There is an increasingly strong rationale for going “water free” (or at least “water lite”) in our delivery of critical care to reduce the risk of antibiotic-resistant Gram-negative infections. But it’s a challenging concept in quite a few ways. In fact, when I’ve suggested it in the past, there has been a palpable gasp and quite a few objections raised! So I was struck by a recent JHI study exploring barriers to implementing water free care.

Several years ago, I had my own experience of going water free in a neonatal ICU setting. There were some issues with Pseudomonas contamination of a hand washing sink in a neonatal ICU bay. Despite the usual remediation methods, the hospital engineering department were unable to provide assurance that the outlets were safe to use. Point of use filters were not an options due to the design of the sink, so we decided to go water free. This was quite a controversial decision, both from the viewpoint of the IPC team, clinical team, and engineering department! It was a useful exercise to get everybody around the table, review what tap water was used for on the unit, and think about how “water free” (or a at least tap water free) solutions could be provided, especially for patient bathing, hand hygiene. Through a combination of patient bathing wipes and wipes for hand hygiene, we were able to go water free for a short period of time while the sinks were sorted out. Perhaps you could argue there was an opportunity missed to not go water free across the whole unit!

The experience related in the JHI article was similar to mine, with concerns about how to go water free whilst maintaining optimal levels of hygiene in the unit. The concerns from the engineering department outlined in the study were slightly different, and related more to water supply and the age-old issue of getting access to clinical areas to carry out maintenance and improvement work.

One final point to consider here. I’m writing this on my way to an IPC & sustainability conference – and it would be great if water free care could be delivered without increasing our reliance on disposable wipes. But it’s difficult to see a way around this currently.

So, it’s possible to get to water free care. But it requires collaboration with a range of stakeholders and it won’t be popular with everybody.