A New Approach To Training In SSD & EDU

A new approach to training in decontamination

Reported instances of failed decontamination practices within the UK are fortunately infrequent, however due to their nature they are always significant. Very recently, the Healthcare Safety Branch Investigation report has highlighted yet again the causes and consequences of these such failures.

After each event, a review of the root cause analysis may highlight many contributing factors;

• Failure to follow Instructions for Use (IFU)
• Inadequately cleaned/disinfected prior to packaging
• Incorrectly packaged
• Incorrect sterilization method/cycle
• Equipment failure
• Failure to follow Work Instructions / SOP’s

If we disregard wilful neglect, each of the above failures are a consequence of someone undertaking a duty or task without sufficient knowledge and understanding.

Almost every report published of this nature makes recommendations to ensure that staff are adequately trained and understand the critical aspects being performed in their role. One of the earliest reports advising of the need to adequately train people was published in 1958, Present Sterilizing Practises in Six Hospitals, this concluded that the need for trained and competent operators is essential.

So why after 60 years are we still seeing reports of failures to decontaminate equipment effectively and that staff training is a root cause?

The latest report published concludes that staff completed a local training and that “there is not a national competence framework”. It also states that “staff were the strongest barrier to prevention of incorrectly decontaminated equipment being sent to operating theatres for use”. These two statements underline the importance of each and every staff member’s departmental training, but also a need to ensure that Continuous Professional Development (CPD) is incorporated as part of staff Training and Development.

Guidance and Reference

In decontamination guidance provided today and in historical guidance, training is mentioned usually in one short paragraph, stating training is required to be undertaken, records maintained, and line managers are responsible for these records.

Our current guidance HTM 01-01 (2016) Part A states;

6.30 Staff undertaking decontamination and management of decontamination should be able to demonstrate their competencies and training in this area through individual training records, detailing the appropriate core competencies and any other supplementary training. These records should be updated at least annually. Line or training managers should be responsible for maintaining these records.

The purpose of the HTM is to help health organisations to develop policies. Other than stating people need to be trained the HTMs do not offer any other support with training. On the job training is the norm for most staff working in decontamination.

Many departments are accredited to ISO 13485:2016 Medical devices — Quality management system, the standard advises that the organisation needs to provide training, establish competency, and maintain appropriate records of education, training, skills, and experience. They do have an additional element under Human Resources 6.2 which explains the training requirements, ‘d) ensure that its personnel are aware of the relevance and importance of their activities and how they contribute to the achievement of the quality objectives’. Which is an excellent addition to the requirements. People working in decontamination need to be aware how important their role is for the patient.

It is clear that there is a large gap in the guidance the departments follow to provide a national competency framework and ongoing training and development for every member of staff in a department, no matter their role or level.

In 2016, The World Health Organization created a manual to provide guidance in improving standards in sterile services across health-care facilities worldwide. The manual ‘provide guidance to health managers and health workers on required infrastructures and standard procedures for effective sterilization, and decontamination reprocessing of medical devices.’ Supporting managers with every element you would need to run an effective department.

The manual set out an example of the levels of competence is shown below.

Educational requirements and qualifications

• Entry level operator: high school leaving certificate
• Two-year trained operator: completion of the basic SSD curriculum
• Five-year trained operator or supervisor: completion of the intermediate SSD curriculum
• More than 8 years of training or manager level: completion of the advanced SSD curriculum

Each of the 3 curriculums provide basic objectives and content for what should be covered in the competencies, which is extremely helpful for departments. Each of the elements could be expanded in much more detail but it is a great starting point to help departments who are all creating their own framework to support their staff.

The Education Landscape

Education for decontamination has changed many times over the last few decades.

The IDSc, one of the UK’s leading bodies for Decontamination Sciences, has promoted education and development within the industry for over 50 years. The IDSc Technical Certificate established in 2010, was recently accredited by the Scottish Qualifications Authority (SQA) which provides candidates who successfully complete the programme with a recognised qualification at a Level 3 – Qualification in England and Wales. Usually taking around 2 years to complete with significant mentoring and support.

