CAUTI Prevention

• Before ordering, assess whether a lower-risk alternative meets the need: external (condom/female external) catheter, intermittent catheterization, bedside commode, or incontinence management.
• Insert an IUC only for a defined indication, e.g.: perioperative use in selected surgeries, acute urinary retention or obstruction, hospice/ comfort/palliative care, accurate urine output measurement in a critically ill patient, or required strict immobilization (trauma/ surgery).
• The EMR should require the physician/APP to select the indication at order time — this is what makes Step 6's daily reassessment possible.

• Hand hygiene, sterile technique, sterile supplies, and a documented insertion procedure.
• Use the smallest appropriate catheter size; involve urology for an anticipated difficult insertion rather than attempting repeated insertions.
• Use an insertion kit whose packaging order matches your facility's insertion protocol steps — stopping mid-insertion to retrieve a missing item is a common aseptic-technique break point.

• Apply a securement device — this reduces urethral trauma and inadvertent traction, both of which increase infection risk.

• Maintain a sterile, continuously closed drainage system — do not routinely flush the catheter or leave it open into a diaper/chux.
• Keep the drainage bag below the level of the bladder at all times, including during ambulation, wheelchair transport, and transport between departments.
• Avoid dependent loops or kinks in the tubing; empty the drainage bag regularly.
• If a break in aseptic technique, disconnection, or leakage occurs, replace the affected component — but routine scheduled replacement of a functioning IUC is not recommended.

• Collect the specimen from the drainage tubing/port, not from the drainage bag — bag urine is likely contaminated from prior drainage and doesn't reflect current status.
• Apply diagnostic stewardship: order a urine culture only with a clear clinical indication, not reflexively — reflex culturing drives overtreatment of asymptomatic bacteriuria, not better outcomes.
• In select high-colonization scenarios, consider replacing the IUC before collecting the culture to reduce false-positive results from catheter biofilm colonization rather than active infection.

• Build daily indication reassessment into rounds and the EMR — if the original indication (Step 1) no longer applies, the catheter should come out that day, not at end of shift or next rounds.
• Where a nurse-driven removal protocol is in place, use it — this removes the physician-order bottleneck as the rate-limiting step for timely removal, which is the single highest-leverage intervention in this bundle.

These have more limited evidence and should be a deliberate facility decision, not a default:

• Bladder-scanning algorithms for post-void residual, to guide insertion/reinsertion decisions in urinary retention.
• "Foley-free" emergency department protocols limiting IUC insertion at the point of first contact.
• Chlorhexidine-impregnated cloth cleansing of catheter tubing.
• Structured monitoring of catheter-related adverse events beyond CAUTI itself (obstruction, unintended removal, reinsertion within 24 hours).

• Per NHSN, a CAUTI requires the IUC to have been in place for more than 2 consecutive days in an inpatient location on the date of event or the day before (day of catheter placement = Day 1).
• If a catheter is removed and the patient goes without one for at least 1 full calendar day, the device-day count resets; if reinserted before a full calendar day has passed, the count continues uninterrupted.
• This surveillance definition exists for standardized reporting — it should not be used to guide clinical diagnosis or treatment decisions, which follow separate clinical criteria.