A review of the decontamination of

surgical instruments in the NHS

in England
© Crown copyright 2001

All pictures in this report are reproduced with the kind

permission of Salford Royal Hospitals NHS Trust. They are of
the new Sterile Services Department at the Hope Hospital
which is currently being commissioned
“Decontamination is a combination of
processes, including cleaning, disinfection
and/or sterilization, used to render reusable
surgical instruments safe for further use.”

HFN 13,
‘Ambulatory care and diagnostic
centres – the experience of Central
Middlesex Hospital’
NHS ESTATES, 1996
A REVIEW OF THE DECONTAMINATION OF SURGICAL INSTRUMENTS IN THE NHS IN ENGLAND

A review of the decontamination of

surgical instruments in the NHS in England

INTRODUCTION improve the management of decontamination services,

The Department of Health has completed the first ever
comprehensive national survey of decontamination
services for surgical instruments in the NHS. This
national survey follows advice from the Spongiform
Encephalopathy Advisory Committee (SEAC) that a key
factor in reducing the theoretical risk of person-to-
person spread of variant Creutzfeldt-Jakob Disease
(vCJD) is a high standard of decontamination of surgical
instruments. Effective decontamination is also a key
component in high-quality surgical care.
the standard of decontamination in those hospitals was
raised to an acceptable level.
Standards of decontamination in the remaining 140
hospitals with SSDs were also reviewed to ensure that
acceptable standards were maintained, and raised
where necessary.
The Department of Health is determined to build on
this momentum to raise standards of decontamination
throughout the NHS. The Department of Health has

This report outlines how the Department of Health has New packaging room at Hope Hospital
worked with NHS trusts to improve decontamination
services and patient safety.

The national survey was informed by a preliminary

snapshot survey of NHS trusts by NHS Estates. This
initial sample had found examples of unacceptable
practice, which trusts tackled immediately.

NHS Estates then led inspections to all 249 NHS

hospitals with Sterile Services Departments (SSDs). The
results of these inspections (summarised in Figure 3)
showed that decontamination services in 109 hospitals
did not initially meet acceptable standards. By working
with hospitals to implement urgent action plans and

Old packaging room at Hope Hospital

announced that £200 million will be spent improving

decontamination services by 2003. This will be invested
in new equipment and facilities that will decontaminate
surgical equipment to the highest standards. A future
programme of work will include providing NHS trusts
with continuing support and ensuring that
decontamination standards are met throughout the
NHS.

4
Figure 1: Life-cycle of reusable surgical instruments
EFFECTIVE DECONTAMINATION
The effective cleaning and sterilization of reusable
surgical instruments between operations is essential in
reducing the risk of cross-infection. A key component
of high-quality surgical care is attaining safe and high
standards of decontamination.
There are 182 acute NHS trusts covering 249 hospitals
with central Sterile Services Departments in England.
In any one year approximately 6.5 million surgical
procedures take place. The surgical instruments from
these procedures must be routinely and effectively
decontaminated in order to minimise the risk of
transmitting infection.
Effective decontamination requires the implementation of
a number of processes, from purchasing instruments,
through effective washing and disinfection, to
sterilization, delivery and use. To be effective, it requires
standards to be set for all elements of the life-cycle as
illustrated in Figure 1.
This comprehensive set of processes has formed the
template against which our work and future guidance
has been framed. No aspect has been ignored. This
report does not deal with individual segments – for
example “cleaning” or “inspection” separately – but all
are covered in our programme of work.
DEVELOPING A NATIONAL DECONTAMINATION
PROGRAMME
The Department of Health issued revised guidance and
advice to the NHS in August 1999 on how to reduce the
risk of vCJD transmission, and on the importance of
adhering to decontamination standards (Health Service
Circulars 1999/178 and 1999/179 respectively).
The Department then commissioned NHS Estates
to carry out a preliminary “snapshot” survey1 of
decontamination facilities and services in England. The
preliminary “snapshot” survey was an important first
step. In the first survey of its kind since 1958,2 teams of
NHS and private sector professionals visited 19 NHS
trusts to review decontamination facilities and undertake
a high-level technical analysis of their reprocessing of
surgical instruments.
The snapshot survey identified the need for an approach
that tackled decontamination in a holistic manner and
drew upon the necessary specialist expertise. Its
findings have become the basis of our programme
of work. The survey described current practices in
the decontamination of medical devices and the extent
to which existing guidance and standards on
decontamination were being implemented in a limited
number of sites.
It demonstrated that a national approach was needed
to ensure that standards are clearly understood and
achieved.
1 ‘Decontamination Review: Report on a survey of current
decontamination practices in healthcare premises in England’
– available at http://www.decontamination.nhsestates.gov.uk
2 ‘Studies of Sterile Supply Arrangements for Hospitals –
Present sterilizing practice in six hospitals’ compiled by the
Nuffield Provincial Hospitals Trust 1958
5
A REVIEW OF THE DECONTAMINATION OF SURGICAL INSTRUMENTS IN THE NHS IN ENGLAND

