Hospitalized patients face ongoing risks of acquiring catheter-associated urinary tract infections, according to a study published in JAMA Network Open. Researchers evaluated data from more than 1,400 U.S. hospitals surveyed through 2025, revealing that foundational prevention protocols—such as clinical reminders and nurse-driven removal policies—remain inconsistently adopted across general and Veterans Affairs medical centers.
In Plain English: The Clinical Takeaway
- Indwelling catheters: Flexible tubes placed in the bladder to drain urine, which can introduce bacteria if left in place too long.
- Nurse-driven removal: Empowering nursing staff to remove unnecessary catheters without waiting for a physician’s direct order.
- Electronic medical record (EMR) reminders: Automated alerts in hospital computer systems prompting doctors to re-evaluate whether a patient still requires a catheter.
Evaluation of Infection Control Practices Across U.S. Hospitals
Many U.S. hospitals fail to implement simple, evidence-backed steps to lower urinary tract infection rates among catheterized patients. Researchers tracked infection control data through surveys conducted every four years starting in 2005, with the latest wave completed in 2025. The analysis revealed that 49% of general hospitals and 32% of VA hospitals maintain systems to remind clinicians of active catheters or require periodic order renewals. Furthermore, just 58% of general hospitals and 38% of VA hospitals grant nurses the autonomy to discontinue catheters without physician supervision.
Microbes colonizing a catheter can rapidly enter the bladder and bloodstream if clinicians fail to maintain rigorous precautions. While prescribed antibiotics typically clear standard urinary tract infections within a few days, untreated hospital-acquired infections can advance to severe systemic illness. Dr. Jennifer Meddings, a professor of internal medicine and pediatrics at the University of Michigan Medical School, emphasized that hospitals have made strides over the past two decades, but adoption rates for these preventive safeguards have recently plateaued.
Despite these gaps, the broader longitudinal data shows a decline in healthcare-associated infections between 2015 and 2023. Dr. Sanjay Saint, a professor emeritus of internal medicine at the University of Michigan, stressed that clinical teams must continuously assess whether an indwelling catheter remains clinically necessary each day. The utilization of silver alloy Foley catheters dropped significantly in nonfederal hospitals from 2005 to 2025, moving from 32.4% down to 14.0%, while remaining flat in VA hospitals at approximately 15.9%.
| Prevention Practice | General Hospitals Adoption (2025) | VA Hospitals Adoption (2025) |
|---|---|---|
| Catheter Reminders / Renewals | 49% | 32% |
| Nurse-Initiated Discontinuation | 58.3% | 37.8% |
| Portable Ultrasound Bladder Scanners | Over 70% | Not specified |
Leveraging Electronic Medical Records for Diagnostic Stewardship
Addressing the gap in clinical workflows requires health systems to actively configure their electronic health record infrastructure. Meddings pointed out that EMR systems can prompt clinicians during the initial ordering process to restrict indwelling catheters to strictly appropriate clinical indications. These digital safeguards can simultaneously educate trainee physicians—who place a large share of hospital catheter orders—about safer alternatives, such as external catheter placement.
Diagnostic stewardship plays an equally vital role in preventing misuse. Saint cautioned that identifying a positive urine culture in the absence of compatible patient symptoms should not automatically trigger a formal urinary tract infection diagnosis or an immediate prescription for antibiotics. Beyond digital interventions, hospital staff successfully integrated portable ultrasound bladder scanners in over 70% of surveyed facilities to evaluate retention volumes and guide clinical decision-making before inserting a new device.
Long-Term Trajectory of Hospital Infection Control
While the two-decade span from 2005 to 2025 demonstrates a marked shift in institutional awareness regarding the risks of indwelling urinary devices, researchers underscore that safety protocols are not self-sustaining. The reliance on voluntary hospital compliance leaves significant vulnerabilities across both federal and nonfederal systems. Future progress depends on embedding automated prompts and nurse-led protocols directly into daily hospital routines to protect vulnerable populations from preventable systemic complications.
