About the Toolkit Development

The toolkit was developed as part of the AHRQ Safety Program for Surgery, a national implementation project to reduce surgical site infections and other complications in hospitals. The 3-year project brought together subject matter experts and participating hospitals across the country.  Approximately 200 hospitals and more than 370 perioperative teams participated in the project. Among the participating hospitals, implementation of the project was associated with a significant reduction in surgical site infections (relative reduction 25–40%, depending on type of procedure and surveillance system). Details are available in the Final Report.


Approximately 16 million people have surgery in a hospital each year in the United States. Healthcare-associated infections are among the most common complications in surgery patients, including more than 150,000 surgical site infections each year. However many are preventable. These complications place an enormous burden on patients, their families, employers, and society. They can increase the length of hospital stay, health care costs, risk of readmission, and risk of mortality.

To address this problem, the Agency for Healthcare Research and Quality (AHRQ) funded a 3-year project to develop and implement resources that help hospital perioperative areas reduce surgical site infections. The project aimed to—

  • Reduce surgical site infections, and
  • Improve safety culture using AHRQ’s Comprehensive Unit-based Safety Program (CUSP) framework.

This toolkit was developed for the national implementation project and refined based on the experiences of the approximately 200 hospitals across the United States that participated in the project. It provides a foundational understanding of the science of safety, quality improvement, and evidence-based surgical care processes that other facilities can use to reduce surgical complications.

Project Partners

The toolkit was developed through a partnership between subject matter experts and providers in the field. There were three partners:

  • Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality provided clinical, infection control, and analytical expertise as well as overall administration, recruitment, and support for the project.
  • University of Pennsylvania provided an ethnographic team of social scientists to study the qualitative aspects of the frontline implementation efforts.
  • American College of Surgeons provided clinical National Surgical Quality Improvement Program data collection and reporting services, as well as perspective and technical expertise.

Final Report

  • AHRQ Safety Program for Surgery Final Report (PDF, 3.35 MB).

Return to the Toolkit Main Page

Page last reviewed December 2017
Page originally created November 2017
Internet Citation: About the Toolkit Development. Content last reviewed December 2017. Agency for Healthcare Research and Quality, Rockville, MD. https://www.ahrq.gov/professionals/quality-patient-safety/hais/tools/surgery/about.html
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