Catheter-Associated Urinary Tract Infection Prevention Practices in US Hospitals
5 affiliations
- 1Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
- 2Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
- 3Urology Division, Surgery Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
- 4Department of Urology, University of Michigan Medical School, Ann Arbor
- 5Department of Pediatrics, University of Michigan Medical School, Ann Arbor
Abstract
Importance: Catheter-associated urinary tract infection (CAUTI) remains a common and morbid health care–associated infection. Although evidence-based prevention strategies are well established, the degree to which hospitals adopt and sustain these practices over time and whether trajectories differ between Department of Veterans Affairs (VA) and nonfederal systems are not well described.
Objective: To examine 20-year trends in reported CAUTI prevention practices in US hospitals and compare practice use between VA and nonfederal hospitals.
Design, Setting, and Participants: This survey study used repeated cross-sectional national surveys conducted every 4 years from 2005 to 2025. Surveys were sent to the lead infection preventionist at all VA hospitals, as well as a random sample of nonfederal, general medical, and surgical US hospitals with intensive care units. Data were analyzed from January to August 2026.
Main Outcomes and Measures: The outcome of interest was regular use of specific CAUTI prevention practices, including urinary catheter reminders or stop orders, nurse-initiated discontinuation, bladder ultrasonography, intermittent catheterization, external catheters, aseptic insertion, surveillance systems, and leadership prioritization of CAUTI prevention.
Results: Over the 20 year period, 1461 unique hospitals participated in at least 1 study survey, with mean (SD) response rates for the 6 survey waves of 63.4% (8.4%) for VA hospitals and 56.5% (9.2%) for nonfederal hospitals. Both VA and nonfederal hospitals demonstrated substantial long-term increases in surveillance infrastructure, routine monitoring of catheter duration, and leadership prioritization of CAUTI prevention. In nonfederal hospitals, regular use of urinary catheter reminders or stop orders increased from 34 of 372 hospitals (9.1%) in 2005 to 149 of 306 hospitals (48.7%) in 2025, and nurse-initiated discontinuation increased from 43 of 379 hospitals (11.3%) in 2009 to 179 of 307 hospitals (58.3%) in 2025. VA hospitals also showed significant increases in these practices over time, although use in 2025 was lower than nonfederal hospitals (urinary catheter reminders or stop orders: 10 of 90 hospitals [11.1%] in 2005 and 23 of 73 hospitals [31.5%] in 2025; nurse-initiated discontinuation: 10 of 69 hospitals (14.5%) in 2009 and 28 of 74 hospitals [37.8%] in 2025). Use of silver alloy Foley catheters declined markedly in nonfederal hospitals (from 126 of 389 hospitals [32.4%] in 2005 to 41 of 294 hospitals [14.0%] in 2025) but remained stable in VA facilities. External catheter use increased substantially, particularly in women, with 194 of 310 nonfederal hospitals (62.6%) and 30 of 73 VA hospitals (41.1%) reporting regular use by 2025. Nearly universal use of CAUTI surveillance systems was observed in both settings (309 of 315 nonfederal hospitals [98.1%] and 73 of 74 VA hospitals [98.7%]).
Conclusions and Relevance: This survey study of infection-prevention practice use found that US hospitals substantially expanded use of many CAUTI prevention practices, particularly surveillance and monitoring systems, over the past 20 years. However, variability in use of high-yield practices, such as reminders and nurse-driven discontinuation, persisted, underscoring the need for sustained, system-level strategies to optimize urinary catheter safety across health care settings.
Related
- COVID-19 infection prevention and control preparedness among healthcare workers in public hospitals in Yemen: a comprehensive assessment of knowledge, practices, perceptions, and institutional readiness
- Chlorhexidine plus alcohol versus povidone iodine plus alcohol, combined or not with innovative devices, for prevention of short-term peripheral venous catheter infection and failure (CLEAN 3 study): an investigator-initiated, open-label, single centre, randomised-controlled, two-by-two factorial trial
- Infection prevention training and adherence to infection control practices in childcare and early childhood education facilities during COVID-19: a nationwide cross-sectional study in Japan
- MRSA Knowledge, Infection-Prevention Practices, and Antibiotic Use Without Clinician Consultation Among Hajj Pilgrims Arriving in Madinah, Saudi Arabia: A Cross-Sectional Study †
- Adherence of healthcare personnel to infection prevention and control program in maternal and child hospitals in Sana'a City, Yemen, cross-sectional study.
