"From statutory mandate to institutional integration: lessons from the national survey of Israel's healthcare ethics committees.","authors":"Alona Paz, Maya Peled-Raz, Shlomit Zuckerman, Tatiana Talya Fleishman","doi":"10.1186/s13584-026-00785-w","DOIUrl":"10.1186/s13584-026-00785-w","url":null,"abstract":"<p><strong>Background: </strong>Israel's Patients' Rights Act (IPRA, 1996) established a unique statutory model for ethics committees (ECs), with legally binding authority, differing from the advisory nature of ECs in most countries. Following the 2015 State Comptroller's report highlighting widespread under-implementation, the Ministry of Health (MOH) issued a directive in 2018 aimed at standardizing EC structure, procedures, and training. However, the extent of subsequent implementation and operational activity has remained unclear.</p><p><strong>Methods: </strong>This secondary analysis of the 2022‑2023 MOH national survey examined EC structure, governance, training, and activity in 52 institutions (response rate: 71%), including general, geriatric/rehabilitation, and psychiatric hospitals, MOH district bureaus, health maintenance organizations (HMOs), and the Israel Defense Forces (IDF). Institutional characteristics were merged from MOH administrative databases and compared with available 2015 baseline data. Logistic regression and Generalized Estimating Equation (GEE) models were used to identify factors associated with low EC activity. Low EC activity was defined as a committee that reported both one or fewer (≤ 1) meetings AND one or fewer (≤ 1) applications per year. Conversely, committees reporting more than one meeting or more than one application annually were classified as having high activity for the purpose of the analysis.</p><p><strong>Results: </strong>The prevalence of statutory ECs was higher in 2022 (89.7%) than in 2015 (70.9%), and the proportion of committees maintaining written protocols was higher (91% vs. 67%), consistent with substantial structural consolidation. However, more than half of institutions were characterized by low EC activity, reporting one or fewer meetings as well as application per year. Low activity was associated with smaller hospital size, geriatric/rehabilitation hospital type, private ownership, lack of trained members, and absence of internal ethics advisors. In contrast, the presence of trained members and a designated contact person was associated with higher EC activity, while advertising alone was not.</p><p><strong>Conclusions: </strong>Israel's experience demonstrates that robust statutory mandates and top-down regulatory directives successfully drive formal structural consolidation, yet remain insufficient on their own to ensure active clinical utilization. Bridging the gap between structural existence and functional engagement requires institutional integration-specifically through accredited training, designated points of contact, internal ethics advisors, and an institutional culture of deliberation. For health systems internationally, these findings show that translating ethics governance into meaningful bedside practice depends on operational resourcing and clinical integration rather than legal mandate alone.</p>","PeriodicalId":46694,"journal":{"name":"Israel Journal of Health Policy Research","volume":"15 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13640184/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Israel's oral health policy in reflection of the WHO Global Oral Health Action Plan (2023-2030).","authors":"Dara Schwartz, Hagit Domb Herman, Shiri Waingrod, Lena Natapov","doi":"10.1186/s13584-026-00786-9","DOIUrl":"https://doi.org/10.1186/s13584-026-00786-9","url":null,"abstract":"","PeriodicalId":46694,"journal":{"name":"Israel Journal of Health Policy Research","volume":"15 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13637356/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Knowledge and practice of evidence-based mild traumatic brain injury guidelines among physicians providing emergency and trauma care in Israel.","authors":"Barak Levit, Tamar Cafri Oppenheim, Forat Swaid, Wissam Najar, Gilad Sorek","doi":"10.1186/s13584-026-00784-x","DOIUrl":"10.1186/s13584-026-00784-x","url":null,"abstract":"<p><strong>Background: </strong>Over the past decade, clinical guidelines for the management of mild traumatic brain injury (mTBI) have evolved worldwide to prevent re-injury and reduce the risk of prolonged recovery. However, to date, no study has examined the knowledge and practice of these clinical guidelines in Israel.</p><p><strong>Aims: </strong>To describe knowledge and implementation of up-to-date post-mTBI guidelines among physicians providing emergency and trauma care in Israel.</p><p><strong>Methods: </strong>An exploratory cross-sectional survey of 68 hospital-based physicians providing emergency and trauma care (32% residents; 79% male; 87% general surgery/trauma/emergency medicine). Participants completed a 30-item multiple-choice questionnaire covering (1) demographics/professional characteristics and (2) knowledge and implementation of post-mTBI recommendations (e.g., symptom recognition, accepted protocols, and follow-up advice).