| Title: |
Water-free care in Dutch intensive care unit patient rooms:impact on Gram-negative bacteria detections in routine patient care |
| Authors: |
van Kessel, S. A.M.; Schoffelen, A. F.; van Son, K. H.S.; Notermans, D. W.; Severin, J. A.; Bakhshi-Raiez, F.; Velthuis, F.; Schipper, M.; Dongelmans, D.; Verbon, A.; Wielders, C. C.H. |
| Source: |
van Kessel, S A M, Schoffelen, A F, van Son, K H S, Notermans, D W, Severin, J A, Bakhshi-Raiez, F, Velthuis, F, Schipper, M, Dongelmans, D, Verbon, A, Wielders, C C H & the ISIS-AR study group 2026, 'Water-free care in Dutch intensive care unit patient rooms : impact on Gram-negative bacteria detections in routine patient care', Journal of Hospital Infection, vol. 170, pp. 9-16. https://doi.org/10.1016/j.jhin.2025.12.013 |
| Publication Year: |
2026 |
| Subject Terms: |
/dk/atira/pure/sustainabledevelopmentgoals/good_health_and_well_being; name=SDG 3 - Good Health and Well-being |
| Description: |
Background: Patients in intensive care units (ICUs) are at an increased risk of healthcare-associated infections with Gram-negative bacteria (GNB), for which sinks in patient rooms are known reservoirs. We investigated the association between water-free care practices and the incidence of GNB detections in Dutch ICUs in non-outbreak settings. Methods: We performed a retrospective ecological study (2018–2022) using data from the Infectious diseases Surveillance Information System-Antibiotic Resistance (ISIS-AR), the National Intensive Care Evaluation registry and a questionnaire on water-free care. Detections (colonisation and infections) of seven bacteria groups (Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter spp., all Enterobacterales, extended-spectrum beta-lactamase-producing Enterobacterales [ESBL-E] and carbapenemase-producing Enterobacterales) were analysed at ICU-year level. Incidence rate ratios (IRRs) were calculated for water-free vs. non-water-free ICUs, adjusted for ICU and patient characteristics. Findings: Data from 37 ICUs were analysed, 22 ICU-years in the water-free group and 131 in the non-water-free group. Water-free ICUs were larger, with more surgery admissions and mechanically ventilated patients. For all bacteria, adjusted IRRs were close to 1 with broad 95% confidence intervals (CIs), ranging from 0.82 (95% CI: 0.44–1.52) for ESBL-E to 1.39 (95% CI: 0.69–2.84) for Acinetobacter spp. Sensitivity analyses showed similar results. Conclusion: Although positive effects of water-free care on GNB detection rates have been described in single ICUs, these findings were not reflected in this Dutch multi-centre study. Possible explanations are low infection prevalence, high prevention standards, widespread usage of selective decontamination and insufficient power to detect small differences. Evidence for benefits of water-free care in non-outbreak settings remains limited, highlighting the importance of future research in different ICU settings. |
| Document Type: |
article in journal/newspaper |
| File Description: |
application/pdf |
| Language: |
English |
| ISSN: |
0195-6701; 1532-2939 |
| Relation: |
info:eu-repo/semantics/altIdentifier/pmid/41548666; info:eu-repo/semantics/altIdentifier/pissn/0195-6701; info:eu-repo/semantics/altIdentifier/eissn/1532-2939 |
| DOI: |
10.1016/j.jhin.2025.12.013 |
| Availability: |
https://pure.eur.nl/en/publications/322a4481-e91d-49e9-b17d-60b42c81fda9; https://doi.org/10.1016/j.jhin.2025.12.013; https://pure.eur.nl/ws/files/227176122/1-s2.0-S0195670126000083-main.pdf; https://www.scopus.com/pages/publications/105030271522 |
| Rights: |
info:eu-repo/semantics/openAccess ; http://creativecommons.org/licenses/by/4.0/ |
| Accession Number: |
edsbas.BF391967 |
| Database: |
BASE |