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A study of six hospital survey waves found that VA and nonfederal hospitals reported greater use of three practices intended to prevent catheter-associated urinary tract infections between 2005 and 2025. Adoption of nurse-initiated catheter removal remained incomplete, and the survey design cannot show that individual hospitals changed their practices over time.
More U.S. hospitals reported using key measures to prevent catheter-associated urinary tract infections in 2025 than in earlier surveys, according to a study in JAMA Network Open. The measures included portable bladder ultrasound scanners, catheter reminders or stop orders, and protocols allowing nurses to remove catheters when they are no longer needed, but use of those practices was not universal.
Researchers analyzed 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. Because most respondents participated in only one or two waves, the results largely compare different groups of hospitals rather than tracking the same facilities continuously.
Among VA hospitals, reported use of portable bladder ultrasound scanners rose from 50% in 2005 to 75% 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 also reported increases. Scanner use went from 29.6% to 72.8% between 2005 and 2025, while reminders or stop orders rose from 9.1% to 48.7%. Nurse-initiated discontinuation increased from 11.3% in 2009 to 58.3% in 2025. These are reported practice rates in the surveyed hospitals, not evidence that every hospital adopted the measures or that the measures alone caused infection rates to fall.
Catheter Removal Remains Uneven
Urinary catheters can be associated with infection as well as other catheter-related harms, and limiting unnecessary use or duration is a prevention focus. The figures show that hospitals have more frequently reported using tools to track catheters and prompt review, while nurse-led removal protocols remain less common than some other prevention infrastructure.
Study author Sanjay Saint told MedPage Today that avoiding unnecessary catheter placement and shortening catheter duration are central to patient safety. He said the practical challenge is carrying out known prevention steps reliably in busy clinical settings, where competing priorities, differences in leadership engagement, and difficulty sustaining behavior change can contribute to variation.
The findings matter to patients and hospital teams because catheter decisions are made during routine care, not only through infection-control programs. However, the surveys measured reported practices; they do not establish how consistently staff applied them to individual patients or quantify the effect of each practice on infections.
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What Hospitals Reported in 2025
The study found widespread monitoring systems by 2025. Systems to identify patients with urinary 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.
About 73% of leaders in each hospital group described UTI prevention as important or very important. The authors also reported that national surveys showed a decline in the share of hospitalized patients with CAUTIs and other healthcare-associated infections from 2015 to 2023. That broader trend coincided with the rise in reported prevention practices, but the study does not establish that the practices caused the decline.
Use of silver-alloy Foley catheters remained relatively low in VA hospitals, changing from 14% in 2005 to 15.9% in 2025. In nonfederal hospitals, reported use fell from 32.4% to 14%. Saint told MedPage Today that this may reflect limited evidence of meaningful reduction in symptomatic CAUTI and guidelines that do not recommend routine use. External catheters for women were regularly used by 41.1% of VA hospitals and 62.6% of nonfederal hospitals in 2025; evidence that they consistently reduce CAUTI is less definitive, he said.
“These changes show that hospitals increasingly recognize that avoiding unnecessary catheter placement and reducing catheter duration are central to patient safety.”
— Sanjay Saint, study author, speaking to MedPage Today
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Limits of the Hospital Surveys
The survey results show what responding hospitals said they did; they do not verify bedside practice or measure how consistently protocols were followed. Nonresponse bias is possible, and the researchers noted that most hospitals answered only one or two survey waves. The findings therefore reflect largely independent samples, not a longitudinal record of the same hospitals.
The study also cannot determine whether increased use of these practices caused the reported national decline in healthcare-associated infections between 2015 and 2023. It does not establish the effect of any single measure on CAUTI rates, nor does it show how adoption varied within hospitals or across patient groups.
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Sustaining Daily Catheter Review
The study does not identify a new policy deadline or a next scheduled survey. Saint’s comments point to implementation as the immediate issue: hospitals can focus on daily reassessment, reminders or stop orders, and nurse-initiated removal when the clinical reason for a catheter has ended.
For readers, the published figures provide a national snapshot of reported hospital practices through 2025. Further surveys or studies would be needed to establish whether adoption continues to rise, whether protocols are consistently followed, and how changes relate to CAUTI outcomes.
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Key Questions
What is a catheter-associated urinary tract infection?
A CAUTI is a urinary tract infection associated with use of an indwelling urinary catheter. The report describes it as a common, costly healthcare-associated infection.
Which prevention practices became more common?
Hospitals more often reported using portable bladder ultrasound scanners, catheter reminders or stop orders, and protocols that let nurses discontinue a catheter when it is no longer needed.
Were these practices used by every hospital?
No. In 2025, nurse-initiated catheter discontinuation was reported by 37.8% of VA hospitals and 58.3% of nonfederal hospitals. Adoption of the other practices also varied by hospital group.
Does the study prove that the practices reduced infections?
No. It compared reported hospital practices across survey waves and noted that broader infection rates declined from 2015 to 2023. The study does not establish that the prevention measures caused that decline.
What are the main limits of the findings?
The results may be affected by survey nonresponse, and most participating hospitals completed only one or two waves. The study therefore does not track a consistent group of hospitals across the full 2005–2025 period.
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