U.S. Hospitals More Proactive at Preventing Catheter-Associated UTIs, But ...

 

• Catheter-associated urinary tract infection is a common, costly healthcare-associated infection.
• By 2025, significantly more Department of Veterans Affairs (VA) hospitals and nonfederal hospitals said they were using three key CAUTI prevention practices than they were in 2005.
• Despite improvements, only 37.8% of VA and 58.3% of nonfederal hospitals practiced nurse-initiated urinary catheter discontinuation in 2025.

A rising share of U.S. hospitals has embraced strategies to prevent catheter-associated urinary tract infections (CAUTIs) over the last two decades, according to a cross-sectional survey study.

By 2025, significantly more Department of Veterans Affairs (VA) hospitals and nonfederal hospitals alike said they were using three key CAUTI prevention practices than they were two decades prior, Sanjay Saint, MD, of Northwell Health in Lake Success, New York, and colleagues reported in JAMA Network Open.

The percentage of VA hospitals using portable bladder ultrasonography scanners rose from 50.0% in 2005 to 75.0% in 2025 (P=0.003), use of urinary catheter reminders or stop orders climbed from 11.1% to 31.5% (P<0.001), and nurse-initiated urinary catheter discontinuation increased from 14.5% in 2009 to 37.8% in 2025 (P=0.03).

Among nonfederal hospitals, portable bladder ultrasonography scanner use increased from 29.6% in 2005 to 72.8% in 2025 (P<0.001), use of urinary catheter reminders or stop orders rose from 9.1% to 48.7% (P<0.001), and nurse-initiated urinary catheter discontinuation climbed from 11.3% in 2009 to 58.3% in 2025 (P<0.001).

Those increases coincided with national hospital surveys showing a drop in the percentage of hospitalized patients with CAUTIs and other healthcare-associated infections between 2015 and 2023.

"These changes show that hospitals increasingly recognize that avoiding unnecessary catheter placement and reducing catheter duration are central to patient safety," Saint told MedPage Today.

Despite two decades of improvement, however, CAUTI prevention percentages still fell short of universal adoption.

To keep the momentum going, the main challenge isn't in knowing what to do -- it's reliably doing it in busy, complex clinical environments, Saint said. "Competing clinical priorities, variable leadership engagement, uneven availability of champions, and difficulty sustaining behavior change all contribute to variation across hospitals," he added.

CAUTI remains a common, costly healthcare-associated infection. The broad expansion of infrastructure to prevent CAUTI is the study's most encouraging finding, Saint said. By 2025, nearly all hospitals reported having CAUTI surveillance systems, and most of them routinely monitored catheter duration and discontinuation, explained Saint.

For CAUTI prevention, the highest-yield opportunities are daily reassessment of catheter necessity, catheter reminders or stop orders, and nurse-initiated removal protocols when indications have resolved, Saint explained. "These practices should be much more universal because they help reduce catheter duration, the most modifiable risk factor for both infectious and noninfectious catheter-related harm," he noted.

The key question for clinicians should be, "Does this patient need an indwelling catheter today?" Saint said. "Avoid placement when possible, use alternatives when appropriate, and remove the catheter promptly when the indication resolves."

Diagnostic stewardship also matters. "A positive urine culture without compatible symptoms should not automatically trigger a UTI diagnosis or antibiotics," he added.

The researchers analyzed data from six waves of surveys of randomly selected U.S. hospitals conducted every 4 years from 2005 to 2025. The surveys included questions about how often hospitals used a range of CAUTI prevention practices. A total of 1,461 hospitals completed at least one survey, including 133 VA hospitals and 1,328 nonfederal hospitals.

By 2025, nearly all VA hospitals and nonfederal hospitals were using the following CAUTI prevention practices:

• Systems to monitor which patients had urinary catheters placed: 79.2% and 92.1%, respectively
• Routine monitoring of catheter duration and discontinuation: 72.6% and 87.2%
• Surveillance systems to monitor CAUTI rates: 98.7% and 98.1%

In addition, most hospital leaders said they viewed UTI prevention as very important or important (72.6% of VA hospitals and 72.5% of nonfederal hospitals).

Use of silver alloy Foley catheters remained low and relatively flat among VA hospitals from 2005 to 2025 (from 14.0% to 15.9%), while use at nonfederal hospitals in that period slid significantly, from 32.4% to 14.0% (P<0.001). That "likely reflects limited evidence that these catheters meaningfully reduce symptomatic CAUTI, as well as guidelines that do not recommend their routine use," Saint noted.

