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A survey study published in JAMA Network Open found that VA and nonfederal hospitals reported wider use of several practices to prevent catheter-associated urinary tract infections from 2005 to 2025. Adoption remains incomplete: in 2025, nurse-initiated catheter removal was reported by 37.8% of VA hospitals and 58.3% of nonfederal hospitals.
U.S. hospitals reported broader use of several practices to prevent catheter-associated urinary tract infections (CAUTIs) in 2025 than in earlier surveys, according to a study published in JAMA Network Open. But nurse-initiated catheter removal remained far from universal, 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 questions covered hospitals’ reported use of CAUTI prevention practices; the results do not track one fixed group of hospitals over the full period.
Three practices became more common. Among VA hospitals, use of portable bladder ultrasound scanners rose from 50.0% in 2005 to 75.0% in 2025; catheter reminders or stop orders increased from 11.1% to 31.5%. Nurse-initiated catheter discontinuation was reported by 14.5% in 2009 and 37.8% in 2025.
Among nonfederal hospitals, portable scanner use increased from 29.6% to 72.8% between 2005 and 2025. Reminders or stop orders rose from 9.1% to 48.7%, while nurse-initiated discontinuation increased from 11.3% in 2009 to 58.3% in 2025. These are survey comparisons across waves, not evidence that every individual hospital changed its practice.
Catheter Removal Still Varies
The findings point to wider reported adoption of approaches that can help hospitals avoid unnecessary catheter use or shorten the time a catheter remains in place. The study’s lead author, Sanjay Saint of Northwell Health, told MedPage Today that avoiding unnecessary placement and reducing catheter duration are central to patient safety. Catheters are associated with infection and other harms, making decisions about whether they remain necessary relevant to patients and care teams.
At the same time, the 2025 figures show a substantial gap between broad awareness and consistent use of specific protocols. Nurse-initiated removal was reported by fewer than four in 10 VA hospitals and just under six in 10 nonfederal hospitals. The survey measures whether hospitals said they used these practices; it does not establish how consistently staff applied them to individual patients or quantify the effect of each practice on infections.
The authors also noted that national surveys showed a decline in the percentage of hospitalized patients with CAUTIs and other healthcare-associated infections between 2015 and 2023. The reported timing overlaps with the growth in prevention practices, but the survey findings alone do not establish that the practices caused the decline.
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How Hospitals Track Prevention
CAUTI is a common, costly healthcare-associated infection. The study found that by 2025, 98.7% of VA hospitals and 98.1% of nonfederal hospitals reported surveillance systems for tracking CAUTI rates. 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.
Hospital leaders also commonly rated UTI prevention as important or very important: 72.6% of VA hospitals and 72.5% of nonfederal hospitals. Use of silver-alloy Foley catheters did not follow the same pattern as the other measures. Among nonfederal hospitals, reported use fell from 32.4% in 2005 to 14.0% in 2025; VA use was relatively flat, moving from 14.0% to 15.9%. 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, MD, Northwell Health, speaking to MedPage Today
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Survey Limits and Open Questions
The results depend on hospitals’ survey responses, and the authors said response rates could introduce nonresponse bias. Most participating hospitals completed only one or two survey waves, so the comparisons are largely between independent samples rather than a longitudinal record of the same institutions. The data cannot show whether reported policies were followed in every case or explain why a particular hospital adopted or did not adopt a practice.
The surveys also do not establish how much each prevention measure contributed to changes in CAUTI rates. Saint said evidence is less definitive on whether external catheters for women consistently reduce CAUTI, even though studies suggest they may reduce use of indwelling catheters. In 2025, regular use of external catheters for women was reported by 41.1% of VA hospitals and 62.6% of nonfederal hospitals.
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Focus Turns to Daily Practice
The study does not announce a new federal requirement or a specific next policy milestone. Its findings put attention on whether hospitals can make existing prevention practices more consistent. Saint told MedPage Today that competing clinical priorities, differences in leadership engagement, uneven availability of staff champions, and difficulty sustaining behavior change can contribute to variation between hospitals.
For clinical teams, the practices highlighted by Saint include reassessing catheter need each day, using reminders or stop orders, and allowing nurses to remove catheters when the medical indication has resolved. He also emphasized diagnostic stewardship: a positive urine culture without compatible symptoms should not automatically be treated as a UTI or trigger antibiotics. Whether adoption continues to rise, and whether more consistent use changes infection outcomes, remains to be established by future data.
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Key Questions
What did the study find?
Across surveys from 2005 to 2025, VA and nonfederal hospitals reported increased use of several CAUTI prevention practices, including bladder scanners, catheter reminders or stop orders, and nurse-initiated removal.
How common was nurse-initiated catheter removal in 2025?
It was reported by 37.8% of VA hospitals and 58.3% of nonfederal hospitals. The survey does not show how often the practice was used for eligible patients at each hospital.
Did the study prove that these practices reduced infections?
No. It measured hospitals’ reported prevention practices across survey waves. National infection surveys showed declines in CAUTIs and other healthcare-associated infections from 2015 to 2023, but these findings do not establish that the reported practices caused those declines.
What are the study’s main limitations?
Survey response rates may have led to nonresponse bias, and most hospitals completed only one or two waves. The results therefore compare largely independent groups of hospitals rather than following one cohort over time.
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