Training Effectiveness in Sterile Services: The Need for Innovation in Operator Training

What Are the Limitations of Current Operator Training in the UK? 

Sterile services play a crucial role in patient safety within the healthcare system, striving to ensure that all surgical instruments are sterile at the point of use and following robust quality management systems to reduce the risk of error or infection. A review of recent studies indicates that a single instrument undergoes on average 104 tasks from the operating room to reuse, with 91% of the error risk being concentrated in sterile processing tasks. The same review estimates that between 6.75 and 9.42 million pounds are lost each year in the UK due to instrument errors. In fact, a 2024 report on patient safety published by Imperial College London found that over 26% of surgical cases had at least one instrument error, with 89% of observed errors being linked to tasks in sterile processing. Given the patient safety risk and the soaring costs of such errors, it might be assumed that staff working within sterile services would be given training of the highest quality and effectiveness. In reality, the UK has a notably mixed picture when it comes to training provision in sterile services.

Why Is Teaching the “Why” as Important as Teaching the “How”? 

The Institute of Decontamination Science (IDSc) Technical Certificate is the benchmark qualification for decontamination training in the UK, with over 900 staff completing the course since its accreditation in 2021. This course, however, is aimed at decontamination managers and leaders, which represent a small percentage of the overall staff cohort, and who do not directly take part in the visualisation tasks that make up such a large percentage of the error rate within sterile services. Operator staff have a different experience. The most common approach is for these staff to be trained internally by senior staff who often cascade their own learning downward. There are several commercial providers available, again with levels of variance in approach and quality. There are several striking factors in terms of how this operator training is actually delivered. The NHS Estates Technical Bulletin for 2024 sets out a competency framework for sterile services staff. It found that 82.5% of operator staff had been practically trained, but lacked theoretical knowledge. In other words, the focus of these training programmes is on the “how” and not on the “why.” There exists a vast body of research and a long-held consensus within the educational community that teaching the “why” is far more effective than only the “how” as a theoretical underpinning provides invaluable context for practical tasks. Furthermore, the means by which this training is conveyed seem not to have kept pace with modern training design. Stale presentations or lengthy didactic talks are common, with little opportunity for interaction. Finally, internal training delivery can be at risk of conflating subject matter knowledge with the distinct skill-set required to convey that knowledge – in other words, a pedagogical approach. This approach, alongside the learning materials and delivery options, form a range of inputs that are vital to ensuring effective learning, as well as tangential benefits related to staff wellbeing, job satisfaction and retention. 

How Does Learning Design Impact Training Effectiveness Across Industries? 

International research provides a broader insight into training effectiveness via a range of research studies conducted globally which all reach similar conclusions, even when targeting different learner profiles for a range of purposes. Larenza et al conducted a meta-analysis of leadership training programmes which concluded that learning design had a significant impact on outcomes, specifically where multiple models were utilised to deliver training. A major Canadian study evaluating the effectiveness of training programmes targeting adult literacy found similar results, including the importance of “the interaction between program design and delivery.” Looking at healthcare specifically, a 2024 study by Giovanelli et al measured the effectiveness of healthcare management training programs. They highlighted the importance of program design and the need to tailor inputs to suit the intended learners. “It is suggested to tailor courses on the basis of participants profiles using different pedagogical approaches and tools, for instance, in terms of teacher composition, lesson delivery methods and learning assessment methods while preserving class homogeneity”. In other words, training programs must be designed to address learner needs through a range of conscious choices in inputs. 

What Can Healthcare Learn from Tailored Operator Training in China? 

A perfect example of this tailored approach in action was provided in a study conducted by Hu et al in 2024. They designed and then monitored a training program for operators within sterile services across a number of healthcare settings in China. These staff (designated as nurses within the Chinese system) were facing exactly the same challenges as those identified within the NHS, with similar outcomes on patient safety and error risk. The study consciously designed training to take the staff requirements into account, one element of which was the concept of fragmented time. “Our training was based on fragmented time management, including the use of mobile learning tools (…) which allowed the nurses to study in the fragmented time of their daily life and work.” By reducing the length of each training session, and by making the learning accessible on mobile platforms, the program was able to ensure high levels of concentration for each session. Not only did the study demonstrate higher levels of individual learning outcome and learning transfer, it also provided indicators of improved time management and training efficiency.

How Does Effective Training Design Improve Learning Transfer and Outcomes? 

Finally, a study by Garavan et al evaluated the state of research on training effectiveness in 2020, and found that: “The research essentially suggests 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.” They go on to highlight that learning transfer leads to positive human resource outcomes and even organisational outcomes. The subsequent studies referenced above bear out this assertion in action, even as it specifically pertains to staff working within healthcare and sterile services in particular.

Why Must the UK Invest in Modern Sterile Services Training Now? 

The strong consensus appears to be that training programs are at their most effectiveness when they are designed to be tailored to the requirements of the learner profile. The innovative use of a mobile platform to provide training that can be accessed in fragmented time is a proven approach that is nonetheless not currently available as standard to sterile service operator staff within the UK. Cascaded training from senior staff delivering didactic long-form sessions accompanied by a presentation negates the possibility of a range of pedagogical approaches being adopted in response to learner needs and reduces the chance of positive learner outcomes. Furthermore, the lack of theoretical underpinning only increases the risk of poor learning transfer, as practical task instructions in isolation cannot be adapted to new situations or unfamiliar contexts. With the cost of unsafe care in England estimated at £14.7 billion per year, and with such a concentration of error risk within sterile services, healthcare providers in the UK may need to begin assessing the cost of persisting with outdated training programs and methodologies, and look to the wide body of real-world examples for inspiration as to how a modest investment in modernised operator training could lead to a range of powerful benefits. In conclusion, there are proven solutions to improve the current outcomes being achieved within the UK sterile service sector, and it remains to be seen if, and when, providers or organisations will rise to the challenge.

References

https://www.infectioncontroltoday.com/view/addressing-sterile-processing-instrument-errors-advanced-technology-data-insights

https://www.imperial.ac.uk/Stories/National-State-Patient-Safety-2024/

https://www.england.nhs.uk/long-read/netb-2024-1-competency-framework-staff-sterile-services-and-decontamination-departments/

Larenza, C.N., D.L., Marlow, S.L.,Joseph, D.L., & Salas, E. (2017) Leadership training design, delivery and implementation: A meta-analysis. Journal of Applied Psychology 102(12) 1686-1718

Palameta et al, 2011 Understanding Training Program Effectiveness: A Comprehensive Framework, Social Research and Demonstration Corporation

Giovanelli, L., Rotonodo, F. & Fadda, N. Management training programs in healthcare: effectiveness factors, challenges and outcomes. BMC Health Serv Res 24, 904 (2024)

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)

Garavan, T.N. et al (2020) The Current State of Research on Training Effectiveness Learning and Development Effectiveness I Organisations. Palgrave MacMillan, Cham

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