%0 Journal Article
%T Water-free patient care: a narrative review of the literature and discussion of the pressing need for a way forward.
%A Inkster T
%A Walker J
%A Weinbren M
%J J Hosp Infect
%V 152
%N 0
%D 2024 Jul 3
%M 38969207
%F 8.944
%R 10.1016/j.jhin.2024.06.006
%X <B>BACKGROUND: </B>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.<BR><B>METHODS: </B>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.<BR><B>RESULTS: </B>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.<BR><B>CONCLUSIONS: </B>More studies are highlighting the risks from water and wastewater to patient safety, and the value of water-free strategies in reducing infection rates.