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This study epidemiolofia a reflection on the uses and future prospects of hospital-based health surveillance based on the account of a pioneering experience in hospital epidemiology, the epidemiology service at the Hospital Federal dos Servidores do Estado – HFSE, which served as the basis for the creation of epidemiologic surveillance units in municipal and state hospitals in Rio de Janeiro, Brazil.

The epidemiology service has combined epidemiological surveillance, continuing education, in-service training, research, and health service evaluation since The service is part of the national epidemiological surveillance network and was responsible for the notification of 55, cases between andmost of which were the result of active search.

The integration of various levels of health surveillance and health care makes classical control activities more agile and provides instruments for measuring. The important role played by the service in human resources training is evident in the training of 1, medical interns and 78 residents up to In addition, this mexronho has served as the basis for the implantation of several other hospital epidemiological surveillance units. Current challenges include the promotion of effective communication and coordination among the other health surveillance committees.

Although Epidemiological Surveillance ES is one of the oldest known epidemiklogia of health monitoring, the active participation of hospitals in this process is rather more recent, dating back to the s 1 1. Cad Saude Publica ; 2 3: Cad Saude Publica ; 18 Supl.

Brisse B, Medronho RA. The importance of the participation of hospitals in Epidemiological Surveillance networks is already acknowledged 4 4. Hospitals are an integral part of health systems, serving as important gateways for the treatment of monitored diseases.

However, they require a huge amount of resources and face a string of challenges, including the accumulation of data that often fails to be transformed into information that can be readily used to inform decision making 4 4. Rev Saude Publica ; 32 6: Traditionally, the surveillance of hospital-acquired infections has been touted as one of the most important components of health care in this context.

However, the overall role of hospital epidemiology has been the subject of growing discussion 4 4. The experience gained from implementing this service served as the basis for creating Epidemiological Surveillance units in municipal hospitals in Rio de Janeiro and contributed to the development of hospital surveillance units within the state health system 7 7.

Hospital-based Epidemiological Surveillance HES aims to detect communicable diseases and health problems of national, state and international concern in a timely manner, and describe patterns of disease in strategic regions of the country. The creation of these units led to an increase in the sensitivity and capacity of the Epidemiological Surveillance system 7 7.

Given that hospitals are the gateway of various unusual and emerging diseases, the inclusion of this type of health facility into the Epidemiological Surveillance system represents an important advance. The following aspects of hospital-based Health Surveillance are particularly worth highlighting: The HFSE is a federal general teaching hospital that has been developing Epidemiological Surveillance activities since and has actively participated in the above process over the last three decades.

A statistical analysis of the data generated by Epidemiological Surveillance was also conducted using the following information systems: The authors actively participated in the creation and implementation of the service and their experience is included in the analysis. Although it had been in operation since Novemberthe Epidemiology Service was officially inaugurated on 16 July It was the first hospital epidemiology service to belong to the former INAMPS network and possibly the first in Brazil to include activities that went beyond the ES of notifiable diseases.


The service has played a pioneering role in the following areas: Although these departments were maintained after federal government restructuring, functional allowances were suspended. Hospital Federal dos Servidores do Estado. Problems related to physical structure and human resources are cited in the four states. With respect to physical structure, Rio de Janeiro emphasized problems related to information technology equipment 19 Considerable improvements were reported in two NHEs associated with increased spending on equipment and furniture and consumables 9 9.

Seven of the eight NHEs were coordinated by doctors and one was coordinated by a nurse. The service is responsible for monitoring notifiable diseases in the hospital and liaises with other hospital-based Health Surveillance committees.

The hospital has six permanent staff employed by the federal government: There has been a significant reduction in medical staff, which reached a peak of seven doctors in the s. The hospital also receives an average of one intern per term six medical interns up to and, as fromone nursing intern.

Staffing shortfalls are a frequently cited problem in the national literature on NHEs 8 8. A general increase in the level of staff qualification was observed in Pernambuco between and This increase was not accompanied by an increase in the staffing levels. The service has the following aims in the area of Epidemiological Surveillance: The service also participates in the surveillance of noncommunicable diseases, provides advisory support for research projects developed in the hospital, promotes the development and analysis of indicators to measure the quality of hospital services, and promotes training and refresher training in the area of epidemiology.

The internships coordinated by the epidemiology service include an intense workload dedicated to ES, evaluation of the available information systems, and local health situation analysis. Residents and interns are involved in ES activities during in-service training. Integration between the various levels of ES helps to optimize classical notifiable disease activities and also provides tools for measuring service delivery, thus contributing to the improvement of service quality.