Figure 2: Setting the context for the decontamination programme

HSCs 178 & 179 and

Decontamination guidance issued
(CD-ROM containing all current relevant August 99
decontamination guidance and standards)

SEAC confirm
Sept 99
Decontamination snapshot survey
that rigorous decontamination is the key to
commissioned
minimising the risk of transmission of vCJD

Oct 99– Review fieldwork and analysis

May 00 carried out

Controls Assurance Standards Nov 99/

issued Feb 00
(CD-ROM)

NHS Plan published July 00

Sept 00 Snapshot survey completed

Guidance issued on decontamination

National decontamination survey
(HSC 2000/032) Oct 00
commenced
Comprehensive review commenced

Regional workshops to help trusts

Guidance issued on single-use Jan 01 assess their decontamination
instruments for tonsillectomy
services

Minister announces £200m for Jan 01

decontamination

Mar/ Review of prioritised surgical

Apr 01 facilities

June 01
Regional workshops to further
assist trusts

May/ Review of rest of NHS

Nov 01 surgical facilities

Dec 01 Comprehensive report published

6
A full national survey of NHS trust decontamination
facilities began when the Department of Health issued a
Health Service Circular (HSC 2000/032) on 18 October
2000. This HSC instructed trusts to conduct urgent
reviews of their decontamination services and to feed
this information back to NHS Estates. This included
details on management arrangements and on the age
and condition of their decontamination equipment and
facilities.
Analysis of this “self assessment” information confirmed
the findings of the preliminary snapshot survey. The
biggest area for improvement was found to be in the
management of decontamination practices. The
analysis also showed that changes in equipment and
environment were required. At the time of the HSC, less
than 50% of Sterile Services Departments were built to
current guidance, and less than a third of sterilizers were
under five years old (see Figures 4 and 5).
While trusts were conducting their own self-
assessments, NHS Estates drew up plans to
systematically review all Sterile Services Departments in
the NHS as part of the national approach to raising
standards.
The context of the national decontamination programme
showing the sequence of events is displayed in Figure 2.
NATIONAL APPROACH TO RAISING STANDARDS
Alongside the national survey, the Department of Health
has developed a comprehensive programme, which
aims to deliver improvements to decontamination
practices across the NHS and includes:
1. assessing all Sterile Services Departments against
extant guidance and standards;
2. agreeing and monitoring the implementation of action
plans with local management to address areas of
concerns and minimise risks;
3. a programme of significant investment in
decontamination services and careful managing of
the investment process to ensure funding meets the
need to provide facilities and equipment;
4. implementing a programme of work to improve
standards and support for the NHS;
5. extending the programme to other healthcare
settings.
1. Assessments against standards
The Department of Health launched a series of
development workshops in January 2001 to inform the
NHS of current decontamination standards and provide
them with a self-assessment “toolkit” (Process
Assessment Tool) to undertake a comprehensive review
of decontamination practices in their own organisation.
As part of the national survey, teams of assessors
assisted NHS trusts in creating action plans to address
areas of concern, such as lack of appropriate statutory
documentation, and work towards improving standards
of decontamination. These assessment teams, drawn
mainly from the NHS and including engineers, sterile
services managers and infection control nurses under
the leadership of NHS Estates, made 475 visits to NHS
hospitals in England between March 2001 and
November 2001.
The main objectives of this programme were:
• to investigate the provision and use of equipment,
facilities, trained personnel, management
arrangements and technical support for
decontamination of reusable surgical instruments
within NHS acute hospitals;
• to establish the extent to which facilities complied
with current legal requirements, published standards
(both European and UK) and Department of Health
best practice guidance;
• to establish a series of ratings to classify sites as
green, amber or red to represent an overall view of
the standard of decontamination in the hospital. The
ratings are intended as a guide to establishing where
hospitals are most in need of improvement. Green
hospitals are those where standards are good
throughout. An amber rating indicates that standards
provided are acceptable. Red sites were those where
standards needed to be raised as a matter of priority;
• to agree and implement action plans for those
hospitals that needed to improve.
Details of the review are set out below.
The assessment programme
Following advice from SEAC that the risk of vCJD
transmission is likely to be greatest from operations
involving central nervous system and ophthalmic
tissues, NHS Estates implemented a prioritised series of
visits to all NHS facilities undertaking reprocessing. The
assessment programme was undertaken in two stages:
Stage 1
The first NHS trusts to be reviewed during March and
April 2001 had hospitals carrying out procedures
involving tissues with a higher theoretical risk of
transmission of vCJD.
The table below shows both the initial assessments and
the current position for the 115 hospitals that were
visited in Stage 1. A total of 33 were classified as “red”,
7
A REVIEW OF THE DECONTAMINATION OF SURGICAL INSTRUMENTS IN THE NHS IN ENGLAND

