TL;DR
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A survey study of U.S. hospitals found broader use of three catheter-associated urinary tract infection prevention practices between 2005 and 2025. In 2025, nurse-initiated catheter discontinuation was reported by 37.8% of VA hospitals and 58.3% of nonfederal hospitals, showing that adoption remains incomplete.
U.S. hospitals reported greater use of several practices to prevent catheter-associated urinary tract infections (CAUTIs) in 2025 than in surveys conducted two decades earlier, according to a study published in JAMA Network Open. The gains included wider use of bladder scanners, catheter reminders or stop orders, and nurse-initiated catheter removal, but the last practice remained far from universal.
Researchers analyzed six waves of surveys, conducted every four years from 2005 through 2025, with responses from 1,461 hospitals that completed at least one survey. The sample included 133 Department of Veterans Affairs hospitals and 1,328 nonfederal hospitals. The surveys asked how often facilities used a range of CAUTI prevention practices.
Among VA hospitals, reported use of portable bladder ultrasound scanners rose from 50.0% in 2005 to 75.0% in 2025. Use of catheter reminders or stop orders increased from 11.1% to 31.5%. Nurse-initiated catheter discontinuation rose from 14.5% in 2009 to 37.8% in 2025.
Nonfederal hospitals reported similar increases: scanner use rose from 29.6% to 72.8%; reminders or stop orders from 9.1% to 48.7%; and nurse-initiated discontinuation from 11.3% in 2009 to 58.3% in 2025. The study reported statistically significant increases for these comparisons. Its authors also found that, by 2025, surveillance systems for CAUTI rates were in place at 98.7% of VA hospitals and 98.1% of nonfederal hospitals.
Catheter Removal Remains Uneven
The results point to wider hospital infrastructure for tracking catheter use and infections, while showing a gap between monitoring and action. Catheter duration is a modifiable risk factor for infection and other catheter-related harm, the study’s lead author, Sanjay Saint of Northwell Health, told MedPage Today. Timely removal when a catheter is no longer needed is one way hospitals can reduce unnecessary exposure.
That gap matters for patients because urinary catheters can be associated with infection and other harms, and CAUTI is described in the source report as a common, costly healthcare-associated infection. But the survey documents reported practices, not patient-level outcomes from each participating hospital. It cannot establish that the increases in these practices caused the national decline in infections cited by the authors.
National hospital surveys have reported a decline in the proportion of hospitalized patients with CAUTIs and other healthcare-associated infections between 2015 and 2023. The study authors noted that this period overlapped with wider use of prevention measures; the survey findings alone do not show that one caused the other.
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Two Decades of Prevention Surveys
The study compares responses across six survey waves rather than tracking the same hospitals continuously. Although 1,461 facilities took part in at least one wave, most responding hospitals participated in only one or two. The findings therefore describe largely independent samples, not a single cohort whose progress can be followed year by year.
Some prevention approaches changed little or became less common. Reported use of silver-alloy Foley catheters among VA hospitals was 14.0% in 2005 and 15.9% in 2025. In nonfederal hospitals it fell from 32.4% to 14.0%. Saint told MedPage Today this may reflect limited evidence that these catheters meaningfully reduce symptomatic CAUTI and guidelines that do not recommend routine use. In 2025, external catheters for women were regularly used by 41.1% of VA and 62.6% of nonfederal hospitals; the evidence that they consistently reduce CAUTI was described as less definitive.
“These changes show that hospitals increasingly recognize that avoiding unnecessary catheter placement and reducing catheter duration are central to patient safety.”
— Sanjay Saint, MD, of Northwell Health, speaking to MedPage Today
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Survey Limits and Outcome Questions
The reported percentages reflect survey responses and may not represent every U.S. hospital. The authors identified possible nonresponse bias as a limitation. Because most hospitals participated in only one or two survey waves, the comparisons cannot show how individual facilities changed over time or explain why they adopted particular practices.
The survey also does not establish whether greater reported use of a specific measure led to fewer infections at the hospitals that used it. Although national surveys showed lower proportions of hospitalized patients with CAUTIs and other healthcare-associated infections from 2015 to 2023, the source material does not provide a causal link between those trends and the prevention practices measured here. The degree to which reported policies were consistently followed in daily care is also not established by the survey results.
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Focus on Daily Catheter Review
The study does not announce a new policy or a specific next research milestone. Its findings point to the continuing task of turning prevention systems into routine practice, particularly daily review of whether each patient still needs a catheter and timely removal when the clinical indication has ended.
Saint told MedPage Today that competing clinical priorities, differences in leadership engagement, uneven availability of staff champions, and difficulty sustaining behavior change can contribute to variation among hospitals. The survey findings provide a baseline for tracking reported prevention practices, but further evidence would be needed to show how specific implementation efforts affect infection rates and patient outcomes.
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Key Questions
What did the hospital survey find?
Hospitals reported greater use of three CAUTI prevention practices in 2025 than in earlier survey years: portable bladder scanners, catheter reminders or stop orders, and nurse-initiated catheter discontinuation.
How many hospitals took part?
1,461 hospitals completed at least one of the six surveys conducted from 2005 to 2025. They included 133 VA hospitals and 1,328 nonfederal hospitals.
Was nurse-initiated catheter removal widely adopted?
Not universally. In 2025, 37.8% of VA hospitals and 58.3% of nonfederal hospitals reported using nurse-initiated catheter discontinuation.
Does the study show that these practices caused infection rates to fall?
No. The study reports changes in hospital practices. National surveys showed a decline in the proportion of hospitalized patients with CAUTIs and other healthcare-associated infections from 2015 to 2023, but these findings do not establish that the surveyed practices caused that decline.
What limitations did the researchers identify?
Survey response rates may have created nonresponse bias, and most hospitals took part in only one or two survey waves. The results therefore come from largely independent samples rather than a cohort consistently followed over time.
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