Decontamination
means in measurable terms. Under EN 556, a terminally sterilised medical device can be described as sterile when the theoretical probability of a viable micro-organism being present on or in the device is no greater than 1 × 10-
⁶, following a validated sterilisation
process. Put simply, this equates to a probability of less than one in a million that a finished device contains a viable micro-organism. Andrew further explored whether a probability can be assigned to the risk of infection when a CSSD-validated decontamination cycle and steam sterilisation are used. Starting with the standard sterility assurance
level of 1 in 1,000,000, Andrew explained that the organisms most commonly associated with surgical site infections are generally more susceptible to destruction than the heat-resistant endospores used to validate sterilisation processes. This creates an additional safety margin of 1–2 log, improving the probability to between 1 in 10,000,000 and 1 in 100,000,000. Validated cleaning further reduces bioburden before sterilisation, adding another 2–3 log safety margin. In practical terms, this improves the estimated probability to between 1 in 100,000,000 and 1 in 10 billion. Andrew also outlined how the Health and
Safety Executive categorises risk: l Highest risk (unacceptable): greater than 1 in 1,000 to 1 in 10,000
l Intermediate risk (risk reduction – ALARP): 1 in 10,000 to 1 in 1,000,000
l Lowest risk (broadly acceptable): less than 1 in 1,000,000
The lecture also considered how surgeons assess infection risk. Across several studies, common themes included: l A wide variation in perceived probability, ranging from 4% to 100%.
l Risk perception influencing behaviour (49–85%).
Clear, transparent communication of risk is essential in decontamination sciences. By combining evidence, probability and confidence levels with plain language, services can support better decision-making, strengthen trust and demonstrate their vital role in patient safety.
l Infection risk frequently underestimated. l A tendency to rely on heuristics (intuition) rather than data.
Andrew then turned to the consequences of poor risk communication and organisational decision-making. He shared examples from the Clostridioides difficile outbreak at Maidstone and Tunbridge Wells NHS Trust (2004–2006), and the waterborne and airborne infection incidents at the Queen Elizabeth University Hospital in Glasgow. In the Maidstone and Tunbridge Wells case, more than 1,000 cases and 90 deaths were attributed to the outbreak. The investigation identified several issues: l Infection risk was perceived as low and manageable.
l Environmental contamination was underestimated.
l The probability of cross-infection was not recognised.
These issues were compounded by bed occupancy pressures, outsourced cleaning arrangements with unclear accountability, limited prioritisation of infection control advice and the normalisation of established ways of working. The Queen Elizabeth University Hospital example further demonstrated how environmental risks can be underestimated.
Infections in a paediatric oncology unit were linked to contaminated water outlets, with several deaths under investigation. l Water contamination was considered very unlikely.
l Environmental reservoirs were not fully recognised.
l Transmission probability was not quantified.
Contributing factors included fragmented governance, strained relationships between estates and infection control teams, unclear ownership of risk, delayed responses to warning signs and an overreliance on compliance documentation. To conclude, Andrew set out practical
principles for improving risk communication in Decontamination Sciences, drawing on Blastland et al (2020).1
l Inform, not persuade l Achieve balance, but avoid false balance – clearly present calculations and emphasise that even low risks must be considered alongside confidence levels.
l Disclose uncertainties – be open and transparent where evidence is limited.
l State evidence quality l Preempt (“prebunk”) misinformation
Andrew concluded that there remains a significant opportunity to improve how risk and uncertainty are communicated across Decontamination Sciences. Clearer explanations would help demonstrate the high standards achieved by decontamination services and strengthen understanding of their value, reliability and role in patient safety. The next generation of HTMs offers an important opportunity to support this shift by including dedicated guidance on risk, risk communication and visualisation. The key takeaway of this session was that
clear, transparent communication of risk is essential in Decontamination Sciences. By combining evidence, probability and confidence levels with plain language, services can support better decision-making, strengthen trust and demonstrate their vital role in patient safety.
October 2026 I
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