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 pediatric 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

Stephanie Morgenstern, M.S.N., A.P.R.N., A.C.C.N.S.-P., C.C.R.N.
Clinical Nurse Specialist, Pediatric Intensive Care Unit, Johns Hopkins Children’s Center

“We have put into place steps to reduce the patient’s risk of developing a CAUTI. We have daily discussions about if the urinary catheter is still needed, and we remove it as soon as we can.

We know the longer the patient has a catheter in place, the greater the risk of developing an infection. But also, each patient is different. We assess the patient-specific risk and then take steps to reduce that risk.

In the intensive care unit, we often need to track a patient’s urine output closely. We have worked to find alternatives to using urinary catheters when we can. This allows us to continue to provide high quality care while avoiding the risk for CAUTI.

These steps are part of the daily care for our patients. We discuss risks and patient health among the care team. This ensures each member of the care team knows the patient’s status. This has kept us CAUTI free for many years.

Staff education is one way we ensure everyone is on the same page. New care team members learn the importance of CAUTI prevention during their orientation. Once they are in the pediatric intensive care unit, we provide education that is specific to children.

Our unit has a strong commitment to improvement. We review our care steps and examine the data to see where we can improve. This ensures we provide the best possible care to our patients and remain CAUTI free.”

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.