as standards there needed to be raised as a matter of Annex A sets out the initial and current status of the
priority. acute hospital Sterile Services Departments reviewed as
part of this assessment programme.
Stage 1 Red Amber Green
Assessments (= below (= acceptable (= good 2. Action plans
standard) standard) standard)
Following initial visits to trusts and a technical review of
Present 0 85 30 information supplied by the assessment team, certain
position hospitals were identified as in need of further assistance
in addressing decontamination issues.
Initial 33 52 30
position Action plans addressed immediate deficiencies within
a five-day period, with medium (1–3 month) and long-
term (3–6 month) plans being developed to address
equipment replacements and/or alterations to the built
Teams of NHS professionals re-visited the red hospitals
environment.
to ensure that standards were immediately brought up
to an acceptable level, action plans were developed to Figure 3 summarises the initial status of Sterile Services
address any further areas of concern, and NHS trusts Departments, and their current status following
continued to maintain and improve standards. implementation of action plans.

Stage 2
The visit programme continued from May to October
2001 to the remaining 134 hospitals with Sterile
Services Departments. The table below shows the initial
findings and the current position.
Stage 2 Red Amber Green
Assessments (= below (= acceptable (= good
standard) standard) standard)
Present position* 0 107 25
Initial position 76 47 11
*Two hospitals have ceased reprocessing and transferred
services to alternative locations.
NHS Estates found that in some hospitals
decontamination practices fell below acceptable
standards. Following the programme of assessments,
implementation of action plans and work within
hospitals, all are now providing at least an acceptable
standard of decontamination. Where it has been
necessary to relocate reprocessing to other hospitals,
this has been carried out with no impact on the
provision of clinical services.
During November, the assessment teams undertook
visits to local reprocessing units. These are units
where routine reprocessing of surgical instruments is
undertaken within hospitals at ward/clinic level rather
than in a Sterile Services Department. In line with best
practice, it is advised that sites relocate reprocessing to
a central unit. In some cases, reprocessing has had
to be retained locally, for example where there is
insufficient capacity in the SSD to currently allow for
centralisation. Where this has been the case, the
assessment teams have supported the hospital by
providing advice and guidance consistent with that
published by NHS Estates in March 2001.
As a result of the intensive work carried out over the last
year, all NHS acute hospitals in England now have
access to satisfactory decontamination services.
3. Investment in decontamination
Of the £200m announced in January 2001, £50m
has been identified as immediate investment during
2001/02. The Department of Health has already
assessed and approved 26 bids and, to date, over
£30m of funding has been released. This funding is
predominantly focused on hospitals initially rated as red
with immediate investment needs.
The investment will start to address the shortfalls in
modern dependable equipment and environments as
identified by HSC 2000/032, and shown in Figures 4
and 5 below.
In addition to improving the built environment of Sterile
Services Departments, over 300 new pieces of state-
of-the-art decontamination equipment and significant
numbers of new surgical instruments will be provided as
part of the investment programme by 2003.
In line with the aims of the NHS Plan, investment of
the remaining funding will be prioritised to ensure that
standards are maintained and continue to improve, and
value for money is achieved.
4. Continuing programme of support for the NHS
Training and development programme
The national survey has shown that improving staff
training can significantly contribute to the improvement
of decontamination practices. To address this, a series
of development workshops held in January and June
2001 carried the message of the need for improved
decontamination to some 2000 people at all levels of
the NHS. Another series of workshops, aimed mainly at

