Catheter-Associated Urinary Tract Infection (CAUTI): Definitions
In order to make sure that every member of the team is clear about the definitions that will be used, we have provided a list of key terms along with commonly used definitions for each term. Of particular note is the distinction between symptomatic urinary tract infection (UTI) vs. asymptomatic UTI (also known as asymptomatic bacteriuria).
Additionally, we define both the process measures (also known as “intermediate outcomes”) as well as the clinically-relevant outcome measures that will be used to evaluate the program.
These definitions were provided to us from the North Carolina Center for Hospital Quality and Patient Safety, Centers for Disease Control and Prevention (CDC), and from a toolkit used by the Michigan Health and Hospital Association written by Mohamad G. Fakih, MD, MPH, Sanjay Saint, MD, MPH, Sarah Krein, RN, PhD., and Russ Olmsted, MPH, CIC. We have modified the definitions and the material as appropriate, based on the literature.
Finally, we also provide recent material and definitions used by the CDC’s National Healthcare Safety Network (NHSN) as a reference source.
Sourced from CDC NSHN on 9/18/2026
CAUTI Prevention Practices
Given the important clinical and economic consequences of catheter-associated urinary tract infection (CAUTI), researchers across the world have attempted various methods to prevent this common, costly, and morbid patient safety problem. In this section, we summarize the evidence supporting the use of several practices to prevent CAUTI.
Between October 2008 and July 2010, at least 4 guidelines were published from the Society for Healthcare Epidemiology of America (SHEA), the Centers for Disease Control and Prevention (CDC), the Association for Professionals in Infection Control (APIC), and the Infectious Diseases Society of America (IDSA). Members of our Ann Arbor VA Medical Center/University of Michigan Patient Safety Enhancement Program have been involved in the development of most of these guidelines.
While there are, of course, some differences between the different guidelines, there are several key areas of overlap. We provide below a concise summary of the recommended practices used to prevent CAUTI using the memory aid “ABCDE”:
Adherence to general infection control principles (e.g., hand hygiene, surveillance and feedback, aseptic insertion, proper maintenance, education) is important
Bladder ultrasound may avoid indwelling catheterization
Condom catheters or other alternatives to an indwelling catheter such as intermittent catheterization should be considered in appropriate patients
Do not use the indwelling catheter unless you must
Early removal of the catheter using a reminder, stop-order, or nurse-initiated removal protocol is warranted
Of the above, A, D, and E are the most important.
Infectious Complications
Urinary tract infection represents almost 40% of all healthcare-associated infections, with the vast majority due to the indwelling urinary catheter. Over 900,000 patients develop a catheter-associated urinary tract infection (CAUTI) in a U.S. hospital each year. Urinary catheter-related infection leads to substantial morbidity. The incidence of bacteriuria in catheterized patients is about 5% per day. Among patients with bacteriuria, 10 to 20% will develop symptoms of local infection, while 1 to 4% will develop bloodstream infection. The urinary tract is implicated as the source in 11 to 40% of hospital-acquired bacteremic episodes.
The presentation of catheter-associated infection varies from asymptomatic bacteriuria to overwhelming sepsis and death. Clinical manifestations of CAUTI may include such local symptoms as lower abdominal discomfort or flank pain, or systemic symptoms such as nausea, vomiting, and fever. Patients with bloodstream infection may present with fever, confusion, and hypotension.
A key first step leading to CAUTI is the colonization of the catheter with organisms. Indeed, urinary catheters readily develop biofilm – a collection of microbial organisms on a surface that is surrounded by an extracellular matrix – on their inner and outer surfaces once they are inserted. Such biofilm provides a protective environment for microorganisms.
Many of the infectious complications of the urinary catheter could be prevented by using the catheter only when necessary and promptly removing it when no longer needed.
Non-infectious Complications
Over five decades ago, the late Dr. Paul Beeson persuasively argued against the routine use of indwelling urinary catheters in hospitalized patients. His advice remains relevant today. While these devices provide important benefits in some patients, they are also the primary risk factor for catheter-associated urinary tract infection (CAUTI). Indwelling urinary catheters, however, also lead to significant non-infectious complications. Perhaps most importantly, they have the practical effect of restricting patients in what some consider a “one-point” restraint, raising serious safety and ethical concerns analogous to those noted a few decades ago with "four-point" (or limb) restraints.
Urinary catheters cause patient discomfort. In one prospective study, for example, 42% of catheterized patients report the indwelling catheter was uncomfortable, 48% complained that it was painful, and 61% noted that it restricted their activities of daily living.
Thus, for some patients urinary catheters operate as a physical restraint, tantamount to binding them to the bed, substantially and unnecessarily limiting their ability to function freely and with dignity. Restricted activity not only reduces patient autonomy, it also promotes other patient safety problems, such as venous thromboembolism, deconditioning, and pressure ulcers.
In short, there are compelling reasons to limit indwelling urinary catheterization because of both non-infectious and infectious complications.