Florence Nightingale was the first person to recognise 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 AMR 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 programmes 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. A narrative review was undertaken using terms; waterless/waterfree units, waterless/waterfree care, sink reduction, sink removal, washing without water. Databases employed were Pubmed, CDSR,and DARE from January 2000- February 2024 for reviews and original articles. Unit type, geographical location, reasons for a waterless/waterfree approach and outcomes were recorded. Seven papers were identified. Four involved adult intensive care units (ICU), one from care of the elderly settings and two involved a neonatal ICU (NICU). In five papers the aim of intervention was to reduce Gram-negative infections/colonisations. One paper was a systematic review of 'washing without water' which reviewed cost effectiveness and patient experience Of the five papers focusing on Gram-negative bacilli (GNB) all reported a reduction in infections or colonisations post intervention. More studies are highlighting the risks from water and wastewater to patient safety and the value of "waterfree" strategies in reducing infection rates.