Reported use of urinary catheter reminders or stop orders declined from earlier peaks in US hospitals, despite substantial improvements in catheter-associated urinary tract infection (CAUTI) prevention practices between 2005 and 2025, according to a study published in JAMA Network Open. The findings highlight persistent variation in strategies intended to reduce unnecessary catheterization and promote timely removal.
Researchers conducted a repeated cross-sectional study using 6 national survey waves administered every 4 years from 2005 to 2025. The study included 1,461 unique hospitals, comprising 133 Department of Veterans Affairs (VA) hospitals and 1,328 nonfederal hospitals. Surveys were distributed to lead infection preventionists at all VA hospitals and randomly selected nonfederal general medical and surgical hospitals with intensive care units.
The main outcome of interest was the reported regular use of CAUTI prevention practices, defined as use almost always or always on a 5-point scale. Researchers assessed catheter removal strategies, alternative catheterization methods, monitoring systems, and infection surveillance.
Among nonfederal hospitals, regular use of catheter reminders or stop orders increased from 9% in 2005 to 49% in 2025, but remained below its 2017 peak of 61%. VA hospitals showed a similar pattern, with reported use increasing from 11% in 2005 to 32% in 2025 after reaching 48% in 2013. Nurse-initiated catheter discontinuation increased over the study period, reaching 58% of nonfederal hospitals and 38% of VA hospitals in 2025.
In 2025, 69% of nonfederal hospitals and 49% of VA hospitals reported regularly using at least 1 catheter reminder, stop-order, or nurse-initiated discontinuation strategy. Daily rounds to assess catheter necessity were also more common in nonfederal hospitals (83% vs 66%).
Surveillance infrastructure improved substantially. By 2025, established CAUTI surveillance systems were reported by 98% of nonfederal hospitals and 99% of VA hospitals. Systems for monitoring which patients had urinary catheters increased in nonfederal hospitals from 44% to 92% and from 43% to 79% in VA hospitals between 2005 and 2025. Routine monitoring of catheter duration and discontinuation also increased from 26% to 87% in nonfederal hospitals and from 25% to 73% in VA hospitals.
Regular use of external urinary catheters among female patients increased from 42% to 63% in nonfederal hospitals and from 11% to 41% in VA hospitals between 2021 and 2025. Although these devices may reduce indwelling catheter use, evidence of their effect on CAUTI rates remains limited, and further research is needed to evaluate skin injury, device-associated urinary tract infections, and cost-effectiveness.
Conversely, regular use of silver alloy Foley catheters declined from 32% in 2005 to 14% in 2025 among nonfederal hospitals,consistent with guidelines that do not recommend their routine use.
The study was limited by self-reported practices, potential nonresponse bias, and changes in hospital sampling across survey waves. Because the study evaluated reported prevention practices rather than infection rates or patient outcomes, the findings do not establish the clinical effects of changing practice patterns.
Catheterization duration remains a major modifiable risk factor for harm. The researchers cited systematic reviews demonstrating approximately 50% lower CAUTI rates with catheter reminders or stop orders, underscoring the importance of sustaining these practices despite broader improvements in surveillance infrastructure.
National surveys can help stakeholders optimize CAUTI prevention practices “with the goal of minimizing this common but preventable harm,” concluded lead study author Sanjay Saint, MD, of the University of Michigan Medical School, and colleagues.
Saint reported personal fees from Doximity and publishers, along with a patent for a catheter placement device. Jennifer Meddings, MD, reported grants from the Agency for Healthcare Research and Quality, a catheter placement device patent, and an editorial role outside the submitted work. No other conflicts were reported. The study was supported in part by the VA National Center for Patient Safety, with additional survey infrastructure funding from the National Institutes of Health .Full disclosures are available in the published study.
Source: JAMA Network Open
