At Wexham Park Hospital in Slough, Intensive care unit consultant Dr Karim Fouad Alber had a few questions when he and his colleagues were asked by his hospital to start washing their hands less.
“I had multiple questions,” he recalled while speaking to The Telegraph.
The first sounds pretty reasonable. “Whether (not handwashing) was going to be clean enough for the sterile procedures that we were doing?” he asked.
For a time, he simply kept washing as usual — until the sinks were taped over, and then removed entirely.
Over the past year, 23 sinks have been taken out of the hospital’s ICU and 108 removed across nine wards, including elderly care and oncology. Eventually, as much as 80% of all sinks on the site may disappear, leaving only those in toilet facilities. At Wexham’s sister site, Frimley Park Hospital, even neonatal units are slated for sink removal.
The move may sound counterintuitive — especially after years of public-health campaigns urging vigilant handwashing — but Wexham Park is the first hospital in the UK to adopt a “water-safe” model, inspired by emerging practices in the Netherlands and Germany, reported The Telegraph.
The strategy’s architect, consultant clinical microbiologist Dr Manjula Meda, insists the aim is not to reduce hygiene but to eliminate a hidden, powerful source of antimicrobial-resistant bacteria: hospital plumbing.
Dr Meda explained that sinks, drains and wastewater pipes act as “reservoirs of bacteria… an Amazon rainforest in drain systems.”
When people wash their hands — often inadequately — microbes enter drains, flourish in warm, nutrient-rich pipes, and grow more resistant when exposed to antibiotics excreted in urine.
“These bugs are using drainage systems as a superhighway,” The Telegraph quoted her as saying.
Studies show a sink’s splash zone can extend two meters. Pressure changes in pipes can push bacterial “plumes” back into the air. In environments full of vulnerable patients, such as ICUs, this creates a dangerous pathway for multidrug-resistant organisms, or superbugs.
The most feared among them are carbapenemase-producing Enterobacterales (CPEs), such as E. coli strains that colonise the gut harmlessly but can cause fatal infections if they enter the bloodstream. CPEs are resistant to almost all antibiotics, with mortality rates from 30% to more than 50%.
According to the report, international research has linked a significant portion of hospital-acquired CPE cases to sinks. Studies estimate 7–40% of patient acquisitions originate from them. In French ICUs, half of sink drains have tested positive for multidrug-resistant organisms. A German study found ICUs with sinks had 30% higher rates of hospital-acquired infections, added the report.
Rise in superbug cases triggers drastic action
Wexham Park began considering water-safe policies after increases in CPE cases: 8 detected in 2022–23, rising to 14 in 2023–24, with limited screening. While many cases represented harmless colonisation, up to 20% can progress to infection. That was enough for the trust to act.
Now, all patients are screened on admission and discharge.
Early results are striking as hospital-acquired CPE cases fell from 80 in 2024–25 to 40 in 2025–26. In ICU, rates of infections across the board — including pneumonia— have dropped by almost half. The Eden Day oncology unit reported just one new CPE case since early 2024, down from nine the previous year, reported The Telegraph.
Culture shock for staff
For nurses and doctors, adjusting to water-free workflows has been a seismic cultural shift.
“Handwashing is what we are taught — Florence Nightingale handwashing,” The Telegraph quoted ICU matron Ruramai Chidzambwa as saying. Senior sister Sandra Stirzaker admits she still finds herself walking to where sinks used to be.
Instead of sinks, ICU bays now feature sanitiser stations, glove dispensers and specialised waste bins. Only three sinks remain in the unit, along with two experimental wall-mounted taps known as “Frimley faucets”, which dispense a single litre of water at a time. Staff rely on wipes for patient hygiene, collect limited water for washing, and use gel plus dental-style suction to clean patients’ teeth.
“It’s quite challenging to keep walking around,” said staff nurse Margie Yambao, whose trips to the distant faucet have become part of her daily routine.
Despite the logistical hurdles, sanitiser — used between every patient interaction —has replaced soap and water for most staff. Hands are washed only when visibly soiled, after toilet use, or when caring for patients with gastrointestinal infections.
Why soap and water aren’t always safer
To infection-control specialists, the shift aligns with mounting evidence that water can carry more risk than benefit in clinical settings. Past infection-control approaches pushed hospitals to install sinks “in every corner,” especially to combat infections such as C. difficile. But newer studies show C. difficile can contaminate sinks as well.
Keeping each sink “safe” costs about £1,000 per year, according to the trust—a significant sum in an era of rising NHS financial pressures.
At Wexham’s redesigned ICU utility room, new washable bowls and nine-minute disinfection cycles replace much of the sink’s role. Even the shower room has been re-engineered: the shower head was moved far from the plughole to prevent splash-back.
Chidzambwa says the turning point was reframing the concept, “Defining it as hand hygiene made a difference.”
Patients adjust to water-free hospital
Reactions among patients have ranged from surprise to curiosity. In the Eden Day oncology unit, chemotherapy patients sit beside bottles of hand sanitiser rather than sinks.
“Especially in a hospital environment, it was surprising,” The Telegraph quoted Rosalind Bieber, accompanying her partner for treatment, as saying.
“But everywhere you go they have hand sanitiser—you’re not short of it,” Bieber added.
Sisters Marian Poff, 71, and Eileen Conroy, 68, admit the change felt strange.
Conroy, herself an oncology nurse at another hospital, said, “If I have a sandwich, I like to wash my hands… But if results are proving positive, go with it.”
Global movement toward water-free ICUs
The UK is not pioneering this approach alone.
At Radboud University Medical Center in the Netherlands, microbiologist Dr Joost Hopman led a two-year study removing sinks after outbreaks linked to Enterobacter cloacae.
“We tried cleaning and disinfecting, putting disinfectants in the drain—nothing worked,” Infection Control quoted Hopman as saying.
Biofilms, he explains, always return. “To me, the only sustainable solution is to remove this source,” Hopman added.
Tap water itself can be a risk, carrying bacteria like Pseudomonas and Legionella. Sinks also create aerosols that contaminate nearby surfaces, including medication-prep areas. Combined with biofilm growth deep in plumbing, sinks become nearly impossible to sanitise reliably.
Hopman emphasises that sink removal is only one piece of infection control.
“Prevention is always a multimodal intervention,” he said. But eliminating a constant source of multidrug-resistant bacteria makes every other measure more effective.
The future: Waterless hospitals?
Dr Meda envisions even bolder innovations, including aviation-style waterless toilets. “Wexham is a blueprint for the NHS,” she said, though she acknowledges the cultural transition has been significant.
For Dr Alber, the initial sceptic, the evidence has been persuasive. He admits he once used running water simply to warm his hands before examining patients. Now he accepts that those sinks may have posed more danger than comfort.
“I very much support the project,” he said. “I think it should be the standard.”
Then he smiles. “But I don’t think handwashing is a bad thing either.”
With inputs from agencies
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