Consensus Recommendations for Preventing Hospital-Onset Urinary Tract Infections

Overview

Hospital-onset urinary tract infections (HOUTIs), including catheter-associated (CAUTI) and non-catheter-associated types, pose significant morbidity and healthcare costs. A multidisciplinary expert panel developed consensus recommendations to guide prevention strategies, particularly addressing the under-recognized burden of non-CAUTI HOUTIs.

Background

Urinary tract infections are among the most common healthcare-associated infections, with catheter-associated UTIs historically the focus of prevention efforts. Despite reductions in CAUTI rates, non-CAUTI HOUTIs remain prevalent and are associated with substantial complications, including secondary bloodstream infections. Lack of standardized definitions and surveillance for non-CAUTI HOUTIs impedes effective prevention and management. This consensus effort aims to harmonize CAUTI best practices with expert guidance on non-CAUTI prevention to reduce overall HOUTI burden.

Data Highlights

Key data points include an 11% decrease in CAUTI rates from 2022 to 2023 per CDC data, and evidence that non-CAUTI HOUTIs cause three times more secondary hospital-onset bacteremia and fungemia than CAUTIs. The expert panel comprised 17 interdisciplinary specialists who reached strong consensus (≥88% agreement) on 37 prevention statements covering surveillance, interventions, provider training, and outcome assessment.

Key Findings

• Strong consensus was achieved on 37 statements addressing comprehensive HOUTI prevention strategies.
• Non-CAUTI HOUTIs are substantially more prevalent than CAUTIs and contribute significantly to secondary bloodstream infections.
• Current prevention efforts focus predominantly on CAUTI, leaving a critical gap in non-CAUTI surveillance and management.
• Standardized definitions, surveillance protocols, and targeted interventions for non-CAUTI HOUTIs are urgently needed.
• The Delphi process integrated multidisciplinary expertise to harmonize CAUTI best practices with emerging evidence on non-CAUTI prevention.
• Recommendations provide a scalable framework for hospitals to reduce all HOUTIs and identify future research priorities.

Clinical Implications

Clinicians and infection prevention teams should expand surveillance and prevention efforts beyond CAUTI to include non-CAUTI HOUTIs, employing standardized definitions and protocols. Implementing the consensus recommendations can improve patient safety by reducing the overall burden of hospital-onset UTIs and associated complications. Ongoing provider education and outcome monitoring are essential components of effective HOUTI prevention.

Conclusion

These expert consensus recommendations establish a foundational roadmap to comprehensively prevent hospital-onset urinary tract infections, bridging existing gaps in non-CAUTI management and enhancing patient safety. Adoption of these strategies promises to reduce morbidity and healthcare costs associated with all HOUTIs.

References

1. CDC 2023 -- National Healthcare Safety Network Data
2. Infectious Diseases Expert Panel 2024 -- Consensus Recommendations for Preventive Measures Against Hospital-Onset Urinary Tract Infections