</p><p><strong>Results: </strong>Most respondents (90%) recognized common post-mTBI symptoms, such as headaches and dizziness; however, only 40-60% identified neck pain, sleep disturbances, balance problems, and light/noise sensitivity. Although 50% reported familiarity with the internationally accepted guidelines, only 38% instructed for return-to-activity/sport protocol, 32% for return-to-school/work protocols, and 21% provided standardized discharge handouts. While 60% recommended post-injury medical follow-up, only 44% instructed patients to seek further care if they develop persisting symptoms, only 16% referred patients to clinicians specializing in post-mTBI management when clinically indicated, and only two respondents (3%) referred patients to a specialized mTBI clinic. The most frequently reported barrier (38-50%) was a lack of awareness of mTBI specialized services/providers.</p><p><strong>Conclusions: </strong>In this exploratory sample, gaps in both knowledge and implementation of internationally accepted post-mTBI guidelines were observed among Israeli physicians providing emergency and trauma care. The findings support revisions to national procedures, targeted training, and the development of a coordinated stepped-care pathway that links emergency and primary care with community-based follow-up for all patients following mTBI. They also support better access to interdisciplinary rehabilitation services for those with persistent or complex symptoms.</p>","PeriodicalId":46694,"journal":{"name":"Israel Journal of Health Policy Research","volume":"15 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13576113/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148971786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Israel's oral health policy in reflection of the WHO Global Oral Health Action Plan (2020-2023).","authors":"Dara Schwartz, Hagit Domb Herman, Shiri Waingrod, Lena Natapov","doi":"10.1186/s13584-026-00779-8","DOIUrl":"10.1186/s13584-026-00779-8","url":null,"abstract":"<p><strong>Background: </strong>Oral diseases are among the most prevalent non-communicable conditions worldwide, contributing to significant health burdens and disparities. In response, the World Health Organization established the Global Oral Health Action Plan 2023-2030, urging countries to integrate oral health into universal health coverage and adopt comprehensive prevention strategies. This article examines Israel's alignment with these objectives.</p><p><strong>Main body: </strong>Over the past 15 years, Israel has advanced oral health within Universal Health Coverage by integrating dental services into the National Health Insurance Law and progressively expanding public financing to children and the elderly, while maintaining coverage for special patient groups. Children and the elderly now account for over 40% of those eligible for publicly funded dental care. Prevention is central to policy. National school and mother-and-child health programs provide supervised toothbrushing, fluoride varnish applications, and oral health education, reaching nearly all children in recognized educational settings. Multidisciplinary primary care models link dental professionals with nurses and pediatric providers to deliver coordinated, life-course services, while strengthening the oral health workforce. Additional system measures include front-of-pack sugar warning labels, a national policy to phase down dental amalgam use, and ongoing efforts to establish a unified digital surveillance system for oral health. Together, expanded coverage, prevention-focused delivery, workforce development, and system strengthening position oral health as an integral component of Universal Health Coverage in Israel.</p><p><strong>Conclusion: </strong>Israel has made considerable progress in aligning with the Global Oral Health Action Plan, particularly by expanding coverage and preventive interventions for children and the elderly. However, continued efforts are needed to address remaining gaps in adult coverage, strengthen the capacity and distribution of the oral health workforce, and further integrate oral health care into innovative, multidisciplinary models. Systematic surveillance systems are also needed to accurately track disease burden and ensure equitable outcomes across all population groups.</p>","PeriodicalId":46694,"journal":{"name":"Israel Journal of Health Policy Research","volume":"15 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13573377/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148963827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maintaining ambulatory care capacity through telemedicine during wartime: insights from a tertiary center's experience.","authors":"Shachar Shapira, Danny Epstein, Meital Zur, Gilad Twig, Gad Segal, Yitshak Kreiss, Galia Barkai, Yael Frenkel Nir","doi":"10.1186/s13584-026-00783-y","DOIUrl":"10.1186/s13584-026-00783-y","url":null,"abstract":"<p><strong>Background: </strong>A state of war has the potential to profoundly disrupt routine, essential ambulatory hospital services, negatively impacting both acute hospitalizations and continuity of care. During June 2025, a war ignited between Israel and Iran, causing multiple casualties and substantial damage to essential healthcare facilities. This study examined the impact of the war on ambulatory visit volumes at Israel's largest tertiary medical center and assessed the contribution of telemedicine encounters to mitigating conflict-related disruptions.