Closed tracheal suction systems (CTSS) are currently being used to minimize complications associated with endotracheal suctioning. Advantages of CTSS include improved oxygenation, decreased clinical signs of hypoxemia, maintenance of positive end-expiratory pressure, infection control, convenience, cost, and reduced patient anxiety. Some concerns related to use of CTSS include autocontamination, decreased effectiveness, difficult to use, excess negative pressure, and airway trauma. Strategies for reducing these and other concerns are shared. Recommendations for nursing practice and nursing research are discussed

Medical microbiology is a subspeciality of pathology. Most medical microbiology laboratories in the UK are managed by medical (clinical) microbiologists. They have a primary and often a secondary medical quali¢cation, or some experience in branches of medicine or surgery, before embarking on training in microbiology. There have been some important recent changes in the training structure which will be highlighted elsewhere. However, training in individual subspecialities in pathology no longer includes a period in all of these specialities. Trainees must therefore commit themselves to their chosen speciality at an early stage.The scheme of training is usually carried out in teaching or a¤liated hospitals, lasts for 4^5 years and includes experience in virology and district (non-teaching) hospitals. The quali¢cation required to be a consultant microbiologist is Membership of the Royal College of Pathologists (MRCPath). A primary examination at 3 years consists of essays, a long practical examination and viva voce. The ¢nal examination consists of work on a dissertation and a long viva voce. The aim of the trainee is to become a consultant medical microbiologist.Consultants are employed by NHS Trusts, universities (Honorary Consultants at Senior Lecturer level and above) or by the Public Health Laboratory Service (PHLS).There are some 490 consultant microbiologists but only 85 consultants in infectious diseases in the UK. This means that microbiologists have to take some of the responsibility for managing infection in hospitals, though they rarely admit and care for patients alone. Clinical responsibilities will be discussed below. PROVISION OF THE M ICROBIOLOGY SERVICEAll hospitals and general practitioners have access to a microbiology laboratory service. Most hospitals have a laboratory on-site funded by the NHS Trust. Several hospitals may be served by one larger laboratory. A few are privatized (on-or