UK Hospital Removes Sinks to Combat Infection Risk in Patients

Wexham Park Hospital in Slough has removed sinks from its intensive care unit (ICU) and other wards to combat the risk of infections among patients. This initiative, led by consultant clinical microbiologist Dr Manjula Meda, is part of a pioneering “water-safe” model inspired by practices in the Netherlands and Germany. The hospital has already removed 23 sinks from the ICU and a total of 108 across nine wards, including those dedicated to elderly care and oncology. Ultimately, up to 80% of sinks may be eliminated, leaving only those in toilet facilities.

The decision has raised eyebrows, particularly after years of public health campaigns emphasizing the importance of handwashing. Dr Karim Fouad Alber, an ICU consultant, expressed concerns about whether the absence of handwashing facilities would maintain cleanliness during sterile procedures. Initially, he continued to wash his hands as usual until the sinks were taped over and subsequently removed. At Wexham Park’s sister facility, Frimley Park Hospital, plans are underway to remove sinks even from neonatal units.

The rationale behind this controversial approach is to reduce the presence of antimicrobial-resistant bacteria, particularly in hospital plumbing systems. Dr Meda explained that sinks, drains, and wastewater pipes harbor bacteria that can flourish and become resistant to antibiotics. She described these plumbing systems as “reservoirs of bacteria… an Amazon rainforest in drain systems.” Handwashing can inadvertently introduce microbes into these drains, creating a breeding ground for superbugs, including carbapenemase-producing Enterobacterales (CPEs), which are resistant to nearly all antibiotics.

Research indicates that a significant portion of hospital-acquired CPE infections can be traced back to sinks. In French ICUs, half of the sink drains tested positive for multidrug-resistant organisms, while a study in Germany found that ICUs with sinks had a 30% higher rate of hospital-acquired infections. Wexham Park began reviewing its water safety policies following an increase in CPE cases, which rose from eight in 2022–23 to 14 in 2023–24.

To address this issue, the hospital now screens all patients upon admission and discharge. Early results indicate a promising trend, with hospital-acquired CPE cases dropping from 80 in 2024–25 to 40 in 2025–26. The ICU has also seen a nearly 50% reduction in infection rates, including pneumonia. The Eden Day oncology unit has reported only one new CPE case since early 2024, a significant drop from nine cases the previous year.

Adjusting to a sink-free environment has presented challenges for staff. ICU matron Ruramai Chidzambwa noted the cultural shift required for nurses and doctors, who have long been taught the importance of handwashing. Senior nurse Sandra Stirzaker admitted she still instinctively walks towards where the sinks once stood. Instead of sinks, ICU areas now feature hand sanitiser stations, glove dispensers, and specialized waste bins, with only three sinks remaining in the unit. Staff have adapted by using wipes for patient hygiene and relying on hand sanitiser between patient interactions.

The removal of sinks aligns with growing evidence suggesting that water in clinical settings may pose more risks than benefits. Traditional infection control measures led to the installation of sinks “in every corner” to combat infections like C. difficile. However, recent studies have shown that these sinks can also harbor harmful bacteria. Maintaining a single sink can cost about £1,000 annually, a considerable expense for the financially pressured NHS.

At Wexham Park’s redesigned utility room, new washable bowls and disinfection cycles replace many functions previously served by sinks. The shower room has also been re-engineered to minimize splash-back. Chidzambwa emphasized that reframing the concept of hygiene has played a critical role in this transition.

Patient reactions to the changes have varied from surprise to curiosity. In the Eden Day oncology unit, chemotherapy patients are now seated beside bottles of hand sanitiser instead of sinks. One patient, Rosalind Bieber, remarked on the surprising absence of sinks but noted the ample availability of hand sanitiser throughout the hospital.

This innovative approach is not unique to Wexham Park. At Radboud University Medical Center in the Netherlands, microbiologist Dr Joost Hopman led a study that removed sinks following outbreaks linked to Enterobacter cloacae. Hopman stated that no amount of cleaning or disinfecting could eliminate the persistent biofilms in drains, leading to the conclusion that removing the source was the most sustainable solution.

Dr Meda envisions future advancements, such as aviation-style waterless toilets, as part of this evolving model. She believes Wexham Park could serve as a blueprint for the NHS, though she acknowledges the significant cultural adjustment required. For Dr Alber, who initially questioned the decision, the evidence supporting this approach has been compelling. He now recognizes the potential dangers of sinks, stating, “I very much support the project… But I don’t think handwashing is a bad thing either.”