The pre-qualification for undertaking the IDSc Technical Certificate course is completion of;

• An Induction Programme
• Initial Department Training

This puts a focus on the departmental training being provided and delivered as this is the most commonly used training method and will be the only decontamination training for the majority of staff within the Decontamination industry.

Back in 2004, the NHS National Decontamination Training Programme provided access to an e-learning package which intended to provide 13,000 staff with best-practice advice and guidance related to the decontamination of surgical instrument, which was centrally funded. This package is no longer available.

Over the years there has been many formal qualifications available such as NVQs, Foundation Degrees, BSc (Hons) and MSc all created with a focus on decontamination, unfortunately all of which have been withdrawn for differing reasons.

Currently, formal qualifications available are Apprenticeships and City & Guilds accredited courses. City & Guilds generally have a focus on machine operation, engineering courses and courses for Users and Decontamination Leads who are responsible for the process. There are not many courses of this type available for Technician level and would require considerable investment from the department of time and money.

Apprenticeships for decontamination come under BTEC Level 2 Diploma in Healthcare Science. There is an element of mandatory units which are not decontamination related but will provide some important information. The decontamination units are part of the optional units. This is an approach some departments are completing for new starters who have no decontamination background, the mandatory units can cause some confusion though about what they are being trained on. For established staff, this is rarely a route they would like to take as they are already trained and completing the role, there is no perceived benefit to staff who have worked in a department for many years. This qualification would also require a mentor from the department.

Typically, the focus for formal qualifications has been for staff who are looking to progress their careers into managing a department, where managers are looking at succession planning. But we need to look after the education of those who continue to provide the service of clean and sterile instruments for patients.

What does a departments training programme look like?

With over 200 Trusts in the UK and many private hospitals, the decontamination departments are creating their own internal training programmes and framework to help support their staff. Therefore, creating many different approaches and plans to provide training; how can staff be sure that they are receiving the same level of training and the same correct information as another department.

Most training completed in departments is relative to internal work instructions/SOPs. These documents are focused on how to do the task and rarely cover why we do the task, explaining the specific details behind the processes. This specific information could be discussed as part of the hands-on training, but it is unlikely to be documented and therefore where do staff turn to refresh themselves with this level of training and information.

The quality and content of the local training material across the UK will no doubt vary considerably which in turn means the staff are likely to be receiving differing levels of education and knowledge between departments but also within each department. There needs to be consistency of how training is delivered to each member of staff, ensuring the trainer/mentor has the required knowledge and skills to perform this role, again this role could be clarified by a structured framework.

Budgets & Funding

Budgets for training differ from Trust to Trust. Obviously investing in your staff requires funding, department budgets rarely allow for training of every member of staff. There are a few people that are able to go on a course for formal qualification as mentioned before and if there is any budget this is spent on the qualifications for engineers or staff members looking to progress their careers into department management. In some cases, departments have not had any training available to utilise the training element of their budget and therefore this gets removed from the budget the follow year.

All Trust Learning &Development departments do have a budget specially for training. There are various processes that departments are required to go through to get access to this funding but again historically it has not been used by decontamination departments. It may take a little bit of work to complete the required applications or processes but there should be training funds available for all departments.

Investment in your staff and the future of your department

Departments across the country are experiencing difficulties in recruiting and retaining staff. 

NHS’s health career website states for someone who is interested in a career in decontamination and sterile services the training and development they would receive is a department induction, on the job training and then encouraged to take additional training such as the IDSc Technical Certificate. It goes on to advise that no matter what level you are working at, as part of your development, you will be expected to do continuing professional development (CPD) to show that you are keeping yourself up to date with the policies and procedures in your area of work.

CPDUK, which was established in 1996, is the largest and leading independent CPD accreditation organisation working across all industry sectors. They advise that CPD learning helps employers retain key staff and develop the skills & knowledge in their organisation. It is clear that CPD is a key motivator in staff retention and but also to attract new people to their organisation.

