Abstract / Summary
Importance Catheter-associated urinary tract infection (CAUTI) remains a common and morbid health care–associated infection. Although evidence-based prevention strategies are well established, the degree to which hospitals adopt and sustain these practices over time and whether trajectories differ between Department of Veterans Affairs (VA) and nonfederal systems are not well described. Objective To examine 20-year trends in reported CAUTI prevention practices in US hospitals and compare practice use between VA and nonfederal hospitals. Design, Setting, and Participants This survey study used repeated cross-sectional national surveys conducted every 4 years from 2005 to 2025. Surveys were sent to the lead infection preventionist at all VA hospitals, as well as a random sample of nonfederal, general medical, and surgical US hospitals with intensive care units. Data were analyzed from January to August 2026. Main Outcomes and Measures The outcome of interest was regular use of specific CAUTI prevention practices, including urinary catheter reminders or stop orders, nurse-initiated discontinuation, bladder ultrasonography, intermittent catheterization, external catheters, aseptic insertion, surveillance systems, and leadership prioritization of CAUTI prevention. Results Over the 20 year period, 1461 unique hospitals participated in at least 1 study survey, with mean (SD) response rates for the 6 survey waves of 63.4% (8.4%) for VA hospitals and 56.5% (9.2%) for nonfederal hospitals. Both VA and nonfederal hospitals demonstrated substantial long-term increases in surveillance infrastructure, routine monitoring of catheter duration, and leadership prioritization of CAUTI prevention. In nonfederal hospitals, regular use of urinary catheter reminders or stop orders increased from 34 of 372 hospitals (9.1%) in 2005 to 149 of 306 hospitals (48.7%) in 2025, and nurse-initiated discontinuation increased from 43 of 379 hospitals (11.3%) in 2009 to 179 of 307 hospitals (58.3%) in 2025. VA hospitals also showed significant increases in these practices over time, although use in 2025 was lower than nonfederal hospitals (urinary catheter reminders or stop orders: 10 of 90 hospitals [11.1%] in 2005 and 23 of 73 hospitals [31.5%] in 2025; nurse-initiated discontinuation: 10 of 69 hospitals (14.5%) in 2009 and 28 of 74 hospitals [37.8%] in 2025). Use of silver alloy Foley catheters declined markedly in nonfederal hospitals (from 126 of 389 hospitals [32.4%] in 2005 to 41 of 294 hospitals [14.0%] in 2025) but remained stable in VA facilities. External catheter use increased substantially, particularly in women, with 194 of 310 nonfederal hospitals (62.6%) and 30 of 73 VA hospitals (41.1%) reporting regular use by 2025. Nearly universal use of CAUTI surveillance systems was observed in both settings (309 of 315 nonfederal hospitals [98.1%] and 73 of 74 VA hospitals [98.7%]). Conclusions and Relevance This survey study of infection-prevention practice use found that US hospitals substantially expanded use of many CAUTI prevention practices, particularly surveillance and monitoring systems, over the past 20 years. However, variability in use of high-yield practices, such as reminders and nurse-driven discontinuation, persisted, underscoring the need for sustained, system-level strategies to optimize urinary catheter safety across health care settings.