Decontamination training
to decline. What might be seen as a saving in a training budget may be totally outweighed by the unintended consequences. In the study by Nichol et al2
(where, it was
quoted), they observed 91% of error risks sat with sterile services. Over the course of one summer, they estimated that lost operating theatre time, due to instrument error (calculated in lost chargeable minutes), was between 6 and 9 million dollars. In the NHS, it is estimated that on-the-day cancellations cost £400 million annually. FOI evidence from multiple Trusts14
consistently demonstrates that 5-10% of these cancellations are directly attributable to issues within sterile services, from instrument error to equipment breakdowns, to late delivery and traceability failures. At its lowest estimate of £20 million a year, this is still double what it would cost to invest £500 in training every single person working in sterile services within the NHS. This financial impact, significant as it is, is additional to the risks to operational integrity, patient safety and workforce sustainability.
Potential solutions A modest investment at a national level could enable a number of proactive steps to be taken to reduce all of these risks. Establishing national baseline competencies tied to recognised qualifications that cater to all roles within sterile services would provide a framework. Funding protected learning time can be costly, but the rollout of micro-learning formats that enable “fragmented-time learning” to take place would be scalable and achievable. A standardised framework such as this could
incorporate career progression pathways, empowering sterile services staff to take their professional journey as far as they wish it to
go, and nurturing aspiration, while also boosting staff retention.
Decontamination services perform a safety-
critical function that surgical services are utterly dependent upon, and decontamination is a recognised healthcare science. There is a volume of evidence that warns of the risks of underinvestment in decontamination training, and demonstrating the positive impact that the introduction of standardised training makes to these teams. Sterile services are run by dedicated, skilled professionals working in a constant cycle within a highly-regulated, high- stress environment. Despite their lack of visibility or prominence compared to services such as surgical theatres, the evidence seems to bear out the contention that the NHS simply cannot afford to leave these staff behind.
CSJ
References 1.
https://www.bbc.co.uk/news/articles/ c8r370k1yx5o
2. Nichol, P.F., Saari, M.J.M. Risk modelling of errors in the surgical instrument cycle, insights into solutions for an expensive and persistent problem. Journal of Perioperative Care and Operating room Management, Vol. 32, (September 2023) 100333
3.
https://www.imperial.ac.uk/Stories/National- State-Patient-Safety-2024/
4. Efthmious CA, Cale AR, Implications of equipment failure occurring during surgery, The Annals of The Royal College of Surgeons of England, Volume 104, Number 9 (2022)
5. World Health Organization, Decontamination and reprocessing of medical devices for health- care facilities (2016) ISBN: 9789241549851
6.
https://www.gov.uk/government/publications/ productivity-in-nhs-hospitals
7. Pure Processing, SPD State of the Industry Report (2025)
www.pure-processing.com
8.
https://nhsproviders.org/resources/state-of- the-provider-sector-2025
9. Castelli, A. et al. Review of decontamination protocols for shared non-critical objects in 35 policies of UK NHS acute care organizations, Journal of Hospital Infection, Volume 120, 65 – 72 (2025)
10. Wu L, Tang L, Zhuang L, Xie W, Liu M, Li J (2023) Construction of a standardized training system for hospital infection prevention and control for new medical staff in internal medicine ICUs based on the Delphi method. PLoS ONE 18(11): e0294606.
https://doi.org/10.1371/journal. pone.0294606
11. Hu, T., J., Jiang, S. et al. Improvement and implementation of central sterile supply department training program based on action research. BMC Nurs 23, 184 (2024)
12. Garavan, T.N. et al (2020), The Current State of Research on Training Effectiveness Learning and Development Effectiveness in Organisations. Palgrave MacMillan.
13.
https://www.audit.wales/sites/default/files/ operating-theatres-2016-eng_7.pdf
14. Results of FOI request issued to UK Trusts, submitted by All Things Decontamination. Details available on request.
About the author
Tony Sullivan has worked in Decontamination for over 20 years, following 23 years of service in the Royal Air Force. Starting out as a service engineer, Tony went on to manage a national team of engineers for Getinge, before moving into the NHS. He led sterile services as Decontamination Lead in several Trusts before moving to offer external Decontamination training and support during the COVID-19 pandemic. Tony now leads All Things Decontamination, a business that provides City & Guild’s accredited training programmes for Sterile Services leaders, engineers and operators.
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