Decontamination training
Underinvestment in training creates systemic risk
In this article, Tony Sullivan argues that underinvestment in sterile services training is one of the most overlooked contributors to patient safety risk across UK healthcare. This department’s deceptive lack of visibility risks costing the system far more than slashing its training budget will save, he argues.
Sterile services may go unseen, but they serve a safety-critical role which, when it fails, has potentially catastrophic implications for patients, staff and healthcare organisations. In an increasingly strained financial climate, there is a need for greater visibility and focus on the function of sterile services within NHS Trusts and private healthcare, to enable these departments to make a strong case for their funding to be protected and increased. Underinvestment in staffing and training
may feel like a difficult but necessary choice when frontline services are threatened, but this decision carries with it high risks to patient safety and fosters long-term problems around recruitment, progression and retention within a critical healthcare science. In this paper, we examine how budgetary and operational pressures are affecting decontamination and offer multiple examples of how these problems manifest and the consequences that follow. It will be argued that investment in decontamination services, and in decontamination teams, in particular, is the only approach that reduces overall costs while enhancing patient safety.
Unprecedented challenges The NHS faces unprecedented challenges in maintaining safe levels of provision across the UK, while facing sustained operational and budgetary pressures. Chronic underinvestment over recent years, combined with the shocks delivered by the COVID-19 pandemic, have combined to create an environment where every spending decision needs to be closely scrutinised and each penny spent in the NHS has to have a clear justification. This is an incredibly challenging backdrop for decontamination units and sterile services, in particular, for several key reasons. The first is that decontamination is one of the least visible service areas within the health service, and occupies much less of the public imagination than doctors, nurses, emergency services etc.
Secondly, sterile services by their very nature are often only visible when they go wrong. This creates a situation where resources can be stretched and pressure can mount while investment is diverted to frontline services. The key issue here is that the concept of decontamination as background function is, in fact, an illusion. In 2025, Arrowe Park Hospital gained national news coverage when a mechanical failure in sterile services left residue on surgical instruments, making them unsafe for use. This resulted in a shortage of sterile instruments. Within two weeks of the failure coming to light, the Trust declared a critical incident and 1300 surgeries were cancelled within a matter of weeks.1
Patients were
diverted to other hospitals and neighbouring providers loaned sterile instrument kits, but the impact was immediate, significant, and its effects long-lasting. The Trust calculated that the number of patients waiting more than 65 weeks from referral to treatment had increased from 4 to 26, with 21 of those directly attributable to the problem in sterile services.
The prevalence of instrument error Mechanical failures such as the one at Arrowe Park are aberrations, and thankfully rare. However, surgical instrument error (and the risks associated with it) is far from uncommon. An American study in 2023 by Peter Nichol et al estimated that a surgical instrument undergoes 104 tasks on average before coming into contact with a patient. The study showed that 91% of the error risk associated with each instrument sits within sterile services, and that 62% of those tasks take place in what the study designated “high-stress environments” – in other words, environments with elevated risk of error due to various pressures.2 Several studies bear out the unfortunate
reality that too many errors occur as a result. A report on patient safety by Imperial College London, in 2024, found that 26% of surgical cases recorded at least one instrument error over a 12-month period, and that 89% of those errors were linked to a task in sterile reprocessing.3 Another study from the Royal College of
May 2026 I
www.clinicalservicesjournal.com 35
▲
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60
