This article by Tony Sullivan argues that underinvestment in sterile services training is one of the most overlooked contributors to patient safety risk across UK healthcare, and was published in the May 2026 edition of the Clinical Services Journal. A Sterile Service Department’s deceptive lack of visibility risks costing the system far more than slashing its training budget will save.
Sterile services may go unseen, but they serve a safety-critical role which, when it fails, has potentially catastrophic implications for patients, staff and healthcare organisations. In an increasingly strained financial climate, there is a need for greater visibility and focus on the function of sterile services within NHS Trusts and private healthcare, to enable these departments to make a strong case for their funding to be protected and increased.
Underinvestment in staffing and training may feel like a difficult but necessary choice when frontline services are threatened, but this decision carries with it high risks to patient safety and fosters long-term problems around recruitment, progression and retention within a critical healthcare science. In this paper, we examine how budgetary and operational pressures are affecting decontamination and offer multiple examples of how these problems manifests and the consequences that follow. It will be argued that investment in decontamination services, and in decontamination teams in particular, is the only approach the reduces overall costs while enhancing patient safety.
Unprecedented Challenges
The NHS faces unprecedented challenges in maintaining safe levels of provision across the UK whilst facing sustained operational and budgetary pressures. Chronic underinvestment over recent years combined with the shocks delivered by the Covid-19 pandemic have combined to create an environment where every spending decision needs to be closely scrutinised and each penny spent in the NHS has to have a clear justification. This is an incredibly challenging backdrop for decontamination units and sterile services in particular, for several key reasons. The first is that decontamination is one of the least visible service areas within the health service, and occupies much less of the public imagination than doctors, nurses, emergency services etc. Secondly, sterile services by their very nature are often only visible when they go wrong. This creates a situation where resources can be stretched and pressure can mount while investment is diverted to frontline services.
The key issue here is that the concept of decontamination as background function is, in fact, an illusion. In 2025, Arrowe Park Hospital gained national news coverage when a mechanical failure in sterile services left residue on surgical instruments, making them unsafe for use. This resulted in a shortage of sterile instruments. Within two weeks of the failure coming to light the Trust declared a critical incident and 1300 surgeries were cancelled within a matter of weeks. Patients were diverted to other hospitals and neighbouring providers loaned sterile instrument kits, but the impact was immediate, significant, and its effects long-lasting. The Trust calculated that the number of patients waiting more than 65 weeks from referral t treatment had increased from 4 to 26, with 21 of those directly attributable to the problem in Sterile Services.
The Prevalence of Instrument Error
Mechanical failures such as the one at Arrowe Park are aberrations, and thankfully rare. However, surgical instrument error (and the risks associated with it) is far from uncommon. An American study in 2023 by Peter Nichol et al estimated that a surgical instrument undergoes 104 tasks on average before coming into contact with a patient. The study showed that 91% of the error risk associated with each instrument sits within Sterile Services, and that 62% of those tasks take place in what the study designated “high-stress environments” – in other words, environments with elevated risk of error due to various pressures. Several studies bear out the unfortunate reality that too many errors occur as a result. A report on patient safety by Imperial College London in 2024 found that 26% of surgical cases recorded at least 1 instrument error over a 12-month period, and that 89% of those errors were linked to a task in sterile reprocessing. This is not a unique problem for the UK. Another study from the Royal College of 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.
It would be unfair to attribute these results with 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 Organisation 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. More locally, the Carter Review published by the UK Government discusses chronic underinvestment in support services, which includes decontamination.
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 with 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.
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. 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, viii 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.ix Given that all 35 subjects follow the exact same regulations and standards, it is initially difficult to understand how such variance can occur. However, if protocols are being set by staff who have not been subject to nationally standardised training, it becomes much easier to draw a connection between variance in input and variance in output. Standardised, equally accessible training for decontamination staff could provide a wide range of benefits.
First, knowledge and skills would be more transferable, allowing for greater circulation among the workforce and faster induction cycles for staff with prior experience. Second, protocols developed from standardised training would align much more closely. These would then have secondary impacts, such as the opportunity for much more collaborative working between different organisations, more opportunity for shared learning and professional discussion as staff face common challenges and can arrive at common solutions.
Preventative Maintenance – Standardised Training
There are a number of recent international studies which may offer the NHS a signpost to follow. Several studies from China show the positive impact that training has upon decontamination/support service staff and, by extension, the performance of their organisations. A 2023 study by Wu et al introduced a standardised training programme into ICU and found that a wide range of safety-critical behaviours improved significantly throughout the staff groups involved. In another example, more specific to decontamination operators, a second study introduced standardised training to nurses (in China, the decontamination operator role is performed by nurses) working in decontamination. This study recognised that one of the key challenges to training this cohort of staff (a challenge shared by the UK) is releasing them for long periods of training when their role is so demanding on their time. The study authors introduced an e-learning component which allowed the staff to learn in “fragmented time” – in other words, small windows that fit within their schedule. This approach not only led to better individual learning outcomes, but the subject organisation reported a number of secondary benefits such as improved time management and spread of training to wider teams.
This awareness of modes of training and the need for them to integrate with the role of the learner, is borne out by research on training effectiveness conducted by Garavan et al in 2020. This study concluded that “where design components are effectively executed this will lead to a sequence of positive cognitive, affective and satisfaction reactions that then lead to positive learning outcomes on transfer.” Applying this to the specific role of the decontamination operator, a design component such as fragmented time learning could reasonably be expected to deliver positive learning outcomes. This transfer of knowledge, retention of learning and ability to apply it in new contexts, should lead to reductions in instrument error, which would in turn cascade positive outcomes up to surgical theatres and impact patient safety overall.
A study conducted in Wales attempted a number of interventions in operating rooms with the aim to reduce risk and promote a culture of safety. One of the 6 interventions listed by staff as having made a positive contribution was the introduction of standardised training. Interestingly, the study authors note in their conclusions that it was difficult to spread this positive impact beyond the pilot theatre.xiii This arguably points to the importance of standardised training needing to be rolled out for all staff and not cascaded internally.
Conclusion – The Cost of Doing Nothing
Budgetary constraint is a reality for the NHS at this moment in time, and while the 10-year plan has been welcomed by many, it remains to be seen what impact, if any, it will have on the provision of training to support Sterile Service staff who serve a critical function to their organisations. The Arrowe Park incident and the consequences for 1300 patients was not caused by a lack of training, but it underscores the potential harm if decontamination is allowed 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 al (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 Trusts 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 whilst 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.
