# 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

1. Is there a valid current indication today?
2. Is the indication documented in chart today?
3. If no valid indication, remove now.

## Urine Culture Check

1. Is there a plausible urinary source with clinical findings?
2. Will UA/urine culture result change management now?
3. In catheterized patients, have non-urinary sources been evaluated first?
4. 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

1. If uncertain, discuss with attending/APP before placing UA/culture order.
2. 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`