Abstract：
BACKGROUND: Florence Nightingale was the first person to recognize the link between the built environment and patient ill-health. More than 160 years later, the threat of the end of the antibiotic era looms large. The antimicrobial resistance action plan focuses on antimicrobial stewardship and developing new therapeutic agents. The risk from the built environment has been ignored, with wastewater systems identified as major sources of antimicrobial resistance within healthcare facilities. England is undertaking the largest healthcare construction programme globally. These facilities will be operating when antimicrobial resistance is predicted to be at its fiercest. Water-free patient care is a strategy for limiting dispersal of antimicrobial resistance, and preventing patient infections that need further evaluation in new hospitals.
METHODS: A narrative review was undertaken using the terms: waterless/water-free units; waterless/water-free care; sink reduction; sink removal; and washing without water. PubMed, Cochrane Database of Systematic Reviews, and Database of Abstracts of Reviews of Effects were searched from January 2000 to February 2024 for reviews and original articles. Unit type, geographical location, reasons for a waterless/water-free approach, and outcomes were recorded.
RESULTS: Seven papers were identified. Four involved adult intensive care units (ICUs), one involved a care of the elderly setting, and two involved neonatal ICUs. In five papers, the aim of intervention was to reduce Gram-negative infections/colonizations. One paper was a systematic review of \'washing without water\' which reviewed cost-effectiveness and patient experience. All of the five papers focusing on Gram-negative bacilli reported a reduction in infections or colonizations post intervention.
CONCLUSIONS: More studies are highlighting the risks from water and wastewater to patient safety, and the value of water-free strategies in reducing infection rates.
METHODS: A narrative review was undertaken using the terms: waterless/water-free units; waterless/water-free care; sink reduction; sink removal; and washing without water. PubMed, Cochrane Database of Systematic Reviews, and Database of Abstracts of Reviews of Effects were searched from January 2000 to February 2024 for reviews and original articles. Unit type, geographical location, reasons for a waterless/water-free approach, and outcomes were recorded.
RESULTS: Seven papers were identified. Four involved adult intensive care units (ICUs), one involved a care of the elderly setting, and two involved neonatal ICUs. In five papers, the aim of intervention was to reduce Gram-negative infections/colonizations. One paper was a systematic review of \'washing without water\' which reviewed cost-effectiveness and patient experience. All of the five papers focusing on Gram-negative bacilli reported a reduction in infections or colonizations post intervention.
CONCLUSIONS: More studies are highlighting the risks from water and wastewater to patient safety, and the value of water-free strategies in reducing infection rates.
摘要：
背景：弗洛伦斯·南丁格尔是第一个认识到建筑环境与患者不良健康之间联系的人。160多年后，抗生素时代结束的威胁迫在眉睫。AMR行动计划侧重于抗菌药物管理和开发新的治疗剂。建筑环境的风险被忽视了，废水系统被确定为医疗机构内抗生素耐药性的主要来源。英格兰正在进行全球最大的医疗保健建设计划。当预计抗菌素耐药性最严重时，这些设施将开始运作。无水患者护理是一种限制抗生素耐药性扩散和预防患者感染的策略，需要在新医院进行进一步评估。
方法：使用术语进行了叙述性审查；无水/无水单位，无水/无水护理，减少水槽,拆卸水槽,没有水的洗涤。使用的数据库是Pubmed，CDSR,和DARE从2000年1月至2024年2月，用于评论和原创文章。单元类型,地理位置,记录了无水/无水方法的原因和结果。
结果：确定了7篇论文。四名涉及成人重症监护病房(ICU)，一名来自老年人护理机构，两名涉及新生儿ICU（NICU）。在五篇论文中，干预的目的是减少革兰氏阴性感染/定植。一篇论文是对“不用水清洗”的系统评价，回顾了成本效益和患者经验。五篇论文侧重于革兰氏阴性杆菌（GNB），均报告了干预后感染或定植的减少。
结论：更多的研究强调了水和废水对患者安全的风险，以及“无水”策略在降低感染率方面的价值。
方法：使用术语进行了叙述性审查；无水/无水单位，无水/无水护理，减少水槽,拆卸水槽,没有水的洗涤。使用的数据库是Pubmed，CDSR,和DARE从2000年1月至2024年2月，用于评论和原创文章。单元类型,地理位置,记录了无水/无水方法的原因和结果。
结果：确定了7篇论文。四名涉及成人重症监护病房(ICU)，一名来自老年人护理机构，两名涉及新生儿ICU（NICU）。在五篇论文中，干预的目的是减少革兰氏阴性感染/定植。一篇论文是对“不用水清洗”的系统评价，回顾了成本效益和患者经验。五篇论文侧重于革兰氏阴性杆菌（GNB），均报告了干预后感染或定植的减少。
结论：更多的研究强调了水和废水对患者安全的风险，以及“无水”策略在降低感染率方面的价值。
