TL;DR
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A survey study published in JAMA Network Open found that U.S. VA and nonfederal hospitals reported greater use of several catheter-associated urinary tract infection prevention practices in 2025 than in earlier survey years. Adoption remains uneven: nurse-initiated catheter discontinuation was reported by 37.8% of VA hospitals and 58.3% of nonfederal hospitals.
U.S. hospitals reported wider use of several practices to prevent catheter-associated urinary tract infections (CAUTIs) in 2025 than in earlier survey years, according to a study published in JAMA Network Open. But nurse-initiated catheter removal remained far from universal: the practice was reported by 37.8% of VA hospitals and 58.3% of nonfederal hospitals.
Researchers examined six waves of surveys conducted every four years from 2005 through 2025. In total, 1,461 hospitals completed at least one survey: 133 Department of Veterans Affairs hospitals and 1,328 nonfederal hospitals. The surveys asked hospitals about their use of CAUTI prevention practices.
Among VA hospitals, reported use of portable bladder ultrasound scanners increased from 50.0% in 2005 to 75.0% in 2025. Use of catheter reminders or stop orders rose from 11.1% to 31.5%. Nurse-initiated discontinuation increased from 14.5% in 2009 to 37.8% in 2025.
Nonfederal hospitals reported similar increases: scanner use grew 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. The researchers reported statistically significant increases for these comparisons.
Where Prevention Still Falls Short
Urinary catheters can expose patients to infection and other catheter-related harms, and the study authors identify unnecessary placement and prolonged use as targets for prevention. Wider adoption of monitoring, reminders and removal protocols suggests hospitals have expanded systems intended to limit catheter use. However, the reported figures show that key practices are not consistently in place across all hospitals.
Lead author Sanjay Saint of Northwell Health told MedPage Today that avoiding unnecessary catheter placement and reducing catheter duration are central to patient safety. He said the challenge is less about identifying prevention steps than carrying them out reliably in busy clinical settings, where leadership engagement, staffing and sustained behavior change can vary.
The study also notes that national surveys found a decline in the percentage of hospitalized patients with CAUTIs and other healthcare-associated infections between 2015 and 2023. That trend occurred alongside the reported expansion of prevention practices, but the survey study does not establish that the practices caused the decline.
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Two Decades of Hospital Surveys
The survey series tracked hospital-reported prevention practices at four-year intervals. By 2025, surveillance systems for CAUTI rates were reported by 98.7% of VA hospitals and 98.1% of nonfederal hospitals. Systems to identify patients with urinary catheters were reported by 79.2% and 92.1%, respectively, while routine monitoring of catheter duration and discontinuation was reported by 72.6% and 87.2%.
Hospital leaders also commonly rated UTI prevention as important or very important: 72.6% of VA hospitals and 72.5% of nonfederal hospitals did so in 2025. Yet reported use of individual strategies varied. For example, silver alloy Foley catheter use remained low in VA hospitals and fell among nonfederal hospitals from 32.4% in 2005 to 14.0% in 2025. Saint told MedPage Today that limited evidence of meaningful reductions 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, study lead author, speaking to MedPage Today
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Limits of the Survey Findings
The results describe hospital-reported practices; they do not show whether each practice was consistently followed for individual patients or directly measure the effect of those practices on infection rates. The study’s authors also cautioned that response rates could have introduced nonresponse bias.
Most participating hospitals completed only one or two survey waves. The findings therefore draw largely on different samples over time, rather than tracking the same hospitals as a single longitudinal group. The reported association between expanding prevention infrastructure and falling infection rates does not by itself prove a causal link.
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Making Removal Protocols Routine
The findings point to continued work on daily reassessment of catheter need, reminders or stop orders, and nurse-led removal when a catheter is no longer indicated. Saint told MedPage Today that hospitals also need to avoid catheter placement when possible and use alternatives when appropriate.
He also highlighted diagnostic stewardship: a positive urine culture without compatible symptoms should not automatically lead to a UTI diagnosis or antibiotics. The survey report does not specify a next study milestone or a national deadline for broader adoption. Whether hospitals can close the remaining gaps—and whether wider use of these practices leads to further reductions in CAUTIs—remains to be established.
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Key Questions
What did the study find?
Hospitals reported greater use of several CAUTI prevention practices in 2025 than in earlier survey years, including bladder scanners, catheter reminders and nurse-initiated discontinuation.
How many hospitals reported nurse-initiated catheter removal?
In 2025, the practice was reported by 37.8% of VA hospitals and 58.3% of nonfederal hospitals surveyed.
Does the study prove that prevention practices reduced infections?
No. The study compared survey responses across years and noted that infection rates declined in national surveys from 2015 to 2023, but it does not establish that the reported practices caused that decline.
What are the study’s main limitations?
Survey response rates may have led to nonresponse bias, and most hospitals took part in only one or two survey waves. The results therefore largely compare different groups of responding hospitals over time.
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