Recommendations
Table 1. Recommendations to Prevent CAUTI
Essential Practices
Infrastructure and resources
1. Perform a CAUTI risk assessment and implement an organization-wide program to
identify and remove catheters that are no longer necessary using 1 or more methods
documented to be effective. (M)
a. Develop and implement institutional policy requiring periodic, usually daily, review
of the necessity of continued catheterization.
b. Consider utilizing electronic or other types of reminders (see Supplementary
Content, Appendices 2 [https://doi.org/10.1017/ice.2023.137] and 3 [https://
doi.org/10.1017/ice.2023.137]) online) of the presence of a catheter and required
criteria for continued use.
c. Conduct daily review during rounds of all patients with urinary catheters by nursing
and physician staff to ascertain necessity of continuing catheter use.
2. Provide appropriate infrastructure for preventing CAUTI. (L)
a. Ensure that the supplies for following best practices for managing urinary issues
are readily available to staff in each unit, including bladder scanners, non-catheter
incontinence management supplies (urinals, garments, bed pads, skin products),
male and female external urinary catheters, straight urinary catheters, and indwelling
catheters including the option of catheters with coude tips.
b. Ensure that non-catheter urinary management supplies are as easy to obtain for
bedside use as indwelling urinary catheters.
c. Ensure the physical capability for urinary catheters with tubes attached to patients
(eg, indwelling urinary catheters, some external urinary catheters [EUCs]) to be
positioned on beds, wheelchairs, at an appropriate height and without kinking for
patients in their rooms and during transport.
3. Provide and implement evidence-based protocols to address multiple steps of the
urinary catheter life cycle (Fig. 1): catheter appropriateness (step 0), insertion
technique (step 1), maintenance care (step 2), and prompt removal (step 3) when no
longer appropriate. (L)
a. Adapt and implement evidence-based criteria for acceptable indications for
indwelling urethral catheter use, which may be embedded as standardized clinical-
decision support tools within electronic medical record (EMR) ordering systems.
Expert-consensus-derived indications for indwelling catheter use have been
developed, although there is limited research that assesses the appropriateness of
these uses.
4. Ensure that only trained healthcare personnel (HCP) insert urinary catheters and that
competency is assessed regularly. (L)
a. Require supervision by experienced HCP when trainees insert and remove catheters
to reduce the risk of infectious and traumatic complications related to urinary
catheter placement.
5. Ensure that supplies necessary for aseptic technique for catheter insertion are available
and conveniently located. (L)
