The risk of CO getting to people from a room sealed boiler depends on a faulty seal at the combustion chamber or a broken flue joint, (potentially from a hole caused by corrosion in the combustion chamber itself)
Compete combustion depends on the correct gas & oxygen mix, as the oxygen comes from outside its very unlikely to be compromised if the seal and flue are ok, even after many years of no servicing there could be some dust etc on the burner and injector, even if it produced CO this would be be pushed out the properly sealed flue to outside so risk is minimal.
Room sealed fires: if they are fan glued they will be negative pressure now, so same as above, I can't remember if any of the old balanced flue fires were positive pressure, (one of the older guys will tell us !!!!!)