8
Figure 3: Classification of Sterile Services Departments in the NHS in England

200
192
180

160

109
140
99
120

100

80

60 41

40
55

20
0 Initial
classifications
0

RED
Current
AMBER classifications

GREEN

Figure 4: Environment – Sterile Services Departments built to current guidelines

2% Partial
6% Not answered

37% Yes

55% No

Figure 5: Equipment – Age of sterilizers, in years

27% More than 16 years

22% 11 to 15 years 29% Less than 5 years

22% 6 to 10 years

9
A REVIEW OF THE DECONTAMINATION OF SURGICAL INSTRUMENTS IN THE NHS IN ENGLAND
people working in primary care, is planned for early
next year. NHS Estates has also set in motion the
development of a training programme by peer groups
such as the Infection Control Nurses Association (ICNA),
the National Association of Theatre Nurses (NATN) and
the Institute of Sterile Services Management (ISSM). This
is part of a programme of building front-line capacity
with respect to decontamination services.
Guidance and standards
NHS Estates has reviewed the technical guidance
available to the NHS and consolidated up-to-date
versions on CD-ROMs, which were issued in August
1999 and June 2001. NHS Estates has also developed
web-based automated tools to assist organisations in
continuing self-assessment and to develop ongoing
programmes of improvement. Decontamination is one
of the set of Controls Assurance Standards forming part
of corporate governance in the NHS. NHS trust Chief
Executives are required to certify that their organisations
meet a series of criteria concerning the environment in
which decontamination is carried out, the equipment
used for it, and the management of the whole process.
5. Decontamination in independent healthcare
settings
The Department of Health has held discussions with the
independent healthcare sector about the need for them
to have access to improved decontamination facilities.
The private sector has undertaken to adopt the same
standards as the NHS. The Department of Health has
set up a series of “information exchange” meetings, to
which the independent healthcare sector, the Ministry
of Defence and the Prison Health Service are all invited
to discuss progress.
Future programme of work
The decontamination programme has delivered
significant improvements in decontamination standards
across the NHS. The Government is taking action to
ensure that this rate of improvement is maintained into
the future, and improvements in knowledge techniques
are incorporated into NHS practice. The NHS will build
on the achievements of the past year to take the overall
standard across the NHS even higher.
• NHS Estates is continuing to support NHS trusts in
improving decontamination standards through
training, guidance and advice.
• We have worked – and will continue to work – closely
with many professional bodies including:
– Commission for Health Improvement
10
– Institute of Healthcare Engineering and Estate
Management
– Royal College of Anaesthetists
– Royal College of Ophthalmologists
– Royal College of Pathologists
– Royal College of Surgeons
– British Association of Orthopaedic Surgeons
– British Association of Oral and Maxillofacial
Surgeons
– Society of British Neurosurgeons
– British Association of Otorhinolaryngologists
Several of the above have placed supporting information
on their websites. For example:
“The Royal College of Surgeons
welcomes the improvements in
decontamination across the NHS and
the very necessary upgrading of
Sterile Supply Services. The Royal
College supports the high priority
being given to this need”
(Mr Charles Collins on behalf of the
Royal College of Surgeons)
• work has begun to assess and improve
decontamination standards in Primary Care;
• the development of a National Training Scheme to
improve training arrangements for healthcare
professionals and an approval process for
decontamination facilities is under way;
• NHS Estates is reviewing the current arrangements
with respect to the level of professional and technical
support available to NHS hospitals on
decontamination.
The modernisation of NHS decontamination services is
a long-term process, not a one-off event, and we will
continue to ensure that appropriate precautions, based
on evidence and scientific advice, are taken to ensure
patient safety.
Annex A RED Standards need to be raised

AMBER Standards are acceptable

GREEN Standards are good throughout

SUMMARY RESULTS, DECEMBER 2001

Initial Current
Trust Hospital classification classification

Addenbrookes NHS Trust Addenbrookes Hospital Amber Amber

Aintree Hospitals NHS Trust Walton Hospital Green Green

Airedale NHS Trust Airedale General Hospital Red Amber

Ashford & St Peter’s Hospital NHS Trust Ashford Hospital Amber Amber

St Peter’s Hospital Amber Amber

Barking Havering & Redbridge Healthcare NHS Trust King George Hospital Green Green

Oldchurch Hospital Green Green

Barnet and Chase Farm Hospitals NHS Trust Barnet General Hospital Amber Amber

Chase Farm Hospital Red Service Transferred

Barnsley District General Hospitals NHS Trust Barnsley District General Hospital Green Green

Barts and the London NHS Trust Barts Hospital/The Royal London Amber Amber

Basildon & Thurrock General Hospitals NHS Trust Orsett Hospital Amber Amber

Bedford Hospital NHS Trust Bedford General Hospital Amber Amber

Birmingham Children’s Hospital NHS Trust Birmingham Children’s Hospital Green Green

