Background: Urinary catheters are commonly used in hospitalized adults and can lead to catheter-associated urinary tract infections (CAUTI), the most common hospital-acquired infection. External urinary collection devices – external urinary catheters (EUCs) and PureWicks – have been increasingly used as presumptively safer alternatives to indwelling urinary catheters (IUCs) and are not currently counted towards hospitals’ official CAUTI reporting metrics. However, data comparing infection rates between internal and external devices remains scarce.
Methods: This study was based at an urban tertiary-care academic hospital. We used the electronic health record to identify adults hospitalized on medicine, neurology, or critical care services between January 2021 and October 2025 who had an IUC or external device placed, as documented in structured nursing flowsheets. Patients with chronic indwelling catheters or nephrostomy tubes, as identified by ICD-10 code or chart review, were excluded. The primary outcome was hospital-acquired CAUTI, identified by positive urine culture obtained after device placement and confirmed by investigator chart review using Centers for Disease Control and Prevention’s National Healthcare Safety Network CAUTI criteria. We compared CAUTI incidence per 1,000 catheter days between devices, excluding patients exposed to both device types, and used multivariable Poisson models to adjust for demographic and clinical characteristics (identified by ICD-10 codes) in these two groups.
Results: We identified 10,164 hospital encounters (representing 8,274 unique patients) with urinary devices placed, including 4,768 with IUCs and 5,396 with external devices. Median days of catheter use was similar between groups; patients with IUCs were more likely to be male, to experience acute or chronic urinary retention, or to receive ICU-level care, and were less likely to have cognitive impairment, dementia, or Parkinson’s Disease (Table 1). The overall CAUTI incidence rate was 0.49 per 1,000 catheter days for patients with IUCs and 0.39 for external devices (Table 2; p=0.60). After adjustment for demographics and clinical characteristics identified in Table 1, no statistically significant difference was observed between groups (Incidence rate ratio IUC vs external device: 1.20; 95% CI: 0.31, 4.62; p=0.79).
Conclusions: In this study of hospitalized adults, we found no statistically significant difference in CAUTI rates between indwelling and external urinary devices. CAUTI incidence was lower than has been reported in the literature [1,2], which may reflect the exclusion of patients with chronic catheters and other risk factors, and may have limited detectable differences between device types. Our findings indicate that external devices do not confer a measurable reduction in UTI risk compared with indwelling catheters, suggesting that infection risk should not be a primary factor when selecting a urinary device. As external devices continue to be promoted and are excluded from CAUTI reporting, these findings highlight the importance of ensuring surveillance policies accurately reflect comparative device risks.
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