# Prevention Strategies for All Hospital-Onset Urinary Tract Infections: Best Practice Consensus Recommendations

## TL;DR

Experts developed consensus recommendations to prevent all hospital-onset urinary tract infections, including those not caused by catheters, by combining existing best practices with new strategies.

## Contribution

The paper presents new consensus-based prevention strategies for non-catheter-associated hospital-onset UTIs, which lack standardized approaches.

## Key findings

- Strong consensus was reached on 37 prevention statements covering surveillance, training, and care interventions.
- The recommendations integrate CAUTI best practices with new guidance for non-CAUTI prevention.
- The framework aims to reduce HOUTI burden and identify future research priorities.

## Abstract

Hospital-onset urinary tract infections (HOUTIs), including catheter-associated (CAUTI) and non-catheter-associated UTI (non-CAUTI), remain a significant source of morbidity and healthcare burden. While CAUTI prevention strategies are well established, non-CAUTIs lack standardized definitions, surveillance protocols, and targeted interventions. To address this gap, consensus recommendations identifying prevention strategies for HOUTIs in adult patients were developed.

A panel of 17 experts in infectious diseases, infection prevention and control, healthcare epidemiology and quality improvement, clinical microbiology, urology, urogynecology, and nursing, participated in a modified Delphi process. An online anonymized survey based on a systematic literature review was completed, before meeting to determine consensus on HOUTI prevention strategies. A further anonymous online survey was shared to finalize recommendations. Thresholds of ≥15/17 panel members in agreement (≥88%) for strong consensus and ≥13/17 (≥76%) for moderate consensus were prospectively set for all statements.

Strong consensus was reached on 37 statements spanning surveillance, intervention selection, strategies and maintenance, related care interventions, specimens and cultures, provider training, and outcome assessment. Key topics—particularly those focused on non-CAUTI HOUTI prevention—were identified as important priorities requiring further exploration and research.

These recommendations offer the foundation for a structured, scalable framework to reduce the burden of all HOUTIs, while also defining future research priorities. By harmonizing established CAUTI best practices with existing literature, and bridging current evidence gaps for non-CAUTI prevention and management with expert consensus, these recommendations provide a road map for improved prevention strategies for all HOUTIs.

A multidisciplinary Delphi panel developed consensus recommendations on preventing all hospital-onset urinary tract infections (HOUTIs)—both catheter-associated UTI (CAUTI) and non-CAUTI—leveraging established CAUTI guidance to close prevention gaps in non-CAUTI and create a scalable framework for comprehensive HOUTI prevention.