Clinical Report: Catheter stop orders may be losing ground

Overview

A repeated cross-sectional survey of 1,461 US hospitals found that regular use of catheter reminders or stop orders rose from 2005 levels but declined from earlier peaks by 2025. Surveillance and catheter-monitoring systems became more common, while the study measured reported practices—not infection rates or patient outcomes.

Background

Indwelling urinary catheter duration is a modifiable risk factor for catheter-associated urinary tract infection (CAUTI), and prevention strategies include avoiding unnecessary placement and removing catheters promptly. The study describes changes in reported prevention practices across six national survey waves from 2005 to 2025. Current CDC guidance directs acute-care hospitals to the CDC CAUTI guideline and the multi-society Compendium, which includes daily review of catheter necessity and consideration of reminders, stop orders, and nurse-driven discontinuation. Prior evidence syntheses cited in the source material reported approximately 50% lower CAUTI rates with reminder or stop-order interventions.

Data Highlights

Key Findings

• The repeated cross-sectional study included 1,461 unique hospitals: 133 VA hospitals and 1,328 nonfederal hospitals, surveyed in six waves from 2005 to 2025.
• Regular use of catheter reminders or stop orders increased from 9% to 49% in nonfederal hospitals, but was below the 2017 peak of 61%; VA use rose from 11% to 32%, below the 2013 peak of 48%.
• By 2025, nurse-initiated discontinuation was reported by 58% of nonfederal hospitals and 38% of VA hospitals. At least one of the three strategies—reminders, stop orders, or nurse-initiated discontinuation—was reported by 69% and 49%, respectively.
• Surveillance infrastructure expanded: established CAUTI surveillance systems were reported by 98% of nonfederal hospitals and 99% of VA hospitals in 2025, alongside increased monitoring of catheter presence and duration.
• Regular external urinary catheter use among female patients increased between 2021 and 2025 in both hospital groups. The source notes that evidence on effects on CAUTI rates remains limited and identifies skin injury, device-associated urinary tract infections, and cost-effectiveness as areas for further study.
• Prior systematic reviews summarized in the source material reported approximately 50% lower CAUTI rates with catheter reminders or stop orders. The survey itself assessed reported practices and did not establish effects on infection rates or patient outcomes.

Clinical Implications

CDC guidance and the multi-society Compendium identify daily review of catheter necessity and consideration of reminders, automatic stop orders, and nurse-driven discontinuation as prevention practices. The survey documents variation in reported adoption but cannot determine whether changes in these practices altered CAUTI rates or patient outcomes.

Conclusion

From 2005 to 2025, US hospitals reported substantial gains in CAUTI surveillance and catheter monitoring, while reminder and stop-order use remained below earlier peaks. The study describes practice patterns and does not establish their clinical effects.

Related Resources & Content

1. Saint S, et al., JAMA Network Open, 2026 — Catheter-Associated Urinary Tract Infection Prevention Practices in US Hospitals
2. CDC, Clinical Safety: Preventing Catheter-associated Urinary Tract Infections (CAUTIs), reviewed 2025
3. Meddings J, et al., BMJ Quality & Safety, 2014 — Reducing unnecessary urinary catheter use and other strategies to prevent catheter-associated urinary tract infection: an integrative review
4. JAMA Network Open — Strategies for Preventing Catheter-Associated Urinary Tract Infections in Hospitals Across the United States
5. MDSpire News — Foley Catheter Management: New Best Practices, Pitfalls
6. MDSpire News — Hydrophobic, Chlorhexidine, vs. Standard PICCs
7. MDSpire News — Midline Catheters Lower Failure in Bariatric Surgery
8. Clinical Safety: Preventing Catheter-associated Urinary Tract Infections (CAUTIs) | CDC
9. Reducing unnecessary urinary catheter use and other strategies to prevent catheter-associated urinary tract infection: an integrative review
10. Catheter-Associated Urinary Tract Infection Prevention Practices in US Hospitals
11. Clinical Safety: Preventing Catheter-associated Urinary Tract Infections (CAUTIs) | UTI | CDC
12. Reducing unnecessary urinary catheter use and other strategies to prevent catheter-associated urinary tract infection: an integrative review | BMJ Quality & Safety