{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:17:15Z","timestamp":1787015835312,"version":"build-2736575974"},"reference-count":27,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T00:00:00Z","timestamp":1767744000000},"content-version":"vor","delay-in-days":6,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100010450","name":"Ministry of Higher Education and Scientific Research","doi-asserted-by":"publisher","award":["MM71\/22"],"award-info":[{"award-number":["MM71\/22"]}],"id":[{"id":"10.13039\/100010450","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Nursing in Critical Care"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>In resource\u2010limited settings, single\u2010use open endotracheal suction catheters are commonly used multiple times. The current evidence of this practice on ventilator\u2010associated pneumonia (VAP) among mechanically ventilated patients remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>The aim of this study was to test the feasibility of single\u2010use and multiple\u2010use endotracheal suction catheters flushed with chlorhexidine versus standard care (multiple\u2010use endotracheal suction catheters flushed with normal saline) to reduce VAP in resource\u2010limited intensive care units (ICUs) and evaluate study methods for designing a future definitive randomised controlled trial (RCT).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>A three\u2010armed feasibility RCT was conducted in three ICUs at a university hospital in Egypt.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Sixty mechanically ventilated patients were randomized into three groups: Intervention I group, single\u2010use catheters, Intervention II group, multiple\u2010use catheters flushed with chlorhexidine, and Control group (standard care) multiple\u2010use catheters flushed with normal saline. Data on feasibility parameters, intervention adherence, and patient outcomes were collected. Recruitment and retention rates were high across all groups, with 96.7% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200958) of participants completing the 3\u2010day follow\u2010up and 93.3% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200956) completing the 6\u2010day follow\u2010up. Adherence to intervention protocols was excellent, with 100% of participants receiving the designed interventions. No adverse events were reported. Chlorhexidine flushing and single\u2010use catheters were practical and successfully implemented. Challenges of budget constraints, supply shortages and the need for staff training were observed. The incidence of VAP was 31.6% in the Intervention I group, 26.3% in the Intervention II group, and 40% in the standard care group. The relative risk of developing VAP compared with the control group was 0.79 (95% CI: 0.51\u20131.23) for Intervention I and 0.66 (95% CI: 0.42\u20131.03) for Intervention II.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A full\u2010scale RCT comparing single\u2010use and multiple\u2010use catheters with chlorhexidine flushing is feasible in resource\u2010limited ICUs. Further investigation into the effectiveness of interventions on VAP prevention is needed in future definitive RCTs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Relevance to Clinical Practice<\/jats:title>\n                    <jats:p>This study highlights the practical implementation of endotracheal suctioning strategies, such as chlorhexidine flushing and single\u2010use suction catheters, to potentially reduce VAP in resource\u2010limited ICUs. These findings can inform clinical decision\u2010making and infection control.<\/jats:p>\n                    <jats:p>\n                      <jats:bold>Trial Registration:<\/jats:bold>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/clinicaltrials.gov\">ClinicalTrials.gov<\/jats:ext-link>\n                      , identifier NCT06207513\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/nicc.70237","type":"journal-article","created":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T04:10:37Z","timestamp":1767845437000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Single\u2010Use Versus Multiple\u2010Use Endotracheal Suction Catheters in Mechanically Ventilated Patients: A Feasibility Randomised Controlled Trial"],"prefix":"10.1111","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6293-2730","authenticated-orcid":false,"given":"Mohamed H.","family":"Eid","sequence":"first","affiliation":[{"name":"School of Nursing and Midwifery, Faculty of Health University of Plymouth  Plymouth UK"},{"name":"Critical Care and Emergency Nursing Department, Faculty of Nursing Mansoura University  Mansoura Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7809-5025","authenticated-orcid":false,"given":"Kevin","family":"Hambridge","sequence":"additional","affiliation":[{"name":"School of Nursing and Midwifery, Faculty of Health University of Plymouth  Plymouth UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4242-754X","authenticated-orcid":false,"given":"Patricia","family":"Schofield","sequence":"additional","affiliation":[{"name":"School of Nursing and Midwifery, Faculty of Health University of Plymouth  Plymouth UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8087-6461","authenticated-orcid":false,"given":"Jos M.","family":"Latour","sequence":"additional","affiliation":[{"name":"School of Nursing and Midwifery, Faculty of Health University of Plymouth  Plymouth UK"},{"name":"The Curtin School of Nursing Curtin University  Perth Western Australia Australia"},{"name":"Department of Nursing Zhongshan Hospital, Fudan University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,1,7]]},"reference":[{"key":"e_1_2_15_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-023-07256-9"},{"key":"e_1_2_15_3_1","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2023.1295277"},{"key":"e_1_2_15_4_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj-2021-069044"},{"key":"e_1_2_15_5_1","volume-title":"Surgical Airway Suctioning","author":"Sinha V.","year":"2025"},{"key":"e_1_2_15_6_1","volume-title":"The ICU Book","author":"Marino P. 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