Prevention of catheter-associated urinary tract infection in adult hospitals: a focused critical narrative synthesis

Background. Indwelling urinary catheters expose adult hospital patients to infectious and non-infectious harms. Prevention evidence must distinguish symptomatic infection from bacteriuria and account for device use, surveillance definitions and urine-culture ordering.

Aim. To appraise prevention strategies in adult hospitals and identify research priorities relevant to Saudi acute care without assuming local adoption or outcome benefit.

Methods. A focused PubMed retrieval on 6 October 2026 used catheter-associated urinary tract infection, prevention, removal and hospital concepts. Selected references were verified through bibliographic records and abstracts. The SHEA/IDSA/APIC/AHA/The Joint Commission update was inspected in full text. This narrative synthesis involved no registered protocol, dual human extraction, new pooled estimates or formal GRADE assessment.

Findings. Appropriate indications, aseptic insertion, closed drainage, daily necessity review and prompt removal are the central practices supported by inspected guidance. Shorter catheter duration probably reduces symptomatic infection but may increase recatheterisation, requiring retention safeguards. Nurse-driven protocols, reminders and bundles are frequently associated with lower device use and surveillance infection rates, but heterogeneous components and predominantly observational designs limit causal attribution. Changes in culture ordering or surveillance definitions may alter reported events independently of prevention. External and intermittent catheters have distinct indications and harm profiles; neither is a universal substitute. Routine antimicrobial-coated catheter use is discouraged by the inspected guidance, while evidence for emerging technologies remains product-specific.

Conclusion. Prevention should combine appropriate device use with safe maintenance and timely removal, while measuring infection, utilisation and patient harms together. Saudi studies should test context-specific care pathways, alternatives and removal safety with explicit denominators and surveillance definitions. A single Saudi rehabilitation-facility improvement report illustrates existing local evidence, without establishing national acute-care effectiveness.