External catheters for women were regularly used by 41.1% of VA hospitals and 62.6% of nonfederal hospitals in 2025. More nonfederal hospitals used them in women than used them in men (55.4%). While studies suggest external catheters for women can reduce indwelling catheter use, Saint said, the evidence that they consistently reduce CAUTI is less definitive.

Study limitations include survey response rates that could lead to nonresponse bias in the results. Given that most responding hospitals participated in only one or two surveys, the cross-sectional findings are from largely independent samples, not from a pure longitudinal cohort.

Disclosures

The study was supported by the Department of Veterans Affairs National Center for Patient Safety and the National Center for Advancing Translational Sciences.

Saint disclosed a patent for a catheter placement device in addition to personal fees from Doximity, Oxford University Press, University of Michigan Press, and CRC Press.

Co-authors had no relevant disclosures.

Primary Source

JAMA Network Open

Source Reference: Saint S, et al "Catheter-associated urinary tract infection prevention practices in US hospitals" JAMA Netw Open 2026; DOI: 10.1001/jamanetworkopen.2026.37540.

https://www.medpagetoday.com/hospitalbasedmedicine/infectioncontrol/123311

Left Ventrical Assist Devices Linked to Concerning Neurologic Events, Strokes Aside

 

• A registry study found an 8% incidence of stroke at 1.4 years after LVAD placement, accompanied by another 8% incidence of nonstroke neurologic adverse events.
• Pre-LVAD extracorporeal membrane oxygenation (ECMO) and concomitant surgery may be modifiable targets to reduce neurologic dysfunction.
• A more complete view of neurologic dysfunction is needed to inform decision-making, researchers said.

It's not all about stroke: Various neurologic events boded poorly for survival on the contemporary magnetically levitated HeartMate 3 left ventricular assist device (LVAD) in a retrospective registry study.

Based on the U.S. INTERMACS database, there was an 8% incidence of both stroke and nonstroke neurologic adverse events (NAEs) over a median 1.4 years among nearly 12,000 people with advanced heart failure who got the contemporary magnetically levitated LVAD.

Two-year survival rates were 45% in LVAD recipients who had a stroke and 56% in peers with nonstroke neurologic events (P<0.001). Compared with no neurologic event, there was an elevated risk of death after a stroke (HR 7.3, 95% CI 6.6-8.1) or a nonstroke neurologic event, the latter associated with:

• Highest mortality risk where there is overt central nervous system (CNS) injury (HR 12.58, 95% CI 10.39-15.23)
• High risk with covert CNS injury detected by neuroimaging (HR 9.19, 95% CI 6.75-12.51)
• Lower but still elevated risk with neurologic dysfunction without CNS injury, such as encephalopathy (HR 3.69, 95% CI 3.20-4.25)

"Stroke and nonstroke NAEs are incurred by a similar proportion of patients, and both are associated with substantially reduced survival. Consequently, stroke and nonstroke NAEs should be given comparable weight with universal nomenclature when evaluating the safety of durable LVADs," concluded a group led by Omar Saeed, MD, MSc, of Montefiore Medical Center, Albert Einstein College of Medicine in New York City, reporting in JACC: Heart Failure.

In their study, there were two potentially modifiable targets to reduce neurologic dysfunction from LVAD therapy: pre-LVAD extracorporeal membrane oxygenation (ECMO) and concomitant surgery.

A Long List of Neglected Neurologic Complications?

Much attention has centered strokes as the neurologic complication of concern in LVAD recipients. Prior work established that strokes may arise due to thromboembolism from various sources, while preexisting cerebrovascular disease, uncontrolled hypertension, and anticoagulation therapy may also contribute to stroke burden, Saeed and colleagues noted.

Other clinically significant neurologic complications, such as encephalopathy, have consequently been less well described.

"Neurological assessment after LVAD implantation should extend beyond focal stroke symptoms," commented Sung-Min Cho, DO, MHS, of Johns Hopkins University School of Medicine in Baltimore, who was not involved with the study.

Of note, Cho told MedPage Today, it may not be the case that encephalopathy itself causes death, as it may reflect underlying infection, shock, or multiorgan dysfunction. "Altered mental status/encephalopathy may warrant clinicians' attention both to possible brain injury and to the systemic illness that may be causing it, both of which increase the risk of death."

There is also an issue with attributing deaths to covert brain injury, as scans are ordered usually when a patient is already doing poorly, according to Mandeep Mehra, MD, MSc, of Brigham and Women's Hospital and Harvard Medical School in Boston, who was also not involved with the study.

