How to improve hand-washing compliance in your ASC: 3 Qs with the AHRQ's Dr. Jeff Brady


Given the increasing popularity of ASCs, quality is essential to success. Jeff Brady, MD, director of the Agency for Healthcare Research and Quality's Center for Quality Improvement and Patient Safety, shared his insights with Becker's ASC Review.

Note: Responses have been lightly edited for style and clarity.

Question: Given that ASCs are becoming a more popular option among patients and insurance companies, what quality trends or issues is AHRQ focusing on?

Dr. Jeff Brady: Each year, about 23 million surgical procedures are performed in more than 5,300 ASCs. Since 2001, more than half of all surgeries have transitioned from an inpatient setting to an ASC. Most surgeries in ASCs are done safely and without incident, but complications can result, including healthcare-associated infections, surgical site infections and other safety problems. As more surgeries continue to shift from the inpatient setting to ASCs, AHRQ understands the need for patients to feel safe about the surgical care they are receiving outside a traditional hospital. To help ASCs make care safer and high quality for their patients, AHRQ developed the Toolkit To Improve Safety in ASCs. The toolkit is designed to help ASCs reduce infections and surgical harms using a surgical safety checklist and to improve safety culture through teamwork and communication.

Q: Hand-washing compliance continues to be a challenge for many healthcare organizations. How can ASCs improve compliance?

JB: Hand hygiene is extremely important for all providers, regardless of the healthcare setting. AHRQ's Toolkit To Improve Safety in ASCs makes resources available to assist ASC healthcare staff in maintaining good hand-hygiene practices. According to theCDC, on average, healthcare providers clean their hands less than half of the times they should. The CDC also has tools and resources available to help providers improve their hand-hygiene practices.

Q: How can surgery centers best utilize the AHRQ's Toolkit To Improve Safety in ASCs?

JB: AHRQ's Toolkit To Improve Safety in ASCs helps ASCs implement and sustain cultural and technical interventions surrounding the safe surgery checklist, which ASCs should use during three critical perioperative periods for all patients. ASCs can best utilize the toolkit by adopting a two-pronged approach: implementing the toolkit within its facilities, and if not already, using AHRQ's ASC Survey on Patient Safety Culture. Within the toolkit is an implementation guide that provides step-by-step guidance on how to implement the ASC-specific safe surgery checklist. Toolkit elements that are uniquely fashioned for ASCs include PowerPoint slidesand facilitator notes on teamwork and communication, coaching clinical teams, patient and family engagement in the ambulatory surgery setting and sustainability. Also included are demonstration videos,checklists and tools to assist in implementation. A patient education brochure titled Getting Ready for Your Ambulatory Surgery can be used by ASCs to share with patients prior to the procedure. Additional resources cover topics such as endoscopic procedures and hand hygiene.

The related ASC Survey on Patient Safety Culture helps ASCs assess their performance in maintaining a staff culture of safety, which is foundational to addressing safety issues at individual facilities.

To participate in future Becker's Q&As, contact Rachel Popa at

For a deeper dive into ASC industry trends, attend the Becker's 17th Annual Future of Spine + Spine, Orthopedic & Pain Management-Driven ASC in Chicago, June 13-15, 2019. Click here to learn more and register.


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