A catheter-associated urinary tract infection (CAUTI) occurs when bacteria or other germs enter the patient’s urinary catheter and cause infection. These infections are serious but can often be successfully treated. CAUTI is one of the most common infections a person can contract in the hospital. Health care workers, patients and families can play an active role in CAUTI prevention.

What is this measure?

A urinary tract infection (UTI) is an infection involving any part of the urinary system. This includes the urethra, bladder, ureters and kidney.

A urinary catheter, also known as an indwelling or Foley catheter, is a tube inserted into the bladder through the urethra to drain urine into a collection bag. Bacteria or germs can enter the bladder through the catheter, causing an infection. Johns Hopkins Medicine tracks many different infections, including patients who develop a CAUTI.

Why is it important?

Providing the best and safest care to our patients is the top priority for Johns Hopkins Medicine. Part of this work includes preventing infections in the hospital, including catheter-associated urinary tract infections. Urinary tract infections are the most common type of infection that patients acquire in the hospital and 75% of these are associated with a urinary catheter. Complications from CAUTIs can cause patient discomfort, longer hospital stays and increased cost and mortality.

What is Johns Hopkins Medicine doing to continue to improve?

At our hospitals, we track the number of CAUTIs in all of our adult units.

Our CAUTI prevention program includes efforts and programs to reduce the number of days that patients have a urinary catheter in place and evidence-based infection prevention measures. These efforts include:

• Whenever possible, using urinary catheters that are not left in place
• Prompt urinary catheter removal
• Proper urine sample collection procedures for urine testing
• Evidence-based best practices for urinary catheter insertion and maintenance
• Proper training and performance feedback for all staff involved in urinary catheter insertion and maintenance 

Frontline Perspective

Beth Petterson, B.S.N., R.N., C.R.R.N.
Assistant Patient Care Manager, Inpatient Rehabilitation, Burton 1, Johns Hopkins Bayview Medical Center

“For about 10 years, we’ve been tracking and studying the causes of CAUTI within our unit. Every time there is a case, I spend hours looking into what we may have missed and how we could have prevented it. This is very important to me, because CAUTIs are something that nurses can have an impact on preventing.

Our goal is to remove the patient’s urinary catheter as soon as possible. However, we have made a care guide for when we need to leave the patient’s catheter in. This guide covers things such as if the patient cannot go to the bathroom or if the patient is taking medications that make it difficult to urinate. When a patient comes to us for not urinating, we have a list we review to figure out the cause. Both approaches have really helped us with CAUTI prevention.

Teaching team members best patient care practices is important too. Every year, we have a day where we review harmful events, such as CAUTI. Taking the time to teach team members about infections helps connect how their actions can affect patients and how missed opportunities can get them sick. We also have prevention champions within the unit who talk and teach about CAUTI, creating a culture that can help prevent it.”

How can patients and families support safety?

Patients and families should discuss with their doctor why the urinary catheter is needed and how long to expect to have it in place. They should only touch the catheter after performing proper hand hygiene. Patients and families can also ask their health care provider if they have performed hand hygiene before touching the catheter. The urinary catheter should always remain below the level of the bladder, but off the floor, and the tubing should not be pulled or twisted.

Patients and families will be provided instructions on how to care for a urinary catheter if the patient leaves the hospital while the catheter is still in place.

For more information

• The Centers for Disease Control and Prevention CLAUTI Patient Education
• Evidence-based best practices for CAUTI Prevention

Quality and Safety Performance During COVID-19

The organization’s quality and safety performance may have been impacted by the COVID-19 pandemic. We would urge patients to consider more recent performance in combination with historical performance. Patients may benefit from discussing with their healthcare provider the disruptions COVID-19 may have caused on quality and safety of care.

See how Johns Hopkins Medicine prioritizes safety during the COVID-19 pandemic.