This is echoed by the job descriptions written and made available by the IDSc for all levels working in the industry. On the job description under the education & training section, staff are asked to ‘To comply with the Department’s training programme’ and ‘To continually develop and maintain a portfolio of evidence of training and CPD activities.’

Without structed training framework and ongoing personal development, how does a role in decontamination look to a school leaver at a career fair compared to other industries? We want to be actively promoting the important roles our staff complete. Structured training and CPD is clearly a key motivator in attracting new people.

Retaining trained staff is also a battle that departments have been contending with. Staff want to feel supported, they want to feel invested in. They want to see the department progressing and moving forward like other Healthcare sectors and other industries. Investing in regular training will help show staff that they are vital to the success of the department, the process and ultimately patient safety.

What could a structured training programme look like?

There are several different approaches to what a structured training framework should contain. The main focus has to be on ensuring all staff have the knowledge and understanding for each area of the decontamination process, no matter where they work to ensure they have the awareness of how they contribute to the end product for the patient. It could contain the following.

EXAMPLE OF A STRUCTURED TRAINING PROGRAMME

A new approach to training in decontamination

Reported instances of failed decontamination practices within the UK are fortunately infrequent, however due to their nature they are always significant. Very recently, the Healthcare Safety Branch Investigation report has highlighted yet again the causes and consequences of these such failures.

After each event, a review of the root cause analysis may highlight many contributing factors;

• Failure to follow Instructions for Use (IFU)
• Inadequately cleaned/disinfected prior to packaging
• Incorrectly packaged
• Incorrect sterilization method/cycle
• Equipment failure
• Failure to follow Work Instructions / SOP’s

If we disregard wilful neglect, each of the above failures are a consequence of someone undertaking a duty or task without sufficient knowledge and understanding.

Almost every report published of this nature makes recommendations to ensure that staff are adequately trained and understand the critical aspects being performed in their role. One of the earliest reports advising of the need to adequately train people was published in 1958, Present Sterilizing Practises in Six Hospitals, this concluded that the need for trained and competent operators is essential.

So why after 60 years are we still seeing reports of failures to decontaminate equipment effectively and that staff training is a root cause?

The latest report published concludes that staff completed a local training and that “there is not a national competence framework”. It also states that “staff were the strongest barrier to prevention of incorrectly decontaminated equipment being sent to operating theatres for use”. These two statements underline the importance of each and every staff member’s departmental training, but also a need to ensure that Continuous Professional Development (CPD) is incorporated as part of staff Training and Development.

Guidance and Reference

In decontamination guidance provided today and in historical guidance, training is mentioned usually in one short paragraph, stating training is required to be undertaken, records maintained, and line managers are responsible for these records.

Our current guidance HTM 01-01 (2016) Part A states;

6.30 Staff undertaking decontamination and management of decontamination should be able to demonstrate their competencies and training in this area through individual training records, detailing the appropriate core competencies and any other supplementary training. These records should be updated at least annually. Line or training managers should be responsible for maintaining these records.

The purpose of the HTM is to help health organisations to develop policies. Other than stating people need to be trained the HTMs do not offer any other support with training. On the job training is the norm for most staff working in decontamination.

Many departments are accredited to ISO 13485:2016 Medical devices — Quality management system, the standard advises that the organisation needs to provide training, establish competency, and maintain appropriate records of education, training, skills, and experience. They do have an additional element under Human Resources 6.2 which explains the training requirements, ‘d) ensure that its personnel are aware of the relevance and importance of their activities and how they contribute to the achievement of the quality objectives’. Which is an excellent addition to the requirements. People working in decontamination need to be aware how important their role is for the patient.

It is clear that there is a large gap in the guidance the departments follow to provide a national competency framework and ongoing training and development for every member of staff in a department, no matter their role or level.

In 2016, The World Health Organization created a manual to provide guidance in improving standards in sterile services across health-care facilities worldwide. The manual ‘provide guidance to health managers and health workers on required infrastructures and standard procedures for effective sterilization, and decontamination reprocessing of medical devices.’ Supporting managers with every element you would need to run an effective department.

The manual set out an example of the levels of competence is shown below.

