Theatres and decontamination
fit for purpose for the patient? There are real risks if we push forward with this without proper consideration of those issues,” he warned. Doros added that there is significant pressure
across Europe, and globally, to reprocess single use devices, and there will be “a brand-new era for decontamination and theatres” that we will need to prepare for, he observed. This may mean re-categorisation of certain devices, under the Spaulding classification, such as blood pressure cuffs, for example. Are they really critical devices or are they semi critical, and do they need to be disposable? Sean called for decisions to be made in a
coordinated way by the whole of the NHS, as Trusts are currently working in silos. This is a wider issue around procurement in general, he observed. The panel emphasised that there is a need
for greater national coordination, with a more standardised approach to procurement choices across the NHS, when it comes to sustainability and infection prevention. This led on to the question on standardised versus clinical preference, and ‘who should decide what is on a theatre tray?’ Doros said that we need to protect clinician
choice and it matters. However, there is a need for greater standardisation – not just within the NHS, but also within hospitals in the same Trust. Variation is “often legacy, not necessity”, he argued. Ian agreed there should be standardisation, but we can support clinical choice by providing additional supplementaries for individual clinicians and procedures. “That way you can keep the standard tray and just add to it,” he commented. Sean also recognised the importance of
collaboration in achieving standardisation on basic tray sets, but pointed out that getting a group of surgeons to agree on what should be included for a specific procedure can be a challenging and lengthy process. “CSSDs can help us because they will know, on a regular basis, where instrumentation isn’t used. There needs to be a conversation with all the stakeholders to say ‘there’s 40 instruments on this and we don’t use 20 of them’,” he commented. Sean further suggested that by standardising common procedure sets nationally, for example for hernias, we can avoid drawn out debates over this. However, it will also prove helpful when a
surgeon moves to another Trust, as they will already be accustomed to using the set. The panel pointed out that this could also help the NHS achieve the best value for money. Doros suggested that AI and cameras are
already being used to monitor the sterile field, so this could also capture data on which instruments are being used by surgeons. “Over 6-12 months, we could build up a data set that accurately reflects what is actually being used, so the conversation can move away from, ‘this is what I think should be on the set’ to ‘for the past four months, you’ve only used these instruments. Why do you need the rest?’” Ultimately, standardisation could support efforts around sustainability, reduce the amount of instruments being sterilised, reduce the pressure on the system, and save money. “We are all processing too much,” Doros commented. Other discussion points included the fact that increasing pressures on services, resources, staff and finances are all contributing to damage of instruments. Many theatres do not have a repair budget, and Trusts are still not carrying out inspections of instruments when they are first procured. This is despite reports by the BBC that rigorous inspections carried out by Barts and the London NHS Trust led to 20% of surgical tools being rejected due to being unsafe for use.1
The
Standardisation could support efforts around sustainability, reduce the amount of instruments being sterilised, reduce the pressure on the system, and save money.
32
www.clinicalservicesjournal.com I July 2026
panel called for increased investment in sterile services and to prioritise replacements for key assets. Trevor pointed out in his closing remarks that,
“All the time you keep coping, nothing is going to change.” It is only when equipment breaks down, that it becomes apparent just how much theatres depend on sterile services, as surgery has to be halted. He called on these critical services to be made a national priority. Ultimately, the take-home message was that the key to improvement is “collaboration, collaboration, collaboration.” CSJ
References 1. BBC Panorama, Surgery’s Dirty Secrets, 5 Jul 2011.
https://www.bbc.co.uk/news/uk-13894880
About NPAG
The National Performance Advisory Group (NPAG) is a national NHS organisation operating on a self-financing basis, with clients from across the UK and from a wide range of NHS organisations. These include Acute, Community, Mental Health, and Ambulance Trusts. The organisation supports NHS and public sector managers in the continuous improvement of their services through Best Value Groups, Conferences and Networking. NPAG is a trading division of the East of
England Ambulance Service NHS Trust, and reinvests off all its profits into their frontline services to support NHS innovations. For further details of future events, visit: https://
www.npag.org.uk/conferences
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