Catheter-associated urinary tract infections (CAUTIs) continue to pose a significant patient safety challenge in acute care, constituting 29 % of healthcare-associated infections (Weiner-Lastinger et al., 2019). CAUTIs lead to increased morbidity, prolonged hospital stays, and heightened healthcare costs (Centers for Disease Control and Prevention, 2024; Nelson et al., 2022; Tyson et al., 2020). The financial impact of CAUTIs is considerable, with a single infection costing between $600 and $20,000, and overall annual healthcare expenses reaching up to $400 million in the US (McCleskey et al., 2021; Nelson et al., 2022; Tyson et al., 2020). The necessity for effective prevention strategies is further highlighted by potential penalties incurred by hospitals under the Centers for Medicare & Medicaid Services Hospital-Acquired Condition Reduction Program (Centers for Medicare & Medicaid Services, 2023).

Urinary catheters are often used unnecessarily or left in place longer than needed; nearly half of surgical patients keep them for more than 48 h, and many medical patients use them without a valid reason (Tyson et al., 2020). The risk of infection is significant, as roughly 75 % of all urinary tract infections are linked to catheter use (McCleskey et al., 2021). This underscores the importance of daily necessity checks, prompt removal of catheters, and the consideration of alternatives like external urine collection devices. For patients requiring catheterization, evidence-based insertion and maintenance bundles have significantly reduced the incidence of CAUTIs (Fritsch et al., 2019; Lilley et al., 2023; Mundle et al., 2020; Rubi et al., 2022; Van Decker et al., 2021).

Prolonged catheter duration remains a significant risk factor, as each additional day of catheterization raises the risk of bacteriuria and infection by 3 % to 10 % and can lead to complications such as antimicrobial resistance, cystitis, pyelonephritis, and urosepsis (Centers for Disease Control and Prevention, 2019; Jin et al., 2023; Kranz et al., 2020; Sharma et al., 2023; Werneburg, 2022). In about 5 % of cases, CAUTIs can lead to bacteremia, which further raises mortality risk and healthcare costs (Centers for Disease Control and Prevention, 2024).

While some CAUTI risk factors like advanced age are non-modifiable, many others—such as prolonged catheterization and poor insertion techniques—are preventable. Studies show that 17 % to 69 % of CAUTIs can be avoided through consistent infection control practices (Agency for Healthcare Research and Quality, 2023). Nurse-led catheter removal protocols and standardized prevention bundles are especially effective in reducing infection rates (Agency for Healthcare Research and Quality, 2023; Chenoweth, 2021).

This study assessed the effectiveness of nurse-led catheter bundles, guided by the Plan-Do-Check-Act (PDCA) model, in reducing CAUTIs and catheter use at an academic hospital. The goal was to achieve an over 10 % reduction by comparing pre- and post-implementation standardized infection ratios (SIRs) and utilization ratios (SURs). Focusing on standardized practices and nursing autonomy, the intervention aimed to improve patient outcomes and support sustainable change. The findings contribute to the evidence for nurse-driven infection prevention and have implications for advancing nursing quality improvement.

To address high CAUTI rates, a nursing-led task force used W. Edwards Deming's Quality Improvement Theory, which is centered on the PDCA cycle (Anderson, 2022). This structured approach allowed nurses to lead evidence-based changes. The team's Plan included developing evidence-based interventions. During the Do phase, they implemented these interventions through multidisciplinary collaboration and training. Outcomes were measured with SIRs, SURs, and reinsertion rates to check the results. In the Act phase, the team refined their practices to enhance bundle compliance, reduce catheter use, and sustain positive outcomes. The PDCA cycle is further detailed by “the Five Ws and One H" (Table 1).