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Updated: Feb 28, 2026
An In Vitro Bladder Model of Catheter-Associated Urinary Tract Infection
Published on: June 24, 2025
A multifaceted quality improvement strategy reduces the risk of catheter-associated urinary tract infection
Cecelia N Theobald1, Matthew J Resnick2,3,4,5, Thomas Spain1,2,6
1Department of Medicine, Vanderbilt University Medical Center, 1161 21st Avenue South, Nashville, TN 37232, USA.
Insights
A comprehensive program significantly reduced catheter use by 35% and catheter-associated urinary tract infections (CAUTIs) in veterans. This initiative improved patient safety without increasing falls or reinsertions.
Area of Science:
- Healthcare-associated Infections
- Infection Prevention and Control
- Medical Device Utilization
Background:
- Catheter-associated urinary tract infections (CAUTIs) are a prevalent and escalating issue in healthcare settings.
- Effective strategies are needed to curb rising CAUTI rates and reduce indwelling catheter use.
Purpose of the Study:
- To implement and evaluate a multifaceted intervention program designed to decrease catheter utilization and CAUTI incidence.
- To assess the program's impact on patient safety, including falls and catheter reinsertions.
Main Methods:
- A pre-post study design was employed involving medical inpatient veterans from December 2012 to February 2015.
- The intervention comprised five components: bedside reminders, education, electronic order sets with decision support, automated discontinuation orders, and post-removal care protocols.
- Catheter utilization, CAUTI rates, patient falls, and catheter reinsertions were monitored throughout baseline, transition, and sustainability periods.
Main Results:
- Catheter use decreased by 35% from baseline to full implementation.
- Significant reduction in CAUTIs observed, with the average time between infections increasing from 101 to over 400 days.
- No significant changes in patient fall rates or catheter reinsertion rates were detected.
Conclusions:
- A targeted, multicomponent intervention effectively reduced catheter use and CAUTIs in a veteran population.
- The program demonstrated success in improving patient safety without adverse effects on other key metrics.
- Addressing local barriers is crucial for sustained reductions in catheter-associated infections.
Objective:
Catheter-associated urinary tract infections (CAUTIs) are common and preventable hospital-acquired infections, yet their rate continues to rise nationwide. We describe the implementation of a multifaceted program to reduce catheter use and CAUTI rates while simultaneously addressing barriers to long-term success.
Design/Setting/Participants:
Pre-post study of medical inpatient veterans between December 2012 and February 2015.
Intervention:
Five component intervention: (i) a bedside catheter reminder; (ii) multidisciplinary educational campaign; (iii) structured catheter order set with clinical decision support; (iv) automated catheter discontinuation orders; and (v) protocol for post-catheter removal care.
Main Outcome Measure(S):
Catheter utilization rates and CAUTI rates on the study ward were followed during the 14-week baseline period, the 27-week transition/intervention period and the 70-week period of full implementation/sustainability. Rates of patient falls per bed days and catheter reinsertions were collected during the same time periods as balancing measures.
Results:
Catheter use declined by 35% from the baseline period to the full implementation/sustainability period. This improvement was not realized until deployment of the structured electronic orders with automated catheter discontinuation and protocolized post-catheter care. The average number of days between CAUTIs on the study ward increased from 101 days in the baseline period to over 400 days in the full implementation/sustainability period. There was no significant change in the rates of falls or catheter reinsertions during the study period.
Conclusions:
A multicomponent intervention aimed specifically at targeting local barriers was successful in reducing catheter utilization as well as CAUTIs in a veteran population without compensatory increase in patient falls or catheter replacement.
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