Sample Surgery Center Hand Washing Flier for Patients

The management of Lakes Surgery Center in West Bloomfield, Mich., assigns staff members to different performance improvement program teams focusing on critical patient safety issues. One such team is assigned to hand hygiene.


This team developed a hygiene-related flier which now goes on the back of every patient's discharge instructions, says Jennifer Butterfield, clinical nurse manager of the ambulatory surgery center.


The flier essentially explains to patients that when they go home after surgery, they need to wash and dry their hands before, for example, putting drops in their eyes or touching a wound.


"We're giving them an actual piece of paper to take home that helps them post-operatively," says Ms. Butterfield. "We didn't have this before, and now there's less chance of our patients getting an infection post-surgery because they have this educational flier."


To download a sample copy of this flier you can adapt for use in your ASC, click here (doc).


Learn more about Lakes Surgery Center.


Download other sample forms for adaptation and use in your ASC:


- Sample OR/Procedure Room Cleaning Checklist


- Sample General Area Cleaning Checklist


- Sample Incomplete Biological Result Form

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