If you perform clean intermittent catheterization (CIC), urinary tract infections are likely something you've experienced or worried about. UTIs are the most common complication of intermittent catheterization — studies estimate around 2.5 UTIs per person per year for regular CIC users, with over 80% of long-term users experiencing at least one UTI over a five-year period.
That statistic can feel discouraging. But it comes with an important counterweight: many UTIs in CIC users are preventable, and the risk factors are well understood. This article draws on the Canadian Best Practice Recommendations for Clean Intermittent Urethral Catheterization in Adults — developed collaboratively by NSWOCC, CNCA, the Urology Nurses of Canada, and IPAC Canada — to outline what the evidence actually supports.
Bacteriuria vs. UTI: An Important Distinction
First, a clarification that matters clinically. The bladder of a CIC user will almost always contain some bacteria — this is called asymptomatic bacteriuria, and it's normal. By three weeks of regular catheterization, more than 50% of CIC users have bacteria detectable in their urine. This does not mean they have a UTI, and it does not require treatment.
A true UTI requires both bacteria in the urine and symptoms. Symptoms include fever or chills, burning on urination, increased frequency or urgency, blood in the urine, pelvic or lower back pain, and cloudy or foul-smelling urine accompanied by one of the above. Cloudy or strong-smelling urine alone — without other symptoms — is not sufficient to diagnose a UTI.
Canadian guidelines are clear: only symptomatic UTIs should be treated with antibiotics. Treating asymptomatic bacteriuria increases antibiotic resistance without improving outcomes. Dipstick testing alone has limited value and should not be used as the sole basis for a UTI diagnosis — a proper urine culture is required.
What Increases UTI Risk in CIC Users
Understanding risk factors is the first step toward addressing them. The following are established contributors to elevated UTI risk in intermittent catheter users:
Catheterizing infrequently or allowing the bladder to overdistend; using a non-hydrophilic (uncoated) catheter; poor hand hygiene technique; inadequate fluid intake; female anatomy; inconsistent or incorrect catheterization technique; poor patient education at initiation
Regular catheterization schedule (4–6x daily); hydrophilic single-use catheters; consistent hand hygiene; adequate fluid intake (1.5–2L daily); correct technique with proper meatal cleaning; good initial teaching by a qualified continence or urology nurse
Evidence-Based Prevention Strategies
1. Hand Hygiene — The Single Most Important Step
Hand hygiene is described in Canadian guidelines as the single most important practice for preventing infection transmission in CIC. Hands must be washed thoroughly with soap and water — or alcohol-based hand rub if visibly clean — before gathering supplies, immediately before catheterization, and immediately after. This applies to both patients and caregivers.
It sounds simple, but in practice it's often abbreviated. Washing for at least 15–20 seconds, including between fingers, is the standard. This single step, done consistently, reduces infection risk more than almost any other intervention.
2. Use a Single-Use, Pre-Lubricated Hydrophilic Catheter
The Canadian best practice guidelines make a Grade A recommendation — the highest level of evidence — that a single-use, pre-lubricated catheter should be used for CIC, particularly for patients with repeated symptomatic UTIs.
Hydrophilic catheters work by binding water to a polymer coating along the catheter surface, creating a consistently lubricious surface that reduces friction and urethral microtrauma during insertion and withdrawal. Research consistently associates hydrophilic single-use catheters with lower rates of UTI, less urethral bleeding, and improved patient satisfaction compared to uncoated alternatives.
Importantly, Canadian guidelines do not support the re-use of single-use catheters. Catheters licensed for single use by Health Canada are designed to be discarded after each insertion. Re-use — even with cleaning — is associated with higher infection risk and is contrary to manufacturer instructions.
3. Catheterize at Regular Intervals — Don't Skip
Low frequency of catheterization is a well-established risk factor for UTI. When the bladder is allowed to overdistend — filling beyond 400–500 mL — the stretched bladder wall has impaired ability to resist bacterial colonization, and the pooled urine creates a favourable environment for bacterial growth.
Most CIC users should catheterize 4–6 times per day, spaced to keep catheterized volumes below 500 mL per session. If you're consistently draining more than 500 mL, this is a signal that you need to catheterize more frequently or reduce fluid intake — speak with your healthcare provider about adjusting your schedule.
4. Drink Enough Fluid
Adequate fluid intake has two benefits: it dilutes the urine (reducing bacterial concentration) and maintains a regular urinary flow that flushes bacteria from the bladder and urethra. Canadian guidelines recommend targeting urine output of at least 1,200 mL per day, with fluid intake based on body weight (25–35 mL/kg/day).
Urine colour is a practical guide. Light straw yellow indicates adequate hydration. Dark yellow or amber urine signals dehydration and the need to drink more. This is particularly easy to forget for CIC users who instinctively limit fluids to reduce catheterization frequency — but the result is more concentrated urine and higher infection risk.
5. Clean the Urethral Meatus Before Each Catheterization
Before inserting a catheter, the area around the urethral opening should be cleaned. For male users: retract the foreskin if present and clean the glans in a circular motion moving away from the meatus using warm water and soap or a clean wipe. For female users: spread the labia and clean front-to-back.
Canadian guidelines note that tap water or sterile water is appropriate for periurethral cleaning in community settings — it's convenient, effective, and cost-efficient. Antiseptic solutions like chlorhexidine may be used in hospital settings per local policy, but are not routinely required at home, and chlorhexidine can cause mucous membrane irritation.
6. Catheterize in a Clean Environment
The environment matters. Perform catheterization on a clean, hard surface — not the floor or a fabric surface. Pets should be removed from the area. Equipment should be clean before use. This is less about achieving a sterile field and more about avoiding obvious contamination sources that can introduce bacteria to the catheter or the periurethral area.
The most impactful UTI prevention strategies for CIC users are: consistent hand hygiene, use of single-use hydrophilic catheters, regular catheterization frequency to prevent bladder overdistension, and adequate fluid intake. These four practices, applied together, substantially reduce UTI risk — and none of them require a prescription.
Recognizing a True UTI
Knowing when to act — and when not to — is as important as prevention. Treat changes in urine appearance or odour without symptoms as normal for a CIC user, not a reason to start antibiotics. Contact your healthcare provider when you experience:
When you do have a symptomatic UTI, increase fluid intake immediately and contact your healthcare provider. Bring a clean urine specimen — a mid-stream or catheter specimen — for culture testing so the appropriate antibiotic can be prescribed. Avoid taking antibiotics without culture confirmation where possible, as this contributes to antibiotic resistance over time.
A Note on Catheter Choice and UTI Risk
For patients experiencing recurrent UTIs despite good technique and hygiene, catheter type deserves re-evaluation. If you're currently using an uncoated catheter with separate lubricant, transitioning to a single-use hydrophilic catheter is the single most evidence-supported product change you can make. The continuous lubrication across the full catheter length — rather than lubricant concentrated at the tip — significantly reduces the urethral microtrauma that creates pathways for bacterial entry.
The IQ Catheter features a full-length hydrophilic coating along with a flexible, atraumatic tip that reduces insertion trauma — particularly relevant for patients with urethral strictures or difficult anatomy, where repeated traumatic insertion compounds infection risk.
Healthcare professionals can request complimentary IQ Catheter samples for patient evaluation. Submit a request →