Recommendations
Table 1. Recommendations to Prevent CAUTI
Approaches that Should Not be Considered a Routine Part of CAUTI
1. Routine use of antimicrobial/antiseptic impregnated catheters. (H)
2. Breaking a closed system. (L)
3. Screening for asymptomatic bacteriuria in catheterized patients except in the
few patient populations for which this is anticipated to have more benefit than
harm, as detailed in the 2019 IDSA Guideline for Management of Asymptomatic
Bacteriuria and the 2019 US Preventative Services Task Force Recommendation
on Asymptomatic Bacteriuria in Adults (eg, pregnant women, patients undergoing
endoscopic urologic procedures associated with mucosal trauma). (H)
a. Treatment of asymptomatic bacteriuria is not an effective strateg y to prevent
CAUTI in other patient groups, as it increases the risk of antibiotic-associated
complications more than any potential benefit for the prevention of symptomatic
CAUTI. The conditions that predisposed the patient to have bladder colonization
(anatomic, immunologic) are not resolved by antibiotics, and so the bacteriuria
recurs.
4. Catheter irrigation as a strateg y to prevent infection. (M)
a. Do not perform continuous irrigation of the bladder with antimicrobials as a
routine infection prevention measure.
b. If continuous irrigation is being used to prevent obstruction, maintain a closed
system.
5. Routine use of systemic antimicrobials as prophylaxis. (L)
6. Routine changing of catheters to avoid infection. (L)
a. The case of a patient with a long-term catheter in place (ie, >7 days), catheter
replacement can be considered at the time of specimen collection for urine testing
to obtain a fresh sample.
7. Alcohol-based products on the genital mucosa. (L)
Unresolved Issues
1. Use of antiseptic solution versus sterile saline for meatal and perineal cleaning prior to
catheter insertion.
2. Use of urinary antiseptics (eg, methenamine) to prevent UTI.
3. Spatial separation of patients with urinary catheters in place to prevent transmission of
pathogens that could colonize urinary drainage systems.
4. Standard of care for routine replacement of urinary catheters in place >30 days for
infection prevention.
5. Best practices for optimizing and tailoring implementation of CAUTI prevention and
urine-culture stewardship from the adult acute-care setting to the pediatric acute-care
setting.
(cont'd)