BibTeX
@article{saint2026catheterassociated,
title = {{Catheter-Associated Urinary Tract Infection Prevention Practices in US Hospitals}},
author = {Sanjay Saint and M. Todd Greene and Sarah L. Krein and Kristin Chrouser and Karen E. Fowler and David Ratz and Jennifer Meddings},
journal = {JAMA Network Open},
year = {2026},
month = oct,
doi = {10.1001/jamanetworkopen.2026.37540},
url = {https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2854878},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Catheter-Associated Urinary Tract Infection Prevention Practices in US Hospitals
AU - Sanjay Saint
AU - M. Todd Greene
AU - Sarah L. Krein
AU - Kristin Chrouser
AU - Karen E. Fowler
AU - David Ratz
AU - Jennifer Meddings
PY - 2026
DA - 2026/10/06
JO - JAMA Network Open
DO - 10.1001/jamanetworkopen.2026.37540
UR - https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2854878
AB - Importance: Catheter-associated urinary tract infection (CAUTI) remains a common and morbid health care–associated infection. Although evidence-based prevention strategies are well established, the degree to which hospitals adopt and sustain these practices over time and whether trajectories differ between Department of Veterans Affairs (VA) and nonfederal systems are not well described. Objective: To examine 20-year trends in reported CAUTI prevention practices in US hospitals and compare practice use between VA and nonfederal hospitals. Design, Setting, and Participants: This survey study used repeated cross-sectional national surveys conducted every 4 years from 2005 to 2025. Surveys were sent to the lead infection preventionist at all VA hospitals, as well as a random sample of nonfederal, general medical, and surgical US hospitals with intensive care units. Data were analyzed from January to August 2026. Main Outcomes and Measures: The outcome of interest was regular use of specific CAUTI prevention practices, including urinary catheter reminders or stop orders, nurse-initiated discontinuation, bladder ultrasonography, intermittent catheterization, external catheters, aseptic insertion, surveillance systems, and leadership prioritization of CAUTI prevention. Results: Over the 20 year period, 1461 unique hospitals participated in at least 1 study survey, with mean (SD) response rates for the 6 survey waves of 63.4% (8.4%) for VA hospitals and 56.5% (9.2%) for nonfederal hospitals. Both VA and nonfederal hospitals demonstrated substantial long-term increases in surveillance infrastructure, routine monitoring of catheter duration, and leadership prioritization of CAUTI prevention. In nonfederal hospitals, regular use of urinary catheter reminders or stop orders increased from 34 of 372 hospitals (9.1%) in 2005 to 149 of 306 hospitals (48.7%) in 2025, and nurse-initiated discontinuation increased from 43 of 379 hospitals (11.3%) in 2009 to 179 of 307 hospitals (58.3%) in 2025. VA hospitals also showed significant increases in these practices over time, although use in 2025 was lower than nonfederal hospitals (urinary catheter reminders or stop orders: 10 of 90 hospitals [11.1%] in 2005 and 23 of 73 hospitals [31.5%] in 2025; nurse-initiated discontinuation: 10 of 69 hospitals (14.5%) in 2009 and 28 of 74 hospitals [37.8%] in 2025). Use of silver alloy Foley catheters declined markedly in nonfederal hospitals (from 126 of 389 hospitals [32.4%] in 2005 to 41 of 294 hospitals [14.0%] in 2025) but remained stable in VA facilities. External catheter use increased substantially, particularly in women, with 194 of 310 nonfederal hospitals (62.6%) and 30 of 73 VA hospitals (41.1%) reporting regular use by 2025. Nearly universal use of CAUTI surveillance systems was observed in both settings (309 of 315 nonfederal hospitals [98.1%] and 73 of 74 VA hospitals [98.7%]). Conclusions and Relevance: This survey study of infection-prevention practice use found that US hospitals substantially expanded use of many CAUTI prevention practices, particularly surveillance and monitoring systems, over the past 20 years. However, variability in use of high-yield practices, such as reminders and nurse-driven discontinuation, persisted, underscoring the need for sustained, system-level strategies to optimize urinary catheter safety across health care settings.
SN - 2574-3805
ER -