</p><p><strong>Methods: </strong>This is a retrospective analysis of ambulatory service data collected at Sheba Tel HaShomer Medical Center between June 13 and June 24, 2025, compared to the corresponding period in the previous years (2021-2024), with a focus on the methodologies and managerial decisions implemented. We conducted an interrupted time series analysis using annual outpatient data from matched dates in 2021-2025. We modeled the proportion of visits delivered via telemedicine using segmented linear regression, incorporating calendar year as a continuous time variable and an indicator marking the onset of the 2025 regional war to estimate the immediate change in telemedicine use, adjusted for pre-war trends.</p><p><strong>Results: </strong>Between June 13 and 24, 2025, Sheba Medical Center conducted 53,158 ambulatory visits, of which 9,478 (17.8%) were via telemedicine. Half of the patients were male, and 47.8% were aged 25-64 years. From 2021 to 2024, telemedicine use increased gradually from 2.5% to 5.0% of visits. In 2025, utilization rose sharply following the Israel-Iran conflict. Interrupted time series analysis estimated a pre-war annual increase of 0.86 percentage points, with a 12.2 percentage point level change during the war (95% CI 9.0-15.5). Compared with 2024, total visits declined 20.0%, in-person visits fell 30.8%, and telemedicine visits increased 182.9%. The largest telemedicine growth occurred in cardiovascular (463.6%), pediatric (434.4%), and neurology/neurosurgery (350.5%) divisions, while pediatrics and psychiatry had the highest proportions of remote visits (40.2% and 33.9%, respectively).</p><p><strong>Conclusions: </strong>A robust telemedicine infrastructure and well-established operational methodologies developed during peacetime may enable the continuity of ambulatory services during wartime. The rapid expansion of telemedicine capacity helped minimize the overall reduction in healthcare services available to the community.</p>","PeriodicalId":46694,"journal":{"name":"Israel Journal of Health Policy Research","volume":"15 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13555855/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148913858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of community water fluoridation cessation on dental caries in 12-year-old Israeli children: a retrospective analysis of socioeconomic disparities (2014-2022).","authors":"Rayan Fawarsy, Tali Chackartchi, Mordechai Findler, Doron Haim, Jonathan Mann, Guy Tobias","doi":"10.1186/s13584-026-00782-z","DOIUrl":"10.1186/s13584-026-00782-z","url":null,"abstract":"<p><strong>Background: </strong>Israel's community water fluoridation policy, mandatory from 2002 until its halt in 2014, provides a natural experiment to assess fluoridation's impact on pediatric oral health. This retrospective study analyzed digital dental records of 12-year-old children (2014-2022) to assess changes in caries experience following community water fluoridation cessation.</p><p><strong>Methods: </strong>We examined the Decayed, Missing, and Filled Teeth index, focusing on its Missing-and-Filled (MF) component, across socioeconomic status groups, gender, and fluoridation status (fluoridated vs. non-fluoridated). Differences were assessed using one-way Welch ANOVA and post-hoc Games-Howell tests.</p><p><strong>Results: </strong>The MF index increased significantly after fluoridation ended, especially in low-SES populations. Twelve-year-olds in low-SES communities without fluoridated water had more than double the caries experience of those in high-SES communities (mean MF 0.82 vs. 0.40; p < 0.05). Fluoridated communities showed a considerably narrower SES gap. SES had a large effect on caries outcomes (partial η²≈0.34), and the absence of fluoridation was associated with a modest but significant increase in MF (partial η²≈0.01). Females exhibited higher MF rates than males, with gender disparities more pronounced in non-fluoridated groups. Cessation of CWF was associated with a rise in caries and widened SES and gender disparities, underscoring fluoridation's value in promoting oral health equity.</p><p><strong>Conclusion: </strong>CWF remains a foundational public health measure, one that is unequaled in its ability to deliver effective, safe, equitable, and cost-saving caries prevention to entire populations.</p><p><strong>Practical implications: </strong>Reinstating mandatory community water fluoridation is essential to reverse the widening oral health disparities that disproportionately affect low-SES children and females. Policymakers must prioritize this measure to restore health equity and protect vulnerable populations who rely on this passive preventive intervention.</p>","PeriodicalId":46694,"journal":{"name":"Israel Journal of Health Policy Research","volume":"15 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13548607/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148901202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Latent profiles of mental health and care barriers among heterosexual and sexual minority adolescents.","authors":"Ateret Gewirtz-Meydan, Ruth Berkowitz, Shir Maoz, Guy Shilo, Yehuda Neumark","doi":"10.1186/s13584-026-00781-0","DOIUrl":"10.1186/s13584-026-00781-0","url":null,"abstract":"<p><strong>Background: </strong>Adolescents often navigate complex psychological, behavioral, and identity-related challenges, yet many do not seek the mental health support they need. Sexual minority youth face additional identity-based barriers that further hinder access to care.