US hospitals expand CAUTI prevention, but key practices remain variable

US hospitals have substantially expanded their use of catheter-associated urinary tract infection (CAUTI) prevention practices over the past 20 years, particularly surveillance systems and processes for monitoring urinary catheter use and duration. However, a national survey study found that use of several high-yield strategies, including urinary catheter reminders or stop orders and nurse-initiated catheter discontinuation, has remained variable and declined in some settings since 2017.¹

The findings, published in JAMA Network Open, were based on 6 national survey waves conducted between 2005 and 2025 and included 1461 unique hospitals.

“Looking back over 20 years, it is encouraging to see how far hospitals have come in recognizing that urinary catheters are not benign devices and in building systems to use them more thoughtfully,” said Sanjay Saint, MD, MPH, professor emeritus of internal medicine at the University of Michigan and now with Northwell Health and the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, in a press release on the study.² “At the same time, our findings are a reminder that progress is not self-sustaining. The most effective strategies – such as prompting clinicians to reassess whether a catheter is still needed and empowering nurses to remove it when appropriate – should be embedded in everyday care.”

Twenty years of CAUTI prevention data

The study used repeated cross-sectional surveys administered every 4 years to lead infection preventionists at all VA hospitals and a random sample of nonfederal US general medical and surgical hospitals with intensive care units.

Across the study period, 133 VA hospitals and 1328 nonfederal hospitals participated in at least 1 survey. Mean response rates across the 6 waves were 63.4% for VA hospitals and 56.5% for nonfederal hospitals. The investigators assessed reported use of multiple CAUTI prevention practices, including catheter reminders or stop orders, nurse-initiated catheter discontinuation, bladder ultrasonography, intermittent catheterization, external urinary catheters, aseptic insertion, catheter surveillance systems, and leadership prioritization of CAUTI prevention.

In nonfederal hospitals, regular use of urinary catheter reminders or stop orders increased from 9.1% of hospitals in 2005 to 48.7% in 2025. Nurse-initiated catheter discontinuation increased from 11.3% in 2009 to 58.3% in 2025.

The same general pattern was observed in VA hospitals, although reported use was lower in 2025. Catheter reminders or stop orders increased from 11.1% of VA hospitals in 2005 to 31.5% in 2025, while nurse-initiated discontinuation increased from 14.5% in 2009 to 37.8% in 2025.

According to the authors, “Urinary catheter reminders or stop orders and nurse-initiated discontinuation protocols are among the most important strategies for preventing both infectious and noninfectious complications of Foley catheter use because duration of catheterization remains the most important modifiable risk factor for harm.”

Surveillance became nearly universal

The largest gains involved systems designed to identify patients with urinary catheters and monitor catheter duration and CAUTI events.

Among nonfederal hospitals, the proportion reporting a system for monitoring which patients had urinary catheters increased from 44.1% in 2005 to 92.1% in 2025. Routine monitoring of catheter duration and discontinuation increased from 25.9% to 87.2%. In VA hospitals, those measures increased from 42.6% to 79.2% and from 24.5% to 72.6%, respectively.

By 2025, CAUTI surveillance systems were reported by 98.1% of nonfederal hospitals and 98.7% of VA hospitals. Leadership prioritization also increased substantially. In nonfederal hospitals, the proportion reporting that hospital leadership considered prevention of urinary tract infections important or very important increased from 58.5% in 2009 to 72.5% in 2025. The corresponding proportion among VA hospitals increased from 36.6% to 72.6%.

Greater use of external catheters

The study also identified substantial changes in the use of external urinary collection devices, particularly among women.

Among nonfederal hospitals, regular use of external catheters in men increased from 13.1% in 2005 to 55.4% in 2025. Use of external catheters in women, which was first assessed in 2021, increased from 42.1% that year to 62.6% in 2025. In VA hospitals, use of external catheters in men reached 66.7% in 2025, while use among women increased from 10.8% in 2021 to 41.1%.

Use of silver alloy Foley catheters moved in the opposite direction. In nonfederal hospitals, regular use declined from 32.4% in 2005 to 14.0% in 2025, while use remained relatively stable in VA facilities. The authors noted that guidelines during the study period have not recommended routine use of silver alloy urinary catheters.

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REFERENCES

1. Saint S, Greene MT, Krein SL, et al. Catheter-Associated Urinary Tract Infection Prevention Practices in US Hospitals. JAMA Netw Open. 2026;9(10):e2637540. doi:10.1001/jamanetworkopen.2026.37540

2. Many hospitals still don’t do enough to prevent UTIs from catheters. News release. Michigan Medicine – University of Michigan. October 6, 2026. Accessed October 6, 2026. https://www.eurekalert.org/news-releases/1146705