What are the latest recommendations for preventing catheter‑associated urinary tract infection (CAUTI) in hospitalized adults, including catheter placement, maintenance, and timely removal?

Recent Updates in CAUTI Prevention

The most critical update in CAUTI prevention is implementing nurse-directed catheter removal protocols, which achieve up to 70% reduction in infection rates by addressing the single most important risk factor: duration of catheterization. 1

Essential Prevention Strategies

Appropriate Catheter Placement

Only insert indwelling urinary catheters (IUCs) when absolutely essential for patient care, using strict criteria: 1

• Specific surgical procedures: Urologic surgery, procedures involving genitourinary structures, prolonged surgeries requiring large-volume infusions/diuretics, or when intraoperative urine output monitoring is necessary. Remove catheters placed solely for surgical duration (e.g., >2 hours) immediately post-procedure. 1

• ICU patients requiring hourly urine output assessment: Only when clinically adjusting therapies frequently (volume resuscitation, diuresis, vasopressors). ICU admission alone does NOT justify catheter placement. 1

• Acute urinary retention: Newly developed retention with post-void residual >500 mL (asymptomatic) or >300 mL (symptomatic with bladder pain, persistent urge, new incontinence). 1

• Wound healing: Open pressure ulcers or skin grafts in incontinent patients when alternative protective measures are not feasible. 1

• Palliative care: Only when catheter use aligns with specific patient goals (reducing frequent bed changes, managing uncontrolled pain). 1

Insertion Technique

Use aseptic technique with chlorhexidine preparation before catheter insertion: 1

• Emerging literature supports chlorhexidine for meatal cleaning before insertion, though this remains an evolving recommendation. 1
• Avoid alcohol-based products on mucosal tissues due to drying effects. 1
• Ensure catheters are adequately secured to prevent movement and reduce urethral traction. 1

Maintenance of Closed Drainage System

Maintain a sterile, closed drainage system at all times: 1

• When breaks in aseptic technique, disconnection, or leakage occur, replace both the catheter and collection system using aseptic technique. 1
• Do NOT introduce openings into the closed system. 1
• Do NOT use catheter irrigation as a preventive measure (continuous irrigation for obstruction prevention is acceptable if the closed system is maintained). 1

Timely Catheter Removal

Implement nurse-directed catheter removal protocols linked to physician insertion orders: 2

• This intervention achieved 50% reduction in catheter use and 70% reduction in CAUTIs over 36 months in a 300-bed hospital. 2
• Duration of catheterization is the predominant risk factor for CAUTI. 3, 4
• Promptly remove any catheter that is no longer essential. 1

Alternative Bladder Management

Consider intermittent catheterization as an alternative to indwelling catheters when appropriate: 1

• Create protocols for nurse-directed intermittent catheterization in postoperative urinary retention. 1
• Utilize bladder scanners to guide decision-making. 1

Interventions NOT Recommended

The following practices should be avoided as they do not prevent CAUTI and may cause harm: 1

• Antimicrobial/antiseptic-impregnated catheters: Routine use is not advisable. 1
• Screening for asymptomatic bacteriuria: Do not screen catheterized patients (except pregnant women and those undergoing endoscopic urologic procedures with mucosal trauma). 1
• Prophylactic systemic antimicrobials: Do not administer routinely before insertion or during catheter use. 1, 5
• Routine catheter changes: Do not replace catheters on a scheduled basis as infection prevention. 1

Implementation Strategies

Successful CAUTI reduction requires systematic approaches: 2, 3

• Physician documentation of catheter insertion criteria at time of order. 2
• Device-specific charting modules in electronic progress notes. 2
• Biweekly unit-specific feedback on catheter use rates and CAUTI rates in multidisciplinary forums. 2
• Regular in-service education and training programs with access to necessary materials. 1
• National guidelines and institutional policies for CAUTI prevention. 1

Common Pitfalls to Avoid

Do not treat asymptomatic bacteriuria in catheterized patients (except pregnant women or before traumatic urologic procedures), as this promotes antimicrobial resistance without clinical benefit. 1, 6, 5

Do not administer prophylactic antibiotics at catheter placement, removal, or replacement, as this increases resistance without reducing CAUTI incidence. 1, 5

Do not delay catheter removal when clinically indicated, as each additional day of catheterization exponentially increases infection risk. 2, 3, 4

Avoid spatial separation of catheterized patients as a primary prevention strategy, as this is not supported by evidence. 1