</p><p><strong>Method: </strong>A sample of 1,129 Israeli adolescents aged 16-18 (M = 17.42, SD = 1.03), including 30% who identified as sexual minorities, completed measures of mental health, substance use, suicidal ideation, and perceived barriers to care. Latent Profile Analysis (LPA) identified subgroups based on mental health and behavioral risk, and Exploratory Graph Analysis (EGA) identified latent dimensions of help-seeking barriers. Moderation analyses tested whether sexual orientation shaped associations between profile membership, perceived barriers, and help-seeking intentions.</p><p><strong>Results: </strong>Four mental health profiles emerged: Within Normal Ranges, Emotional Struggles and Suicidal Ideation, Tobacco and E-cigarette Users, and Cannabis Users. Barriers to care clustered into three domains: Identity-Related Barriers, Accessibility and Structural Barriers, and Emotional and Internal Barriers. Higher-risk profiles reported greater barriers and lower intentions to seek help, with stronger effects among sexual minority youth. Sexual orientation moderated these associations, revealing lower help-seeking intentions among sexual minority Tobacco and E-cigarette Users but higher intentions among sexual minority Cannabis Users.</p><p><strong>Conclusion: </strong>Patterns of psychological distress, substance use, and marginalized identity intersect to shape adolescents' access to mental health care. Tailored, identity-affirming outreach and efforts to reduce structural and emotional barriers are essential for reaching youth who face the greatest obstacles to seeking support.</p>","PeriodicalId":46694,"journal":{"name":"Israel Journal of Health Policy Research","volume":"15 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13543487/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148889143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From licensure to residency: structural barriers and policy options in Israel's residency admission process.","authors":"Ayala Burger, Alexey Belinsky, Joseph Mendlovic, Daniel Minerbi Padon, Michal Laron","doi":"10.1186/s13584-026-00774-z","DOIUrl":"10.1186/s13584-026-00774-z","url":null,"abstract":"<p><strong>Background: </strong>Israel faces a growing need for medical professionals due to population growth and aging, yet the number of licensed physicians per capita remains below the OECD average. The gap is particularly evident in the number of medical specialists. One factor contributing to this shortage may be the delay between medical licensure and the commencement of residency training.</p><p><strong>Objective: </strong>The objective of this study was to assess the extent to which delays in the commencement of residency programs occur, to identify and analyze barriers that delay the start of residency training among newly licensed physicians in Israel, and to explore possible solutions to optimize this process.</p><p><strong>Methods: </strong>This mixed-methods study included a quantitative analysis of administrative datasets from the Israeli Ministry of Health (n = 18,480), and qualitative analysis based on 31 semi-structured interviews conducted with department heads, residents, and residency candidates between January and August 2023.</p><p><strong>Results: </strong>Despite a steady increase in the number of licensed physicians, the median time between licensure and the start of residency has remained constant at approximately four months. According to interviewees' accounts in the study, delays were often associated with inconsistent and opaque admission processes, regional disparities in hospital demand, and mismatched expectations between candidates and departments, and could in part be explained by the absence of a centralized residency allocation system. Factors such as elective choices during internship and geographic location further influenced the timeline. Interviewees did not commonly report postponing residency for personal reasons.</p><p><strong>Conclusions: </strong>Delays in residency placement, compounded by inefficient workforce allocation, may reduce the effective capacity of the healthcare system. A more transparent and structured national framework - similar to those in the US, Canada, and Spain - could help streamline the process and reduce inefficiencies. Policy recommendations include improved data transparency, standardization of admission criteria, and better support for hospitals in peripheral regions. Establishing a unified, annual data reporting system on the physician workforce is a necessary prerequisite for any effective reform or national workforce planning.