This disclosure describes the use of cationic steroidal antimicrobial (CSA) compounds to prevent microbial fouling of medical implants, including microbial fouling caused by bacterial and/or fungal biofilms. The CSAs are incorporated into the medical implants to provide effective antimicrobial properties. A medical implant includes a component formed from a polymeric material. A plurality of CSA molecules are mixed with the polymeric material so that the CSA molecules are incorporated into the structure of the medical implant as formed. A medical implant can additionally or alternatively include a lubricious coating containing CSA molecules.