Birmingham Heartlands & Solihull NHS Trust Yardley Green Hospital Red Green

Blackburn, Hyndburn & Ribble Valley Healthcare Queens Park Hospital

Amber Green
NHS Trust

Blackpool Victoria Hospital NHS Trust Victoria Hospital Amber Amber

Bolton Hospitals NHS Trust Royal Bolton Hospital Amber Amber

Bradford Hospitals NHS Trust Bradford Royal Infirmary Red Amber

St Luke’s Hospital Red Amber

Brighton Health Care NHS Trust The Royal Sussex Hospital Red Amber

Bromley Hospitals NHS Trust Bromley Hospital Red Amber

Farnborough Hospital Red Amber

Burnley Health Care NHS Trust Burnley General Hospital Amber Amber

Burton Hospitals NHS Trust Queens Hospital Green Green

Bury Health Care NHS Trust Fairfield General Hospital Amber Amber

Calderdale and Huddersfield NHS Trust The Calderdale Royal Hospital Green Green

Cardiothoracic Centre Liverpool NHS Trust Cardiothoracic Centre Amber Amber

Carlisle Hospitals NHS Trust Cumberland Infirmary Amber Amber

11
 A REVIEW OF THE DECONTAMINATION OF SURGICAL INSTRUMENTS IN THE NHS IN ENGLAND

Initial Current
Trust Hospital classification classification

Central Manchester Healthcare NHS Trust Manchester Royal Infirmary Red Amber

Central Middlesex Hospital NHS Trust Central Middlesex Hospital Green Green

Chelsea & Westminster Healthcare NHS Trust Chelsea & Westminster Hospital Green Green

Chesterfield and North Derbyshire Royal Hospital Chesterfield & North Derbyshire
Amber Amber
NHS Trust Royal Hospital

Chorley & South Ribble NHS Trust Chorley District Hospital Amber Amber

Christie Hospital NHS Trust Christie Hospital Amber Amber

City Hospital Birmingham NHS Trust City Hospital Amber Amber

City Hospitals Sunderland NHS Trust Sunderland Eye Hospital Amber Amber

Sunderland Royal Hospital Red Amber

Countess of Chester Hospital NHS Trust The Countess of Chester Hospital Amber Amber

Dartford & Gravesham NHS Trust Darent Valley Hospital Green Green

Dewsbury Health Care NHS Trust Dewsbury & District Hospital Amber Amber

Doncaster & Bassetlaw Hospitals NHS Trust Doncaster Royal Infirmary Amber Amber

Dudley Group of Hospitals NHS Trust Russells Hall Hospital Red Amber

Wordsley Hospital Red Amber

Ealing Hospital NHS Trust Ealing Hospital Red Green

East & North Hertfordshire NHS Trust Lister Hospital Red Amber

Queen Elizabeth II Hospital Red Amber

East Cheshire NHS Trust Macclesfield District General Hospital Amber Amber

East Gloucestershire NHS Trust Cheltenham General Hospital Amber Amber

East Kent Hospitals NHS Trust Kent & Canterbury Hospital Amber Amber

Queen Elizabeth The Queen Mother

Amber Amber
Hospital

William Harvey Hospital Red Green

East Somerset NHS Trust Yeovil District Hospital Green Green

Eastbourne Hospitals NHS Trust Eastbourne General Hospital Amber Amber

Epsom & St Helier NHS Trust Epsom Hospital Red Amber

St Helier Hospital Red Amber

Sutton Hospital Red Amber

Essex Rivers Healthcare NHS Trust Colchester General Hospital Amber Amber

Forrest Healthcare NHS Trust Whipps Cross Hospital Amber Amber

Frimley Park Hospitals NHS Trust Frimley Park Hospital Green Green

Gateshead Health NHS Trust Queen Elizabeth Hospital (Gateshead) Red Green

George Eliot Hospital NHS Trust George Eliot Hospital Red Amber

Gloucestershire Royal NHS Trust Gloucestershire Royal Hospital Green Green

Good Hope Hospital NHS Trust Good Hope Hospital Red Green

Great Ormond Street for Children NHS Trust Great Ormond Street Hospital Amber Amber

