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A survey study published in JAMA Network Open found that more U.S. hospitals reported using key practices to prevent catheter-associated urinary tract infections in 2025 than in earlier survey years. Adoption increased across VA and nonfederal hospitals, but nurse-initiated catheter removal remained uneven, and the study cannot show that the practices caused infection rates to fall.
U.S. hospitals reported broader use of several practices to prevent catheter-associated urinary tract infections in 2025 than in earlier survey years, according to a study published in JAMA Network Open. However, nurse-initiated catheter removal was still reported by fewer than four in 10 VA hospitals and fewer than six in 10 nonfederal hospitals, leaving substantial room for wider adoption.
The researchers examined six waves of surveys conducted every four years from 2005 through 2025. In all, 1,461 hospitals completed at least one survey: 133 VA hospitals and 1,328 nonfederal hospitals. The surveys asked how often hospitals used a range of CAUTI prevention practices; most participating hospitals responded in only one or two waves.
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 climbed from 29.6% to 72.8% between 2005 and 2025; reminders or stop orders rose from 9.1% to 48.7%; and nurse-initiated discontinuation increased from 11.3% in 2009 to 58.3% in 2025. These figures describe survey responses at the reported time points, not the experience of a single group of hospitals followed continuously.
Catheter Removal Remains Uneven
Urinary catheters can raise the risk of infection and other catheter-related harm, and keeping one in place longer than needed is a modifiable risk factor. The study’s results suggest that hospitals increasingly report having tools and procedures to track catheter use and prompt review. Such systems matter because they can help care teams notice when a catheter is no longer needed and consider removing it.
But adoption of nurse-initiated removal protocols remains incomplete, particularly in VA hospitals in the 2025 survey. The study authors said that the challenge is not simply knowing which practices to use, but applying them reliably amid competing priorities and differences in leadership support and staffing. The survey measures reported practices; it does not establish that any particular hospital’s approach reduced infections.
National surveys have shown a decline in the share of hospitalized patients with CAUTIs and other healthcare-associated infections between 2015 and 2023. The researchers noted that these trends coincided with increased prevention efforts, but the survey study does not prove that the reported practices caused the declines.
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How Prevention Practices Changed
The report was led by Sanjay Saint, MD, of Northwell Health, and colleagues. The authors assessed hospital-reported practices over two decades, including tools to avoid unnecessary catheter placement, reminders to review ongoing need, and protocols allowing nurses to remove catheters when clinical indications have resolved.
By 2025, most responding hospitals reported monitoring catheter use and duration. Systems to track which patients had catheters were reported by 79.2% of VA hospitals and 92.1% of nonfederal hospitals. Routine monitoring of catheter duration and discontinuation was reported by 72.6% and 87.2%, respectively. CAUTI surveillance systems were reported by 98.7% of VA hospitals and 98.1% of nonfederal hospitals.
Not every intervention expanded. Use of silver-alloy Foley catheters remained relatively flat in VA hospitals, moving from 14.0% in 2005 to 15.9% in 2025. In nonfederal hospitals, reported use fell from 32.4% to 14.0%. Saint said this may reflect limited evidence that the catheters meaningfully reduce symptomatic CAUTI and guidelines that do not recommend routine use.
“These changes show that hospitals increasingly recognize that avoiding unnecessary catheter placement and reducing catheter duration are central to patient safety.”
— Sanjay Saint, MD, speaking to MedPage Today
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What the Survey Cannot Establish
The findings are based on hospital survey responses, so they may not represent every U.S. hospital. The authors cited response rates as a possible source of nonresponse bias. Because most hospitals completed only one or two survey waves, the analysis largely compares independent samples rather than tracking the same hospitals throughout the full period.
The study also does not show whether specific prevention practices caused CAUTI rates to change, or how consistently hospitals applied a reported policy in day-to-day care. It does not establish the effects of each intervention on individual patient outcomes. The findings on external catheters for women are also limited: Saint said they may reduce indwelling catheter use, while evidence that they consistently prevent CAUTI is less definitive.
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Making Daily Review Routine
The report does not announce a new policy or give a timetable for further changes. Its findings point to consistent daily reassessment as a practical next step for hospitals, along with catheter reminders and nurse-led removal protocols when the clinical reason for a catheter has ended. Whether hospitals expand these practices, and whether wider use is followed by further reductions in CAUTIs, will require ongoing monitoring.
For clinicians, Saint framed the decision around whether an indwelling catheter is needed that day: avoid placement when possible, use alternatives when appropriate, and remove it promptly once the indication resolves. He also urged careful interpretation of urine cultures, saying a positive result without compatible symptoms should not by itself prompt a UTI diagnosis or antibiotics.
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Key Questions
What did the study find?
Hospitals reported greater use of three CAUTI prevention practices in 2025 than in earlier survey years: portable bladder ultrasound scanners, catheter reminders or stop orders, and nurse-initiated catheter discontinuation. Adoption levels varied by practice and hospital type.
How many hospitals were included?
1,461 hospitals completed at least one of six survey waves from 2005 to 2025. They included 133 VA hospitals and 1,328 nonfederal hospitals.
Was nurse-initiated catheter removal universal?
No. In the 2025 survey, the practice was reported by 37.8% of VA hospitals and 58.3% of nonfederal hospitals.
Does the study prove that these practices lowered infection rates?
No. The study measured reported hospital practices and noted that their expansion coincided with national declines in healthcare-associated infections from 2015 to 2023. It does not establish that the practices caused CAUTI rates to fall.
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