By Branwen Jeffreys
Health correspondent, BBC News
Surgeons say equipment is being returned broken
Operating theatres are being thrown into chaos and operations cancelled because of broken, missing or dirty surgical instruments, surgeons say.
The Royal College of Surgeons of England said it had contacted 250 doctors with most reporting problems.
The college said the problems have become worse since cleaning started to be handed over to private firms.
But the government said it was working with trusts and private providers to resolve any issues.
A process of upgrading decontamination services was set up by the NHS eight years ago after an audit showed the need to modernise.
Surgeon Andrew Thomas on how incomplete kits hamper operations
The Department of Health in England has provided funding to encourage hospitals to enter into deals with commercial sterilisation services.
The Royal College of Surgeons said the process of moving decontamination off site has thrown up major concerns and it wants a national audit of how these services are working.
Richard Ramsden, from the college, said: "I think we feel an intense sense of frustration and anger ourselves at the moment when we have to cancel an operation or make do with instruments that are just not quite as good as they should be.
"But much more important is the frustration that patients feel. It's a disservice to the patients."
The college has provided the BBC with photographs which it said showed instruments that have been returned without proper sterilisation and examples of contamination.
Even an apparently small speck will lead to an instrument being rejected by a surgeon because of the risk to patients.
'It was awful'
It said operations were being cancelled and the NHS was also having to replace expensive instruments damaged in careless decontamination.
Helene Rigate's operation was postponed twice
Helene Rigate, who has had her hip operation at Leeds' Chapel Allerton Hospital postponed twice because her surgeon did not have the right surgical instruments, said: "To be honest I didn't know whether to laugh or cry.
"I just could not believe that I'd been put through this a second time and then pipped at the post again. It was awful. I was really upset.
"This is supposed to be the 21st century. We're supposed to have sorted these things out. I was angry and upset and a bit stunned as well."
In a statement Leeds Teaching Hospitals NHS Trust apologised to Ms Rigate and said it was urgently working to resolve problems with the decontamination services which had been moved off site to a unit run by a private contractor.
"In both cases affecting this patient, staff were not happy that all the instruments were of a useable standard.
"Patient safety is always our top priority."
B Braun Sterilog, which provides cleaning services for the hospital, said: "We work closely with our partner NHS trusts to deliver our shared goal of bringing the sterilisation of surgical instruments up to the highest standards."
Orthopaedic surgeons are particularly angry at the failings in the new decontamination services.
Andrew Thomas, from the British Orthopaedic Association, said there was a wealth of anecdotal evidence of the problems, which include gynaecological instruments being packed by mistake into trays for orthopaedic operations.
"The view from the average orthopaedic surgeon is that moving the decontamination offsite is a recipe for chaos."
A handful of partnerships with private decontamination services are already operational in England but many more are currently being negotiated.
The orthopaedic surgeons want a moratorium on any more contracts being signed until it can be shown that off site services meet clinical standards.
Mike Jackson, a senior national officer at Unison, added: "We have warned time and time again that taking sterilisation services out of hospitals and replacing them with supercentres - which are often miles away - is a recipe for disaster."
A Department of Health spokesman said: "We have invested over £200m in improving decontamination services in the NHS in England since 2001 and we will continue to support trusts to provide the highest standards of decontamination of instruments as part of their drive against healthcare associated infection.
"We are helping trusts to draw up a local action plans where necessary and we are working closely with both them and the private sector provider to resolve any issues."
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