Decontamination training
Surgeons tracked two cardiac surgeons over a 12-month period. It recorded that out of 139 surgeries, 92% contained at least one equipment failure, and that 80% of those were listed as instrument error.4 It would be unfair to attribute these results
to poor performance by sterile services without a full root cause analysis of the individual organisations within those studies, but the data points to a wider problem. It is telling that in all of the examples above, the studies centre on surgical theatres as the inflection point – but the solution will not be found in surgical theatres. The solution (and the resources to facilitate it) must come from sterile services. And yet, with a body of evidence to suggest that these departments need additional support, there is a gloomy trend of underinvestment in these departments relative to other areas of healthcare.
A global area of underinvestment The World Health Organization guidebook on decontamination, published in 2016, concedes that decontamination staff are often undertrained, relative to the complexity and safety-critical function of their role. It calls for all roles in sterile services to be trained to a job- specific competency and for leaders in those departments to be retrained in decontamination science and not just the processes that the department follows.5
More locally, the Carter
Review, published by the UK Government, discusses chronic underinvestment in support services, which includes decontamination.6
Voices of concern from sterile services This training gap, made worse by said underinvestment, is borne out by the voices of decontamination professionals themselves. The NHS Estates Technical Bulletin found that over 82% of operator technicians within sterile services had been practically trained but lacked theoretical knowledge. This experience is echoed more broadly across decontamination internationally. American survey data on the decontamination workforce found that 33% of respondents had joined sterile services with no prior knowledge. With robust, standardised training in place this would not be a concern. Unfortunately, 40% of respondents also listed training and education (or lack thereof) as their primary concern at work.7 Training of decontamination operators, as the NHS Estates Technical Bulletin notes, is often delivered internally, or as “on-the-job” training, with varying degrees of quality. This decision is driven as much by lack of external options as it is by lack of funding for training.
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If access to standardised external training is restricted, this has the potential to create a bottleneck, where the service overall suffers a lack of succession planning and a shortage of highly skilled, highly trained decontamination leaders to manage this critical service area.
In the UK, the IDSc Technical Certificate is a formal qualification that provides exactly what is needed for these staff, but the investment (both in terms of time and money) makes it difficult to unlock for all operators, and uptake is relatively low compared to the size of the applicable workforce. Recent NHS Providers data shows that 80%
of Trust leaders report some level of concern around career development for their staff, indicating that such constraint with training is felt across multiple support services. Decontamination is a recognised healthcare science, and it is one which rewards a unique combination of skills and knowledge that encompasses microbiology, engineering, quality management, risk assessment and manual processing. The surgical instrument reprocessing cycle is a highly regulated process that demands strict adherence to protocols and standards. In fact, the UK is in the enviable position of having several strong frameworks that would support standardised training, such as the HTM 01-01, the
NHS Long Term Workforce Plan and guidance from the MHRA. It could be reasonably surmised that career
progression that allowed operator technicians to rise through the ranks would be highly valuable and desirable to the healthcare sector overall, as such individuals would bring a unique depth of experience, understanding of the various frameworks and subject mastery. If access to standardised external training is restricted, this has the potential to create a bottleneck, where the service overall suffers a lack of succession planning and a shortage of highly skilled, highly trained decontamination leaders to manage this critical service area.
Unintended consequences Training is not the only area of variation, though it is often the hidden cause. A review by Castelli et al, published in 2025, reviewed decontamination protocols across 35 NHS acute care organisations. It found that protocols were fully aligned in just 2.5% of cases.9
Given that all 35 subjects follow the exact same regulations and standards, it is
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