Educational requirements and qualifications

• Entry level operator: high school leaving certificate
• Two-year trained operator: completion of the basic SSD curriculum
• Five-year trained operator or supervisor: completion of the intermediate SSD curriculum
• More than 8 years of training or manager level: completion of the advanced SSD curriculum

Each of the 3 curriculums provide basic objectives and content for what should be covered in the competencies, which is extremely helpful for departments. Each of the elements could be expanded in much more detail but it is a great starting point to help departments who are all creating their own framework to support their staff.

The Education Landscape

Education for decontamination has changed many times over the last few decades.

The IDSc, one of the UK’s leading bodies for Decontamination Sciences, has promoted education and development within the industry for over 50 years. The IDSc Technical Certificate established in 2010, was recently accredited by the Scottish Qualifications Authority (SQA) which provides candidates who successfully complete the programme with a recognised qualification at a Level 3 – Qualification in England and Wales. Usually taking around 2 years to complete with significant mentoring and support.

The pre-qualification for undertaking the IDSc Technical Certificate course is completion of;

• An Induction Programme
• Initial Department Training

This puts a focus on the departmental training being provided and delivered as this is the most commonly used training method and will be the only decontamination training for the majority of staff within the Decontamination industry.

Back in 2004, the NHS National Decontamination Training Programme provided access to an e-learning package which intended to provide 13,000 staff with best-practice advice and guidance related to the decontamination of surgical instrument, which was centrally funded. This package is no longer available.

Over the years there has been many formal qualifications available such as NVQs, Foundation Degrees, BSc (Hons) and MSc all created with a focus on decontamination, unfortunately all of which have been withdrawn for differing reasons.

Currently, formal qualifications available are Apprenticeships and City & Guilds accredited courses. City & Guilds generally have a focus on machine operation, engineering courses and courses for Users and Decontamination Leads who are responsible for the process. There are not many courses of this type available for Technician level and would require considerable investment from the department of time and money.

Apprenticeships for decontamination come under BTEC Level 2 Diploma in Healthcare Science. There is an element of mandatory units which are not decontamination related but will provide some important information. The decontamination units are part of the optional units. This is an approach some departments are completing for new starters who have no decontamination background, the mandatory units can cause some confusion though about what they are being trained on. For established staff, this is rarely a route they would like to take as they are already trained and completing the role, there is no perceived benefit to staff who have worked in a department for many years. This qualification would also require a mentor from the department.

Typically, the focus for formal qualifications has been for staff who are looking to progress their careers into managing a department, where managers are looking at succession planning. But we need to look after the education of those who continue to provide the service of clean and sterile instruments for patients.

What does a departments training programme look like?

With over 200 Trusts in the UK and many private hospitals, the decontamination departments are creating their own internal training programmes and framework to help support their staff. Therefore, creating many different approaches and plans to provide training; how can staff be sure that they are receiving the same level of training and the same correct information as another department.

Most training completed in departments is relative to internal work instructions/SOPs. These documents are focused on how to do the task and rarely cover why we do the task, explaining the specific details behind the processes. This specific information could be discussed as part of the hands-on training, but it is unlikely to be documented and therefore where do staff turn to refresh themselves with this level of training and information.

The quality and content of the local training material across the UK will no doubt vary considerably which in turn means the staff are likely to be receiving differing levels of education and knowledge between departments but also within each department. There needs to be consistency of how training is delivered to each member of staff, ensuring the trainer/mentor has the required knowledge and skills to perform this role, again this role could be clarified by a structured framework.

Budgets & Funding

Budgets for training differ from Trust to Trust. Obviously investing in your staff requires funding, department budgets rarely allow for training of every member of staff. There are a few people that are able to go on a course for formal qualification as mentioned before and if there is any budget this is spent on the qualifications for engineers or staff members looking to progress their careers into department management. In some cases, departments have not had any training available to utilise the training element of their budget and therefore this gets removed from the budget the follow year.

All Trust Learning &Development departments do have a budget specially for training. There are various processes that departments are required to go through to get access to this funding but again historically it has not been used by decontamination departments. It may take a little bit of work to complete the required applications or processes but there should be training funds available for all departments.

