Hospitals’ use of two high-yield practices for preventing catheter-associated urinary tract infections, commonly known as CAUTIs, has stalled or slipped since 2017, according to research published Oct. 6 in JAMA Network Open.
Researchers at the VA Ann Arbor (Mich.) Healthcare System and Ann Arbor-based Michigan Medicine have surveyed infection preventionists every four years since 2005. Across six waves through 2025, 1,461 hospitals took part: 133 VA hospitals and 1,328 nonfederal hospitals.
The two practices are urinary catheter reminders or stop orders, and protocols that let nurses remove catheters without a physician’s order. Both target how long a catheter stays in. The researchers wrote that this is the most important risk factor for harm that clinicians can change. Each extra day raises a patient’s risk of bacteriuria, infection, immobility and discomfort.
Systematic reviews show reminders or stop orders cut infection rates by about 50%, the researchers wrote.
Even so, adoption has gone backward. Here’s how the two practices tracked in nonfederal hospitals:
- Reminders or stop orders: 9.1% of hospitals in 2005, a peak of 60.7% in 2017, then 48.7% in 2025.
- Nurse-initiated removal: 11.3% in 2009, 58.8% in 2017, then 58.3% in 2025.
VA hospitals use both practices less often:
- Reminders or stop orders: a peak of 48.1% in 2013, down to 31.5% in 2025.
- Nurse-initiated removal: 42.6% in 2021, down to 37.8% in 2025.
“Progress is not self-sustaining,” said lead author Sanjay Saint, MD, professor emeritus of internal medicine at the University of Michigan. Dr. Saint currently is senior vice president and chair of internal medicine at New Hyde Park, N.Y.-based Northwell Health.
The infrastructure around CAUTI prevention looks very different. Nearly every hospital now runs a CAUTI surveillance system: 98.1% of nonfederal and 98.7% of VA hospitals. In 2025, 92.1% of nonfederal hospitals had a system to track which patients have catheters, up from 44.1% in 2005.
Uptake has also been quick for one tool with thinner evidence. In 2025, 62.6% of nonfederal hospitals regularly used external catheters in women, more than the 55.4% using them in men. Studies show these devices cut catheter use, but the researchers said the evidence that they reduce CAUTIs is limited.
Part of the VA gap may come down to incentives and technology. Since October 2014, Medicare has reduced payments to nonfederal hospitals with high rates of hospital-acquired conditions, including CAUTIs. VA hospitals aren’t subject to those penalties. The VA’s homegrown EHR supported automated catheter reminders, and the researchers said its switch to a commercial EHR, Oracle, is a chance to bring those reminders back across the system.
The findings come with caveats. They are self-reported, and most hospitals took part in only one or two waves, so the data show snapshots rather than the same hospitals over time. The nonfederal response rate also fell to 36.8% in 2025, from 70.2% in 2005.