Guy’s and St Thomas’ Hospital NHS Trust St Thomas’ Hospital Amber Amber

Hammersmith Hospitals NHS Trust Charing Cross Hospital Red Amber

Hammersmith Hospital Green Green

12
 Initial Current
Trust Hospital classification classification

Harrogate Healthcare NHS Trust Harrogate District General Hospital Green Green

Hastings & Rother NHS Trust Conquest Hospital Amber Amber

Heatherwood & Wexham Park Hospitals NHS Trust Heatherwood Hospital Red Green

Wexham Park Hospital Red Amber

Hereford Hospitals NHS Trust County Hospital Green Green

Hillingdon Hospital NHS Trust Hillingdon Hospital Red Amber

Hinchingbrooke Health Care NHS Trust Hinchingbrooke Hospital Amber Amber

Hull & East Yorks Hospitals NHS Trust Castle Hill Hospital Amber Amber

Ipswich Hospital NHS Trust Ipswich Hospital Amber Amber

Isle of Wight Healthcare NHS Trust St Mary’s Hospital (Isle of Wight) Red Amber

James Paget Healthcare NHS Trust James Paget Hospital Green Green

Kettering General Hospital NHS Trust Kettering General Hospital Amber Amber

Kings Healthcare NHS Trust Dental Hospital Amber Amber

Kings College Hospital Green Green

Kings Lynn & Wisbech Hospitals NHS Trust Queen Elizabeth Hospital (Kings
Red Amber
Lynn)

Kingston Hospitals NHS Trust Kingston Hospital Amber Amber

Leeds Teaching Hospitals NHS Trust Leeds General Infirmary Red Amber

St James’s University Hospital Red Amber

Liverpool Women’s Hospital NHS Trust Liverpool Women’s Hospital Amber Amber

Luton & Dunstable Hospital NHS Trust Luton & Dunstable Hospital Green Green

Maidstone & Tunbridge Wells NHS Trust Kent and Sussex Hospital Amber Amber

Kent County Ophthalmic & Aural

Red Amber
Hospital

Maidstone Hospital Amber Amber

Pembury Hospital Red Amber

Manchester Children’s Hospitals NHS Trust Booth Hall Hospital Green Green

Mayday Healthcare NHS Trust Mayday University Hospital (new) Green Green

Medway NHS Trust Medway Maritime Hospital Amber Amber

Mid Cheshire Hospitals NHS Trust Leighton Hospital Amber Amber

Mid Essex Hospital Services NHS Trust Broomfield Hospital Amber Amber

St John’s Hospital Red Amber

Mid Staffordshire General Hospitals NHS Trust Staffordshire General Hospital Amber Amber

Mid Sussex NHS Trust The Princess Royal Hospital Red Amber

Milton Keynes General NHS Trust Milton Keynes General Hospital Red Amber

Moorfields Eye Hospital NHS Trust Moorfields Eye Hospital Red Amber

Morecambe Bay Hospitals NHS Trust Furness General Hospital Green Green

Royal Lancaster Infirmary Green Green

Westmorland General Hospital Amber Amber

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 A REVIEW OF THE DECONTAMINATION OF SURGICAL INSTRUMENTS IN THE NHS IN ENGLAND

Initial Current
Trust Hospital classification classification

Newcastle upon Tyne Hospitals NHS Trust Dental hospital Red Amber

Freeman Hospital Red Amber

Newcastle General Hospital Red Amber

Royal Victoria Infirmary Red Amber

Newham Healthcare NHS Trust Newham General Hospital Amber Amber

Norfolk and Norwich NC NHS Trust Norfolk & Norwich Hospital Red Amber

West Norwich Hospital Red Amber

North Bristol NHS Trust Frenchay Hospital Green Green

Southmead Hospital Amber Amber

North Cheshire Hospitals NHS Trust Halton General Hospital Red Amber

Warrington General Hospital Amber Amber

North Cumbria Acute Hospitals NHS Trust West Cumberland Hospital Red Amber

North Durham Healthcare NHS Trust University Hospital of North Durham Amber Amber

North Hampshire Hospital NHS Trust North Hampshire Hospital Red Amber

North Manchester Health Care NHS Trust North Manchester General Hospital Amber Amber

North Staffordshire Hospitals NHS Trust NSPD City General Hospital Amber Amber

North Tees & Hartlepool NHS Trust Hartlepool General Hospital Red Amber

North Tees General Hospital Red Green

Northallerton Health Services NHS Trust Friarage Hospital Amber Amber

Northampton General Hospital NHS Trust Northampton General Hospital Green Green

Northern Devon Healthcare NHS Trust North Devon District Hospital

Red Amber
(Barnstaple)

Northern Lincolnshire & Goole Hospitals NHS Trust Diana Princess of Wales Hospital Amber Amber