Cho and Mehra both stressed the clinical heterogeneity of the so-called "nonstroke" endpoint in the study, which included overt CNS injury from subarachnoid hemorrhage (SAH), hypoxic-ischemic injury, subdural hemorrhage (SDH), or traumatic brain injury; covert CNS injury detected by neuroimaging; and neurologic dysfunction without CNS injury including encephalopathy, delirium, seizures, and transient ischemic attacks (TIA).

"SAH is a cerebrovascular event ordinarily considered a hemorrhagic stroke; SDH is generally classified separately, but grouping both under 'nonstroke neurological dysfunction' obscures the distinction between structural brain injury and conditions such as delirium in my opinion," Cho said.

"The nonstroke category needs dissecting before we give it equal weight with stroke. Seventy percent of these events are encephalopathy, delirium, seizures, or TIA. None of them were adjudicated, and in a very sick postoperative patient they are often a consequence of sepsis or multiorgan failure rather than a device-related brain injury," warned Mehra. "What we need is rigorous, adjudicated, device-attributable neurological endpoints. Lumping heterogeneous, unadjudicated events into a safety endpoint for future device trials could obscure rather than clarify device performance."

Can Neurologic Events Be Prevented?

Saeed's group performed a retrospective cohort study using the nationwide Society of Thoracic Surgeons INTERMACS database. Included were 11,739 patients who got a HeartMate 3 LVAD from 2017 to 2023.

The authors reported that pre-LVAD ECMO was associated with more stroke (HR 1.70, 95% CI 1.35-2.16) and nonstroke events (HR 1.45, 95% CI 1.11-1.90); concomitant surgery was also tied to stroke (HR 1.23, 95% CI 1.08-1.41) and nonstroke events alike (HR 1.17, 95% CI 1.03-1.34).

"Patients coming to implant on ECMO or temporary support, or undergoing concomitant procedures, carry higher neurological risk. That calls for careful thrombus screening, attention to stasis, and early neurological assessment after surgery," Mehra said.

Cho and Mehra both cautioned against calling ECMO a "modifiable" risk factor based on these findings, however. "Patients are on ECMO because they are in shock. ECMO marks severity of illness more than it represents a choice we can simply avoid," Mehra said.

It also remains to be shown that "avoiding ECMO would reduce neurological injury," according to Cho.

In any case, there is already some improvement on the neurologic safety of LVADs, as Saeed and colleagues reported that stroke and nonstroke NAEs occurred at an incidence of 0.044 and 0.049 events per patient-year, respectively, in this real-world cohort. In contrast, in the MOMENTUM3 trial, the incidence of any stroke was 0.050 events per patient-year across HeartMate 3 and HeartMate II LVAD recipients, while other neurologic events were logged at 0.073 events per patient-year.

The contemporary HeartMate 3 is already an improvement over its predecessor HeartMate II in terms of staving off neurologic complications. In a prespecified analysis of MOMENTUM 3, stroke rates were 10.1% and 19.2% in the first 2 years between the two LVAD groups, respectively (P=0.02).

"I was not at all surprised by this analysis which is itself reassuring," and "confirms that neurological complications have fallen substantially in the magnetically levitated era," said Mehra. "The device itself is no longer the dominant driver of neurological risk; the surgery and peri-implant factors are the issue."

The report found that the independent predictors of death after stroke were older age, pre-LVAD implantable cardioverter-defibrillator, higher pre-LVAD blood urea nitrogen level, and pre-LVAD dialysis. Predictors of death after nonstroke NAE were higher pre-LVAD body mass index, higher pre-LVAD serum creatinine, greater pre-LVAD international normalized ratio, and lower pre-LVAD albumin.

"Awareness of these patient-level characteristics may help direct resources to those who are most vulnerable after the occurrence of NAEs," the study authors suggested.

Saeed and colleagues nevertheless acknowledged that their retrospective study left room for bias and did not account for variables such as blood pressure management, anticoagulation management, or atrial fibrillation. Additionally, NAE events may be underestimated due to the lack of reporting of recurrent events and the classification of patients experiencing both stroke and nonstroke NAEs as stroke only.

Disclosures

This study was supported by grants from the National Institutes of Health/National Heart, Lung, and Blood Institute.

Saeed disclosed no conflicts of interest.

Study co-authors reported ties to Abiomed, Johnson & Johnson, Abbott, and other entities.

Mehra reported consulting fees paid to his institution from Abbott and Cadrenal and personal fees from Moderna, Natera, Transmedics, Second Heart Assist, Paragonix, NuPulseCV, FineHeart, FIRE-1, Leviticus, Seismic, and Regeneron.

