Catheter-Associated Urinary Tract Infections

Scope and Impact of the Problem

Urinary tract infections (UTIs) are the most common nosocomial infection, accounting for up to 40% of infections reported by acute care hospitals.1,2 Up to 80% of UTIs are associated with the presence of an indwelling urinary catheter.3

A catheter-associated urinary tract infection (CAUTI) increases hospital cost and is associated with increased morbidity and mortality.2,5,6 CAUTIs are considered by the Centers for Medicare and Medicaid Services to represent a reasonably preventable complication of hospitalization. As such, no additional payment is provided to hospitals for CAUTI treatment-related costs.5

Full Practice Alert

Expected Practice

  • Prior to placement of any indwelling urinary catheter, assess patient for accepted indications and alternatives. [Level C]
  • Adhere to aseptic technique for placement, manipulation, and maintenance of indwelling urinary catheters. [Level E]
  • Document all instances of indwelling urinary catheters, including insertion date, indication, and removal date. [Level C]
  • Promptly discontinue indwelling urinary catheters as soon as indications expire. [Level C]

Supporting Evidence

  • Prolonged catheterization is the major risk factor for CAUTIs.7,8 
  • Twenty-five percent of inpatients and up to 90% of patients in an ICU have a urinary catheter during hospitalization, often without an appropriate indication.4
    • Indwelling urinary catheters are placed without sufficient rationale, and/or remain in place after indications expire.9
  • CAUTIs can be decreased by interventions that facilitate removal of unnecessary catheters.10,11
  • Most hospitals have not implemented effective strategies for preventing CAUTIs.12,13

Actions for Nursing Practice

  • Develop written guidelines for urinary catheterization, include indications for indwelling urinary catheterization, and ensure that catheter placement is limited to patients who meet indications.
  • Have available devices, supplies, and techniques that allow alternatives to indwelling catheters (eg, condom catheters, penis pouches, bladder scanners, incontinence products).
  • Design and implement standards and training programs for catheter insertion and manipulation.
  • Review the necessity of catheter continuation for all patients with urinary catheters on a daily basis.
  • Develop systems to ensure prompt removal of catheters when no longer indicated.
  • Implement infection surveillance programs that include unit-based urinary catheter days and rates of CAUTIs.
  • Develop action plans to address needed improvements.

Need More Information or Help?

  • Contact a clinical practice specialist for additional information or access AACN's Clinical Practice page; then select Practice Resource Network and Ask the Clinical Practice Team.
  • Lo E, Lindsay N, Classen D, et al. Strategies to prevent catheter-associated urinary tract infections in acute care hospitals. Infect Control Hosp Epidemiol. 2008;29:S41-S50.
  • HICPAC/Centers for Disease Control and Prevention. Guideline for Prevention of Catheter-Associated Urinary Tract Infections. 2009. http://www.cdc.gov/hicpac/cauti/001_cauti.html. Accessed October 5, 2011.

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