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A survey study of U.S. hospitals found that use of several catheter-associated urinary tract infection prevention practices increased between 2005 and 2025. Still, nurse-initiated catheter discontinuation was reported by 37.8% of VA hospitals and 58.3% of nonfederal hospitals in 2025; the survey does not establish that the practices caused infection rates to fall.
More U.S. hospitals reported using measures to prevent catheter-associated urinary tract infections in 2025 than in surveys conducted two decades earlier, according to a study of Department of Veterans Affairs and nonfederal hospitals. The findings show broader adoption of tools to limit unnecessary urinary catheter use, but nurse-initiated catheter removal remained far from universal.
Researchers led by Sanjay Saint, MD, of Northwell Health analyzed six waves of surveys conducted every four years from 2005 through 2025. A total of 1,461 hospitals completed at least one survey: 133 VA hospitals and 1,328 nonfederal hospitals. The study was published in JAMA Network Open.
In 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 discontinuation rose from 14.5% in 2009 to 37.8% in 2025.
Nonfederal hospitals also reported increased use: portable bladder ultrasound scanners went 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 measured reported hospital practices; it did not test whether a specific practice directly reduced infections.
Catheter Removal Still Varies
Urinary catheters can be associated with infection and other harms, and limiting how long they remain in place is one way hospitals seek to reduce those risks. The survey suggests that many hospitals have developed systems to track catheter use, but the reported adoption of nurse-led removal protocols remains uneven, particularly among VA hospitals.
By 2025, 98.7% of VA hospitals and 98.1% of nonfederal hospitals said they had surveillance systems to monitor CAUTI rates. Routine monitoring of catheter duration and discontinuation was reported by 72.6% and 87.2%, respectively. Saint told MedPage Today that the challenge is less about knowing the practices than carrying them out reliably in busy clinical settings. The results describe hospital-reported uptake, not patient-level outcomes or proof that adoption drove a change in infection rates.
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Two Decades of Prevention Surveys
The researchers compared responses across six survey waves, rather than following the same hospitals continuously. Most participating hospitals answered only one or two surveys, so the findings represent largely independent samples and show changes in reported practice across survey periods, not a detailed account of how each institution changed.
National hospital surveys have also shown a decline in the share of hospitalized patients with CAUTIs and other healthcare-associated infections between 2015 and 2023. That trend coincided with the broader adoption reported in this study, but the survey design cannot establish that the prevention practices caused the decline.
Use of silver-alloy Foley catheters remained low and relatively steady in VA hospitals, moving from 14.0% in 2005 to 15.9% in 2025. Among nonfederal hospitals, reported use fell from 32.4% to 14.0%. Saint said limited evidence of meaningful reduction in symptomatic CAUTI and guidelines that do not recommend routine use may help explain the decline.
“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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Limits of the Survey Evidence
The survey findings depend on hospitals’ responses, and the authors identified response rates as a possible source of nonresponse bias. Because most hospitals took part in only one or two waves, the analysis cannot show how the same institutions changed their practices over the full 20-year period.
The results also do not establish whether greater use of any one measure caused CAUTI rates to change. Although broader adoption coincided with national declines in reported healthcare-associated infections from 2015 to 2023, the study does not isolate the effect of catheter protocols from other changes in care. It remains unclear why adoption differs between VA and nonfederal hospitals or how consistently reported policies are applied at the bedside.
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Making Protocols Routine
The study reports practices through 2025; it does not set out a new implementation deadline or describe a planned follow-up survey. Saint told MedPage Today that hospitals can focus on daily reassessment of catheter need, reminders or stop orders, and nurse-initiated removal when the reason for catheterization has resolved.
He also said diagnostic stewardship matters: a positive urine culture without compatible symptoms should not automatically be treated as a UTI or prompt antibiotics. Whether hospitals broaden and sustain these approaches, and whether further research links particular practices to patient outcomes, remains to be seen.
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Key Questions
What did the study find?
Hospitals reported greater use of several CAUTI prevention measures in 2025 than in earlier surveys, including bladder ultrasound scanners, catheter reminders or stop orders, and nurse-initiated discontinuation.
How common was nurse-initiated catheter removal in 2025?
It was reported by 37.8% of VA hospitals and 58.3% of nonfederal hospitals surveyed in 2025.
Does the study prove these measures reduced infections?
No. It surveyed hospitals about their practices and found that adoption rose over time. It does not establish that a specific practice caused infection rates to fall.
What are the main limitations?
Survey response rates may have introduced nonresponse bias, and most participating hospitals completed only one or two survey waves. The findings therefore do not track a consistent group of hospitals across the entire period.
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