Cho had no disclosures.

Primary Source

JACC: Heart Failure

Source Reference: Saeed O, et al "Neurological dysfunction during contemporary magnetically levitated left ventricular assist device support for advanced heart failure: an STS-INTERMACS analysis" JACC Heart Fail 2026; DOI: 10.1016/j.jchf.2026.103377.

https://www.medpagetoday.com/cardiology/chf/123312

US said to prepare new charges against Maduro, wife

 The United States prosecutors in New York are preparing to file new charges against former Venezuelan President Nicolas Maduro and his wife, Cilia Flores, accusing them of torturing American nationals who were held in Venezuelan government custody, CNN reported on Wednesday, citing people familiar with the investigation.

According to the report, the new charges could be announced as soon as tomorrow, and they are said to concern "wrongful detention" of over a dozen US nationals in Venezuelan prisons during Maduro's regime. The report added that several additional people may be charged for their alleged role in torturing the American citizens.

The Maduros are currently being held in New York, where they await their trial, which is set to begin on June 1, 2027, after they were captured in a US military operation in Venezuela and charged with "Narco-Terrorism Conspiracy," among other charges. The couple pleaded not guilty to the charges.

https://breakingthenews.net/Article/US-said-to-prepare-new-charges-against-Maduro-wife/67254247

White House set to announce $1B in AI commitments

 United States President Donald Trump will be present at an artificial intelligence (AI) summit on October 8, with his administration set to unveil $1 billion in industry commitments for the Genesis Mission coming from OpenAI, Anthropic PBC, Advanced Micro Devices Inc. (AMD) and others, Axios reported on Wednesday, citing an announcement.

The White House wants to push industry leaders to be more active amid science research and development funding cuts. The Trump administration is also set to reveal a compute hub made up of over 14 institutions spanning 10 Southeast states, as well as a $1 billion investment in Georgia.

It was further detailed that the National Science Foundation and the Energy Department will inject over $100 million in AI-driven science tools, with distinguished experts to be present at the summit.

https://breakingthenews.net/Article/White-House-set-to-announce-dollar1B-in-AI-commitments/67253736

'White House asks Pentagon for Iran strike options before midterms - Atlantic'

 

The White House has asked the Pentagon to develop options for strikes against Iran that could be carried out before the November 3 midterm elections, The Atlantic reported Wednesday, citing two administration officials.

The size and targets of any potential strikes remain under discussion and no final decision has been made, according to the report. US Central Command is developing the options.

The planning comes as President Donald Trump weighs how to demonstrate progress in the eight-month war while seeking to bring down energy prices ahead of the elections, administration officials told The Atlantic.

Supporters of limited strikes acknowledge they would not by themselves bring Iran to the negotiating table, restore safe passage through the Strait of Hormuz or lower gasoline prices before Election Day, the report said.

The Pentagon has also presented Trump with options for military action after the elections, ranging from limited strikes to large-scale attacks that could include further strikes on Iran's energy industry.

The deliberations come as Washington and Tehran continue indirect contacts through mediators while remaining divided over the terms and sequencing of a ceasefire, the US blockade and reopening of the Strait of Hormuz.

Trump has repeatedly raised the possibility of renewed military action. Last week, he said he expected the United States to win the war “right after the election,” before adding, “Maybe before the election.”

https://www.iranintl.com/en/202610072501

Tanker struck by multiple projectiles north of Qatar, casualties reported - UKMTO

 

A tanker was struck by multiple projectiles about 51 nautical miles north of Qatar’s Madinat ash Shamal, with casualties reported, the United Kingdom Maritime Trade Operations said Wednesday in a post on X.

UKMTO WARNING 158-26

Click here to view the full product⤵️ https://t.co/eljQkk03bG#MaritimeSecurity #MarSec pic.twitter.com/4u3X6rEHaB

— UKMTO Operations Centre (@UK_MTO) October 7, 2026

https://www.iranintl.com/en/202610076188

'Iran says it agreed with Oman on safe transit routes in Strait of Hormuz'

 

Iran says it has agreed with Oman on the geographical coordinates of safe transit routes through the Strait of Hormuz, Foreign Ministry spokesperson Esmaeil Baghaei said Wednesday.

“Iran and Oman have reached an agreement on the geographical coordinates of safe transit routes in the Strait of Hormuz and on how they will be communicated to the relevant international body,” Baghaei said, according to the state-run IRNA news agency.

https://www.iranintl.com/en/202610072067