TL;DR
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A survey study published in JAMA Network Open found that more U.S. hospitals reported using key catheter-associated urinary tract infection prevention practices in 2025 than in earlier survey years. Yet nurse-initiated catheter removal was reported by only 37.8% of VA hospitals and 58.3% of nonfederal hospitals, leaving substantial room for broader use.
More U.S. hospitals reported using key practices to prevent catheter-associated urinary tract infections in 2025 than in earlier survey years, but nurse-initiated removal of urinary catheters remained far from universal, according to a study published in JAMA Network Open. The findings track reported practices at Department of Veterans Affairs and nonfederal hospitals across survey waves from 2005 to 2025.
The study’s authors analyzed six survey waves, 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 surveys asked how often hospitals used a range of measures intended to prevent catheter-associated urinary tract infections, or CAUTIs.
Use of portable bladder ultrasound scanners rose from 50.0% to 75.0% among VA hospitals between 2005 and 2025, and from 29.6% to 72.8% among nonfederal hospitals. Catheter reminders or stop orders increased from 11.1% to 31.5% in VA hospitals and from 9.1% to 48.7% in nonfederal hospitals over the same period.
Nurse-initiated catheter discontinuation also became more common, rising from 14.5% in 2009 to 37.8% of VA hospitals in 2025, and from 11.3% to 58.3% of nonfederal hospitals. The comparison for that measure begins in 2009, rather than 2005. The study reports changes in hospital-reported practices; it does not establish that any single practice caused infection rates to fall.
Catheter Removal Remains Uneven
Urinary catheters can be necessary for patient care, but unnecessary placement or prolonged use can expose patients to infection and other catheter-related harms. The findings matter because how long a catheter remains in place is a potentially modifiable part of that risk, while removal decisions must still reflect each patient’s clinical needs.
Lead author Sanjay Saint, MD, of Northwell Health, told MedPage Today that hospitals increasingly recognize the importance of avoiding unnecessary catheter placement and reducing catheter duration. He also said consistent implementation remains difficult in busy clinical settings, citing competing priorities, differences in leadership engagement, availability of local champions, and challenges sustaining behavior changes.
The study points to a gap between widespread infection monitoring and less consistent use of practices that can prompt catheter removal. In 2025, 98.7% of VA hospitals and 98.1% of nonfederal hospitals reported surveillance systems for CAUTI rates. By comparison, fewer reported nurse-initiated removal protocols. These figures describe the responding hospitals and do not show whether a particular hospital’s policies were followed in every case.
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Two Decades of Survey Findings
The researchers drew on six surveys of randomly selected U.S. hospitals, administered every four years from 2005 to 2025. Because most participating hospitals completed only one or two surveys, the results largely compare different groups of hospitals over time rather than following a fixed set of institutions throughout the full period.
By 2025, most responding hospitals also reported systems to identify patients with catheters and routine monitoring of catheter duration and discontinuation. VA and nonfederal hospital figures, respectively, were 79.2% and 92.1% for systems tracking which patients had catheters, and 72.6% and 87.2% for routine duration and discontinuation monitoring. About 73% of leaders in each group said UTI prevention was important or very important.
Use of silver-alloy Foley catheters did not rise in step with the other measures: it remained relatively flat in VA hospitals, moving from 14.0% in 2005 to 15.9% in 2025, while use in nonfederal hospitals fell from 32.4% to 14.0%. Saint told MedPage Today that limited evidence of meaningful reduction in symptomatic CAUTI and guidelines against routine use likely help explain the pattern.
“These changes show that hospitals increasingly recognize that avoiding unnecessary catheter placement and reducing catheter duration are central to patient safety.”
— Sanjay Saint, MD, study author, speaking to MedPage Today
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Limits of Hospital Self-Reports
The survey findings rely on hospital responses, and the authors identified response rates that could create nonresponse bias as a limitation. Hospitals that answered may differ from those that did not. Since most participating hospitals responded to only one or two waves, the results do not track a consistent cohort of hospitals across the entire 20-year period.
The survey records whether hospitals reported using practices; it does not establish how consistently staff applied them or how much each practice changed an individual patient’s risk. The supplied study summary says national surveys showed a decline in the percentage of hospitalized patients with CAUTIs and other healthcare-associated infections between 2015 and 2023, but the reported trend does not by itself prove that the prevention practices measured here caused that decline.
The results also do not establish that every prevention method has the same benefit for every patient. Saint told MedPage Today that evidence for external catheters in women reducing CAUTI is less definitive, even though they may reduce indwelling catheter use. The survey figures capture reported hospital practices, not comparative patient outcomes for each method.
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Focus on Daily Catheter Review
The study describes changes through 2025 but does not announce a new policy or a scheduled follow-up. Saint told MedPage Today that hospitals can focus on daily reassessment of catheter need, reminders or stop orders, and nurse-initiated removal when the clinical reason for a catheter has resolved. Whether those approaches become more widespread will depend in part on how hospitals implement and sustain them.
Saint also raised diagnostic stewardship: he said a positive urine culture without compatible symptoms should not automatically prompt a UTI diagnosis or antibiotic treatment. That statement is guidance attributed to the study author, not a finding that the survey measured. Further surveys or patient-level research would be needed to clarify how reported practices relate to actual catheter use and infection outcomes.
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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 ultrasound scanners, catheter reminders or stop orders, and nurse-initiated removal protocols.
How common was nurse-initiated catheter removal in 2025?
It was reported by 37.8% of VA hospitals and 58.3% of nonfederal hospitals that responded to the 2025 survey.
Did the study prove that the practices reduced infections?
No. The study examined hospital-reported prevention practices over time. Its findings do not establish that those practices caused changes in CAUTI rates.
How many hospitals were included?
1,461 hospitals completed at least one of six surveys conducted from 2005 to 2025: 133 VA hospitals and 1,328 nonfederal hospitals.
What are the main limitations?
Survey response rates may have led to nonresponse bias, and most hospitals completed only one or two survey waves. The findings therefore largely compare separate samples rather than following the same hospitals over time.
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