Scunthorpe General Hospital Red Amber

Northumbria Healthcare NHS Trust Hexham General Hospital Red Amber

North Tyneside General Hospital Red Amber

Wansbeck General Hospital Red Amber

Nottingham City Hospital NHS Trust Nottingham City Hospital Amber Amber

Nuffield Orthopaedic Centre NHS Trust Nuffield Orthopaedic Hospital Red Amber

Oldham NHS Trust Royal Oldham Hospital Amber Amber

Oxford Radcliffe Hospitals NHS Trust Horton Hospital Red Amber

Oxford Radcliffe Hospital Amber Amber

The Churchill Red Amber

The John Radcliffe Amber Amber

Papworth Hospital NHS Trust Papworth Hospital Red Amber

Peterborough Hospitals NHS Trust Peterborough District Hospital Amber Amber

Pinderfields and Pontefract Hospitals NHS Trust Pinderfields Hospital Amber Amber

Pontefract General Infirmary Amber Amber

Plymouth Hospitals NHS Trust Derriford Hospital Amber Amber

Poole Hospital NHS Trust Poole Hospital Red Amber

14
 Initial Current
Trust Hospital classification classification

Portsmouth Hospitals NHS Trust Queen Alexandra Hospital Amber Amber

St Mary’s Hospital (Portsmouth) Amber Amber

Preston Acute Hospitals NHS Trust Royal Preston Hospital Red Amber

Sharoe Green Hospital Amber Amber

Princess Alexandra Hospital NHS Trust The Princess Alexandra Hospital Amber Amber

Princess Royal Hospital NHS Trust Princess Royal Hospital Red Amber

QMC University Hospital NHS Trust Queens Medical Centre – Notts Amber Amber

Queen Elizabeth Hospitals NHS Trust Queen Elizabeth Hospital Green Green

Queen Mary’s Sidcup NHS Trust Queen Mary’s Hospital Green Green

Queen Victoria Hospital NHS Trust Queen Victoria Hospital – Grinstead Green Green

Robert Jones & Agnes Hunt Orthopaedic Robert Jones & Agnes Hunt
Green Green
Hospital Trust Orthopaedic Hospital

Rotherham General Hospitals NHS Trust Rotherham District General Hospital Amber Amber

Royal Berkshire & Battle Hospitals NHS Trust Royal Berkshire Hospital Amber Amber

Royal Bournemouth & Christchurch Hospitals Alderney Hospital

Green Green
NHS Trust

Westbourne Eye Hospital Green Green

Royal Brompton & Harefield NHS Trust Harefield Hospital Red Amber

Royal Brompton Hospital Red Amber

Royal Cornwall Hospitals NHS Trust Royal Cornwall Hospital Amber Amber

St Michael’s Hospital Red Amber

Royal Devon & Exeter Healthcare NHS Trust Royal Devon & Exeter Hospital Green Green

Royal Free Hampstead NHS Trust The Royal Free Hospital Red Amber

Royal Liverpool & Broadgreen University Hospitals Royal Liverpool University Hospital
Red Amber
NHS Trust (St Paul’s Eye Unit)

Royal Liverpool Children’s Hospital NHS Trust Alder Hey Children’s Hospital
Red Amber
(Alder Hey)

Royal Marsden NHS Trust Royal Marsden Hospital – Sutton Site Red Amber

Royal National Orthopaedic NHS Trust Stanmore Hospital Red Amber

Royal Orthopaedic Hospital NHS Trust The Royal Orthopaedic Hospital Amber Amber

Royal Shrewsbury Hospital NHS Trust Royal Shrewsbury Hospital Amber Amber

Royal Surrey County Hospital NHS Trust Royal Surrey County Hospital Amber Amber

Royal United Hospital Bath NHS Trust Royal United Hospital Amber Amber

Royal West Sussex NHS Trust St Richard’s Hospital Green Green

Royal Wolverhampton Hospitals NHS Trust New Cross Hospital Amber Amber

Salford Royal Hospitals NHS Trust Hope Hospital Amber Amber

Salisbury Healthcare NHS Trust Salisbury District Hospital Amber Amber

Sandwell Healthcare NHS Trust Sandwell General Hospital Amber Amber

Scarborough & North East Yorks Health Care Scarborough General Hospital
Red Amber
NHS Trust