</p>","PeriodicalId":46694,"journal":{"name":"Israel Journal of Health Policy Research","volume":"15 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13536638/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When social media becomes medicine: clinician-moderated online consultations as an informal healthcare access point.","authors":"Inna Bleicher, Maya Peled-Raz, Sun Bleicher, Sharon Tzemah","doi":"10.1186/s13584-026-00777-w","DOIUrl":"10.1186/s13584-026-00777-w","url":null,"abstract":"<p><strong>Background: </strong>Social media has evolved significantly as a platform for healthcare communication, education, and consultation, especially following the COVID-19 pandemic. While these platforms are increasingly used for medical advice, they operate largely outside formal health policy frameworks, creating a growing \"informal layer\" of healthcare.</p><p><strong>Methods: </strong>A cross-sectional observational study was conducted using an anonymous online questionnaire distributed to the \"Ask an M.D.\" group members from April to July 2023. Demographic characteristics, consultation patterns, motivations for using the platform, and comparisons between users from central and peripheral regions of Israel were analyzed, to identify potential disparities in digital health access.</p><p><strong>Results: </strong>Of approximately 19,000 members who viewed the survey, 1,508 responded (8%). Respondents were predominantly female (85%), with a mean age of 38.5 years, and 61.5% reported higher education. Common reasons for using the group included seeking a second opinion (36%), delays in obtaining a doctor's appointment (34%), and urgent health concerns (28%). Consultation topics most often involved gynecology and obstetrics (19%), pediatrics (15%), and dermatology (10.5%). Peripheral respondents were underrepresented relative to their proportion in the wider population. Within the respondent sample, central and peripheral participants showed broadly similar reported patterns of platform use.</p><p><strong>Conclusions: </strong>Clinician-moderated social media groups such as \"Ask an M.D.\" may serve as a supplementary source of health information and informal consultation for some users, particularly when immediate formal care is less accessible. The lower representation of peripheral respondents in this survey should be interpreted cautiously and may reflect differences in survey exposure, response propensity, platform reach, or other factors. Because this study did not assess clinical outcomes, it cannot determine whether participation in the platform improves care, safety, or health equity.</p>","PeriodicalId":46694,"journal":{"name":"Israel Journal of Health Policy Research","volume":"15 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13531886/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148866438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dental unit waterlines in Israel: evidence of widespread microbial contamination and a need for national regulation.","authors":"Luda Groisman, Eti Burla, Daniel Kushnir, Shereen Assaly, Roni Gat, Efrat Rorman, Shoshanit Ohad, Ehud Kaliner","doi":"10.1186/s13584-026-00778-9","DOIUrl":"10.1186/s13584-026-00778-9","url":null,"abstract":"<p><strong>Background: </strong>Dental unit waterlines (DUWLs) are susceptible to microbial contamination because of biofilm formation within their complex water delivery systems. Although the US CDC and several professional organizations recommend maintaining dental treatment water at potable water quality, Israel currently lacks specific national standards and regulatory requirements for monitoring and maintaining DUWLs. This study assessed the prevalence of Legionella and other microbial contaminants in DUWLs across dental clinics in central Israel and examined factors associated with contamination to inform patient and dental stuff safety and national policy development.</p><p><strong>Methods: </strong>This survey included 52 randomly selected dental clinics, with 359 water samples collected from DUWL components and water sources. Samples were tested for Legionella spp., Legionella pneumophila, Pseudomonas aeruginosa, and heterotrophic plate count (HPC). Water quality indicators - residual chlorine and turbidity were also measured. Statistical analyses were used to explore associations between microbial and common water quality and clinic characteristics.</p><p><strong>Results: </strong>Of the clinics tested, 94% exhibited at least one abnormal water quality result. Legionella exceeded the threshold in 74% of samples, Pseudomonas in 25%, and HPC in 53%. Contamination was most frequent in turbine and syringe connectors. Low chlorine levels and high turbidity were significantly associated with increased microbial counts. Legionella pneumophila concentrations above 2,500 GU/L were found in 19% of Legionella-positive samples. No consistent effect of dental chair age or clinic operating frequency was observed.</p><p><strong>Conclusions: </strong>The widespread microbial contamination identified in Israeli dental unit waterlines represents a potential patient and occupational health concern and highlights an important regulatory gap in the oversight of dental water quality. These findings support the need to develop national standards for DUWL monitoring, maintenance, and treatment, together with routine surveillance and regulatory oversight, to improve patient safety and ensure safe dental care environments.</p>","PeriodicalId":46694,"journal":{"name":"Israel Journal of Health Policy Research","volume":"15 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13528164/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148866382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}