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Published on: June 24, 2025
Prevention Strategies for All Hospital-Onset Urinary Tract Infections: Best Practice Consensus Recommendations
Edward J Septimus1, Lily A Arya2, Rebecca Crapanzano-Sigafoos3
1Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA.
Insights
New consensus recommendations address hospital-onset urinary tract infections (HOUTIs), including catheter-associated (CAUTI) and non-catheter-associated (non-CAUTI) types. These guidelines aim to reduce HOUTI burden and identify future research priorities.
Area of Science:
- Infectious Diseases
- Healthcare Epidemiology
- Quality Improvement
Background:
- Hospital-onset urinary tract infections (HOUTIs) are a major cause of morbidity and healthcare costs.
- Catheter-associated UTI (CAUTI) prevention is established, but non-CAUTI lack standardized approaches.
- This study addresses the need for consensus on HOUTI prevention strategies in adult patients.
Purpose of the Study:
- Develop consensus recommendations for preventing all types of HOUTIs in adult patients.
- Establish standardized definitions, surveillance, and interventions for non-CAUTI.
- Provide a framework for reducing the overall burden of HOUTIs.
Main Methods:
- A modified Delphi process involving 17 experts from diverse medical fields.
- Systematic literature review and anonymized online surveys to gather expert opinions.
- Pre-defined consensus thresholds (≥88% for strong, ≥76% for moderate agreement).
Main Results:
- Strong consensus achieved on 37 statements covering surveillance, interventions, and training.
- Key priorities identified for non-CAUTI HOUTI prevention require further research.
- Recommendations span multiple aspects of HOUTI prevention and management.
Conclusions:
- The recommendations provide a scalable framework to decrease the burden of all HOUTIs.
- Harmonizes CAUTI best practices with new evidence for non-CAUTI prevention.
- Offers a roadmap for improved HOUTI prevention strategies and future research directions.
Background:
Hospital-onset urinary tract infections (HOUTIs), including catheter-associated (CAUTI) and non-catheter-associated UTI (non-CAUTI), remain a significant source of morbidity and healthcare burden. While CAUTI prevention strategies are well established, non-CAUTIs lack standardized definitions, surveillance protocols, and targeted interventions. To address this gap, consensus recommendations identifying prevention strategies for HOUTIs in adult patients were developed.
Methods:
A panel of 17 experts in infectious diseases, infection prevention and control, healthcare epidemiology and quality improvement, clinical microbiology, urology, urogynecology, and nursing, participated in a modified Delphi process. An online anonymized survey based on a systematic literature review was completed, before meeting to determine consensus on HOUTI prevention strategies. A further anonymous online survey was shared to finalize recommendations. Thresholds of ≥15/17 panel members in agreement (≥88%) for strong consensus and ≥13/17 (≥76%) for moderate consensus were prospectively set for all statements.
Results:
Strong consensus was reached on 37 statements spanning surveillance, intervention selection, strategies and maintenance, related care interventions, specimens and cultures, provider training, and outcome assessment. Key topics-particularly those focused on non-CAUTI HOUTI prevention-were identified as important priorities requiring further exploration and research.
Conclusions:
These recommendations offer the foundation for a structured, scalable framework to reduce the burden of all HOUTIs, while also defining future research priorities. By harmonizing established CAUTI best practices with existing literature, and bridging current evidence gaps for non-CAUTI prevention and management with expert consensus, these recommendations provide a road map for improved prevention strategies for all HOUTIs.
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