Catheter Reminders and Nurse-Driven Removal Use Varies Across Hospitals

US hospitals substantially expanded use of many catheter-associated urinary tract infection (CAUTI) prevention practices from 2005 to 2025, but variability persisted in use of catheter reminders and nurse-driven discontinuation, according to a survey study published in JAMA Network Open.

Every 4 years, investigators surveyed lead infection preventionists at all Department of Veterans Affairs (VA) hospitals and a random sample of nonfederal US hospitals with intensive care units. Over 6 waves, 1461 unique hospitals participated, with mean response rates of 63.4% for VA hospitals and 56.5% for nonfederal hospitals. Regular use was defined as using a practice almost always or always.

In nonfederal hospitals, regular use of urinary catheter reminders or stop orders increased from 9.1% in 2005 to 48.7% in 2025, and nurse-initiated catheter discontinuation increased from 11.3% in 2009 to 58.3% in 2025. VA hospitals also showed significant increases in both practices, although 2025 use was lower than in nonfederal hospitals (31.5% and 37.8%, respectively). By 2025, nearly all hospitals in both settings reported CAUTI surveillance systems (98.1% nonfederal; 98.7% VA).

Use of silver alloy Foley catheters declined in nonfederal hospitals (32.4% to 14.0%) but remained stable in VA hospitals. In 2025, 62.6% of nonfederal and 41.1% of VA hospitals reported regular use of external catheters in women. Nonfederal use in women exceeded use in men (55.4%) despite limited published evidence that external female devices reduce CAUTIs, the authors noted. Use of reminders or stop orders and nurse-initiated discontinuation declined after 2017 in some settings, the investigators reported.

The authors noted that the data were self-reported, that lower response rates in some waves could introduce nonresponse bias, and that most hospitals participated in only 1 or 2 waves, so the results reflect repeated cross-sectional snapshots rather than a longitudinal cohort. They concluded that variability in high-yield practices underscores "the need for sustained, system-level strategies to optimize urinary catheter safety across health care settings."

Source: 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