Sheffield Teaching Hospitals NHS Trust Northern General Hospital Amber Amber

Royal Hallamshire Hospital Amber Amber

15
 A REVIEW OF THE DECONTAMINATION OF SURGICAL INSTRUMENTS IN THE NHS IN ENGLAND

Initial Current
Trust Hospital classification classification

Sherwood Forest Hospitals NHS Trust Kings Mill Centre for Healthcare Amber Amber

South Buckinghamshire NHS Trust Wycombe Hospital Green Green

South Devon Healthcare NHS Trust Torbay District General Hospital Amber Amber

South Durham Healthcare NHS Trust Darlington Memorial Hospital Red Amber

South Manchester University Hospitals NHS Trust Withington Hospital Red Amber

Wythenshawe Hospital Amber Amber

South Tees Acute Hospitals NHS Trust Middlesbrough General Hospital Amber Amber

North Riding Infirmary Amber Amber

South Tyneside Healthcare NHS Trust South Tyneside District Hospital Red Amber

South Warwickshire General Hospitals NHS Trust Warwick Hospital Red Green

Southampton University Hospitals NHS Trust Princess Anne Hospital Red Amber

Southampton General Hospital Amber Amber

Southend Hospital NHS Trust Southend Hospital Amber Amber

Southern Derbyshire Acute Hospitals NHS Trust Derbyshire Royal Infirmary Amber Amber

Southport and Ormskirk Hospital NHS Trust Ormskirk & District General Hospital Red Amber

Southport & Formby District General

Red Amber
Hospital

St George’s Healthcare NHS Trust Atkinson Morley Hospital Red Amber

St Helens & Knowsley Hospitals NHS Trust St Helens Hospital Red Amber

Whiston Hospital Red Amber

St Mary’s NHS Trust Western Eye Hospital Amber Amber

St Mary’s Hospital (London) Red Amber

Stockport NHS Trust Stepping Hill Hospital Green Green

Stoke Mandeville Hospital NHS Trust Stoke Mandeville Hospital Green Green

Surrey & Sussex Healthcare NHS Trust Crawley Hospital Red Amber

East Surrey Hospital Red Amber

Swindon & Marlborough NHS Trust Princess Margaret Hospital Amber Amber

Tameside and Glossop Acute Services NHS Trust Tameside General Hospital Amber Amber

Taunton & Somerset Hospital NHS Trust Taunton & Somerset Hospital Red Amber

The Royal Wolverhampton Hospitals NHS Trust Wolverhampton & Midland Counties
Red Amber
Eye Infirmary

Trafford Healthcare NHS Trust Trafford General Hospital Red Amber

United Bristol Healthcare NHS Trust Bristol Eye Hospital Amber Amber

Bristol Royal Infirmary Red Amber

Bristol Dental Hospital Red Amber

United Lincolnshire Hospitals NHS Trust Grantham and District Hospital Red Amber

Lincoln County Hospital Red Amber

Pilgrim Hospital Red Amber

University College London Hospitals NHS Trust The Middlesex Hospital Red Amber

The Eastman Dental Hospital Red Amber

The Heart Hospital Red Amber

16
 Initial Current
Trust Hospital classification classification

University Hospitals Birmingham NHS Trust Queen Elizabeth Hospital Red Amber

Selly Oak Hospital Amber Amber

University Hospitals Coventry & Warwickshire Coventry and Warwickshire Hospital

Red Amber
NHS Trust

Hospital of St Cross Red Service Transferred

Walsgrave Hospitals Red Amber

University Hospitals of Leicester NHS Trust Glenfield Hospital Red Amber

Leicester General Hospital Red Amber

Leicester Royal Infirmary Red Amber

Walsall Hospitals NHS Trust Manor Hospital Amber Amber

Walton Centre for Neurology & Neurosurgery Walton Centre

Green Green
NHS Trust

West Dorset General Hospitals NHS Trust Dorset County Hospital Green Green

West Hertfordshire Hospitals NHS Trust Hemel Hempstead General Hospital Red Green

St Albans City Hospital Red Green

Watford General Hospital Red Green

West Middlesex University Hospital NHS Trust West Middlesex University Hospital Amber Amber

West Suffolk Hospital NHS Trust West Suffolk Hospital Green Green

Weston Area Health NHS Trust Weston General Hospital Red Green

Whittington Hospital NHS Trust Whittington Hospital Red Amber

Winchester & Eastleigh Healthcare NHS Trust Royal Hampshire County Hospital Green Green

Wirral Hospital NHS Trust Arrowe Park Hospital Red Amber

Clatterbridge Hospital Red Amber

Worcestershire Acute Hospitals NHS Trust Alexandra Hospital Red Amber

Kidderminster General Hospital Amber Amber

Worcester Royal Infirmary –

Red Amber
Ronkswood Hospital

Worthing & Southlands Hospitals NHS Trust Southlands Hospital Red Green

Worthing Hospital (West Sussex

Amber Amber
Eye Unit)

Wrightington, Wigan and Leigh NHS Trust Billinge Hospital Amber Amber

Leigh Infirmary Amber Amber

York Health Services NHS Trust York District Hospital Green Green

17