Objective:

The article examines the objective, findings, and clinical context described in Catheter stop orders may be losing ground.

Approach:

• Design: Repeated cross-sectional analysis of six national survey waves conducted every four years from 2005 through 2025.
• Hospitals: Included 1,461 unique hospitals: 133 Department of Veterans Affairs hospitals and 1,328 nonfederal hospitals.
• Measures: Assessed reported regular use of catheter removal strategies, alternative catheterization methods, monitoring systems, and infection surveillance.

Key Findings:

• Regular use of catheter reminders or stop orders in nonfederal hospitals rose from 9% in 2005 to 49% in 2025, below the 2017 peak of 61%. In VA hospitals, use rose from 11% to 32%, after peaking at 48% in 2013.
• In 2025, nurse-initiated catheter discontinuation was reported by 58% of nonfederal hospitals and 38% of VA hospitals. At least one reminder, stop-order, or nurse-initiated strategy was used regularly by 69% and 49%, respectively.
• Daily rounds to assess catheter necessity were reported by 83% of nonfederal hospitals and 66% of VA hospitals in 2025.
• By 2025, established CAUTI surveillance systems were reported by 98% of nonfederal hospitals and 99% of VA hospitals. Monitoring of catheter presence, duration, and discontinuation also increased substantially from 2005.
• Regular use of external urinary catheters among female patients increased from 2021 to 2025, while nonfederal hospitals’ regular use of silver alloy Foley catheters declined from 32% in 2005 to 14% in 2025.

Interpretation:

The study documents improvements in surveillance and several prevention practices, alongside declines in reminder or stop-order use from earlier peaks. It assessed reported practices, not infection rates or patient outcomes, and therefore does not establish the clinical effects of these changes.

Limitations:

• Practices were self-reported.
• Potential nonresponse bias.
• Hospital sampling changed across survey waves.
• The study did not measure CAUTI rates or patient outcomes.

Conclusion:

The authors noted that catheterization duration is a modifiable risk factor and cited systematic reviews reporting approximately 50% lower CAUTI rates with catheter reminders or stop orders. They called for national surveys to help optimize prevention practices.

Sources:

• JAMA Network Open (study, as described in the supplied article context)