Investment in your staff and the future of your department

Departments across the country are experiencing difficulties in recruiting and retaining staff. 

NHS’s health career website states for someone who is interested in a career in decontamination and sterile services the training and development they would receive is a department induction, on the job training and then encouraged to take additional training such as the IDSc Technical Certificate. It goes on to advise that no matter what level you are working at, as part of your development, you will be expected to do continuing professional development (CPD) to show that you are keeping yourself up to date with the policies and procedures in your area of work.

CPDUK, which was established in 1996, is the largest and leading independent CPD accreditation organisation working across all industry sectors. They advise that CPD learning helps employers retain key staff and develop the skills & knowledge in their organisation. It is clear that CPD is a key motivator in staff retention and but also to attract new people to their organisation.

This is echoed by the job descriptions written and made available by the IDSc for all levels working in the industry. On the job description under the education & training section, staff are asked to ‘To comply with the Department’s training programme’ and ‘To continually develop and maintain a portfolio of evidence of training and CPD activities.’

Without structed training framework and ongoing personal development, how does a role in decontamination look to a school leaver at a career fair compared to other industries? We want to be actively promoting the important roles our staff complete. Structured training and CPD is clearly a key motivator in attracting new people.

Retaining trained staff is also a battle that departments have been contending with. Staff want to feel supported, they want to feel invested in. They want to see the department progressing and moving forward like other Healthcare sectors and other industries. Investing in regular training will help show staff that they are vital to the success of the department, the process and ultimately patient safety.

What could a structured training programme look like?

There are several different approaches to what a structured training framework should contain. The main focus has to be on ensuring all staff have the knowledge and understanding for each area of the decontamination process, no matter where they work to ensure they have the awareness of how they contribute to the end product for the patient. It could contain the following.

EXAMPLE OF A STRUCTURED TRAINING PROGRAMME

Continuous Personal Development for Decontamination Staff – Available Now

Completing CPD is a now a normal part of a person’s development, ensuring they keep their skills and knowledge up to date for their role and industry. Isopharm have created an online training platform specifically for staff working in decontamination – SSD & EDU. There are also courses to support validation engineering.

The platform called iLearn provides access to bite size courses which can be completed during a working week with courses lasting no more than an hour. Each course concludes with an assessment to confirm competency, requiring a pass rate of 80%. The platform provides a certificate for each course completed and these are saved on the training platform under an individual’s training record.

The courses are broken down by area and by working through them as you would process an item thought the decontamination process the flow of understanding is enhanced.

There are additional courses to supplement knowledge and understanding, for example QMS, Anatomy of an Endoscope, How Ultrasonic Washer Work, Basic Microbiology and many more. All courses are created by industry experts and are Technician level, so every member of staff receives the same background knowledge. Additional Supervisors courses are currently being created which would be add-ons to the existing available courses.

The platform also provides admin access so department managers or training officers can oversee the staff’s progress and access their training records, aiding annual appraisals and development planning.

The platform has been live since May 2021 and has been utilised by over 45 departments and companies, feedback has been extremely positive by both the managers and the staff undertaking the training.

Next Steps

It is clear there is a lot of work going into training our staff, who all have extremely important roles to provide clean and sterile instruments for patient’s safety. But for this exact reason we need to ensure all staff members are receiving the same standard of training, no matter which department they work in.

Decontamination Services have had a couple of shake ups over the past few decades as a result of a number of serious incidents, training always comes up as an area of improvement without much progress. Most healthcare jobs have a structured training program with CPD as standard to their roles why not ours?

As professional scientific healthcare managers, shouldn’t it be our goal to ensure all staff undertaking these roles are all given a standardised training and education structure, delivered in a modern approach? Given the answer to this would be a resounding yes, our challenge would be to understand how this can be funded across our entire industry. Isopharm would be happy to facilitate and support a working group to assist moving this forward, if you are interested in getting involved and supporting thousands of staff members to bring them the training they deserve, please get in touch.