CAUTI Rounds Handout (Pocket Version)
Use during SICU rounds in <60 seconds. Goal: Stop non-indicated UA/urine culture orders and reduce false CAUTI labeling.
Foley Use Check
- Is there a valid current indication today?
- Is the indication documented in chart today?
- If no valid indication, remove now.
Urine Culture Check
- Is there a plausible urinary source with clinical findings?
- Will UA/urine culture result change management now?
- In catheterized patients, have non-urinary sources been evaluated first?
- If Foley >14 days and culture is truly indicated, replace Foley first and culture from new catheter.
Hard Stops: Do Not Order UA/Urine Culture For These Alone
- Cloudy or foul-smelling urine alone. [Q1]
- Dark/discolored urine alone. [Q2]
- Sediment, turbidity, or "dirty-looking" urine alone. [Q3]
- Pyuria alone in a catheterized patient. [Q4][Q5]
- Candida in urine without symptomatic UTI criteria.
Do Not Do
- Do not culture from drainage bag.
- Do not reflexively order urine culture for isolated single fever without clinical context.
- Do not label candiduria as CAUTI without criteria.
- Do not continue Foley "just to trend urine quality."
Escalate Before Ordering
- If uncertain, discuss with attending/APP before placing UA/culture order.
- Document one sentence: "How will this result change management?"
Daily Metrics to Record
- Foley-days with documented indication: Yes/No.
- UA/culture orders with documented urinary indication: Yes/No.
Direct Quote References
- [Q1] IDSA CAUTI guideline: "odorous or cloudy urine alone should not be used ... as an indication for urine culture."
https://academic.oup.com/cid/article/50/5/625/324341 - [Q2] CDC stewardship page: "Odorous, cloudy, or discolored urine in the absence of other localizing signs/symptoms."
https://www.cdc.gov/uti/hcp/clinical-guidance/culture-stewardship-strategize.html - [Q3] AHRQ CAUTI stewardship: "Urine quality: color, smell, sediments, turbidity ... do not constitute signs of infection."
https://www.ahrq.gov/hai/cauti-tools/phys-championsgd/section7.html - [Q4] IDSA CAUTI guideline: "In the catheterized patient, pyuria is not diagnostic of CA-bacteriuria or CA-UTI."
https://academic.oup.com/cid/article/50/5/625/324341 - [Q5] CDC stewardship page: "Pyuria alone not diagnostic."
https://www.cdc.gov/uti/hcp/clinical-guidance/culture-stewardship-strategize.html
Full reference appendix:
2026-02-26_ua-culture-hard-stop_reference-quotes.md