Decontamination
Tackling risk and uncertainty
At the Central Sterilising Club (CSC) Annual Scientific Meeting 2026 risk and uncertainty in decontamination was high on the agenda. The event, which took place at the Crowne Plaza Hotel Nottingham, highlighted some of the key challenges and best practice across the sector.
A Professor of Clinical Bacteriology and Honorary Consultant Microbiologist for NHS Greater Glasgow and Clyde, Andrew Smith used the Kelsey Lecture to explore how decontamination professionals can communicate risk, probability and uncertainty more clearly. Drawing on sterilisation science, public health incidents and organisational learning, the lecture showed why vague terms such as “high risk”, “low risk” or “common” can be misleading unless supported by numbers, confidence levels and plain language. The key message was that clearer risk communication can help clinical teams, leaders and boards make safer decisions while recognising the high standards and patient safety value of decontamination services. Drawing on J. C. Kelsey’s 1972 publicationThe
Myth of Surgical Sterility, Andrew challenged delegates to think about how probability and uncertainty shape decision-making, and why clearer communication is essential when engaging with clinical teams, senior leaders and boards. A key influence on Andrew’s thinking has
been Professor Sir David Spiegelhalter’s work on uncertainty, particularlyThe Art of Uncertainty: How to Navigate Chance, Ignorance, Risk and Luck. The lecture used these ideas to explore how professionals can communicate evidence, confidence and uncertainty more effectively. Andrew illustrated the consequences of
unclear language using the 1961 Bay of Pigs invasion. Although the Joint Chiefs of Staff assessed the operation as having a 70% chance of failure, this was presented to President Kennedy as “a fair chance of success”. The example highlighted how words can soften, distort or obscure meaning, particularly when numbers and confidence levels are not made explicit. Andrew reminded the audience that risk is
built from two essential components: l The probability of harm occurring. l The consequences of that harm (its severity).
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In Decontamination Sciences, the harm being considered is the transmission of infection following a failure to adequately decontaminate a medical device. The lecture then explored some of the key concepts that sit behind effective risk communication: l Uncertainty: the conscious awareness of what we do not know, whether about the past, present, or future. In scientific terms, it can be expressed as a quantifiable estimate of error within data.
l Risk (in science): uncertainty that can be quantified in relation to a hazard.
l Probability: a measure of how likely an event is to occur, often described simply as how often something happens out of a given number of opportunities.
Andrew also introduced two common ways of thinking about probability: l Frequentist – based on observed frequencies (e.g. a coin toss having a 50% chance of landing heads).
l Subjectivist (Bayesian) – based on informed judgement, where uncertainty resides in our knowledge rather than the environment.
Both approaches assign a probability value between 0 (impossible) and 1 (certain). The audience was invited to consider
what terms such as “high risk” and “low risk” really mean in practice. Using the Spaulding classification as an example, live polling showed that interpretations varied widely, with many delegates associating “high risk” with a likelihood of 80–90%. This demonstrated the challenge of relying on terminology alone when describing infection risk. Andrew went on to discuss surgical site infections and the factors that contribute to them. He then moved on from the language of risk to the numbers behind it – showing how probability can help make abstract concepts more concrete for clinical and decontamination audiences. The lecture also considered what sterility
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