ES at hospital level is capable of generating and providing feedback on health care quality indicators. These efforts to produce feedback are characteristic of the service, although their impact is difficult to measure.

In Pernambuco, although the level of adherence of NHEs to best practices for the immediate notification of diseases was high, feedback was considered to be a weakness 8 8.

Figure 2 shows temporal trends in 55, notifications of notifiable diseases registered by the epidemiology service, illustrating the significant contribution of the service to ES in the State of Rio de Janeiro. A number of factors should be taken into account when analyzing this graph. The impact of arbovirus epidemics is high, beginning with dengue fever,and, fromZika fever and chikungunya. Since 11 Augustwhen the hospital was included in the Hospital-based Epidemiological Surveillance Subsystem, there has been an increase in notifications, partly due to improvements in surveillance processes and the inclusion of new notifiable disease.

Thumbnail Figure 2 Temporal trends in 55, notifications of notifiable disease made by the Epidemiology Service. The IEISS has played a leading role in the State of Rio de Janeiro in the provision of emergency treatment for infectious diseases and is historically recognized for its role in the treatment of meningitis in Rio de Janeiro, benefitting from a laboratory that specialized in the analysis of cerebrospinal fluid.

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Cad Saude Publica ; 13 2: There is a lack of effective integration between the two institutions, one of which is a state organization and the other federal. In terms of Epidemiological Surveillance, the notification and investigation process is unified and is the responsibility of the epidemiology service.

The proportion of acute bacterial meningitis increased from Sincemeningitis has accounted for around a quarter of all notifications made by the Mexronho. Data made available on the website of the Department of Health of the Municipality of Rio de Janeiro 24 Prefeitura do Rio de Janeiro. The epidemiology service also makes a significant contribution to Epidemiological Surveillance in the Municipality of Rio de Janeiro for other medronhl In the same year, the HFSE was the notifying unit that reported the highest number of cases of meningitis, leptospirosis, and HIV in pregnant women in the municipality, the fifth highest number of cases of hepatitis, and the tenth largest of tuberculosis 24 Notifications increased by There has been an increase in closing capacity in notified cases of bacterial meningitis based eoidemiologia laboratory diagnosis sincealthough the results were heterogeneous across NHEs.


Another process that showed heterogeneous results across NHEs was the opportunity for notification, with some showing unsatisfactory results. The role played by NHEs in the response to new diseases is well documented in relation to the H1N1 influenza pandemic 7 7. Garcia LP, Duarte E. Epidemiol Serv Saude ; 25 4: Figure 3 shows the distribution of the main notified diseases for the period to and for alone.

The main care departments at the time of notification were: The type of care provided was emergency care Thumbnail Figure 3 Distribution of notifications of notifiable diseases made by the Epidemiology Service by disease type.

Historically, hospital-based Epidemiological Surveillance has been based on the active search for cases, which requires a major effort on the part of epidemiology units to detect suspected cases in a timely manner. Of the 25, notified cases between and The percentage of spontaneous notifications varied greatly as a result of awareness campaigns medrronho adherence to partner services.

The integration of the hospital into the Hospital-based Epidemiological Surveillance Medronnho on 11 August led to the review of routines and procedures, including those designed to speed up decision making regarding control measures, promotion of spontaneous notification, awareness campaigns, training for health professionals, and permanent education.

The percentage of spontaneous notifications varied between Financial incentives were used to produce educational material posters, folders, and the Epidemiological Bulletin about mandatory reporting of notifiable mddronho and biosafety regulations.


An awareness raising campaign was initiated on 26 February involving the following activities: To complement these activities, the epidemiology service maintains permanent contact with various departments and harnesses opportunities generated by investigated cases to clarify doubts and raise staff awareness.

The campaign led to a significant increase in the percentage medronbo spontaneous notifications in the same year: The mean and median of spontaneous notifications in were It is important to note the percentage of spontaneous notifications in area registered by services that are historically considered partner services: Although the awareness raising strategies have had a positive medtonho on spontaneous medronuo, the following challenge remains: To use tuberculostatic drugs it jedronho necessary to fill out a SINAN investigation medrongo, reducing the losses associated with the treatment of tuberculosis.

In conjunction with these strategies, active search is the main pillar of case notification and investigation in the hospital. Specific analyses are conducted on a systematic basis using the SINAN to assess information quality, the clinical and epidemiological profile of diseases, and health care quality. In the case of meningitis, hospital-based Epidemiological Surveillance was able to provide feedback to the services on care indicators, culminating in the discussion of routine diagnosis and treatment of meningitis together with the services involved 27 Rev Saude Publica ; 38 5: Probabilistic relationship between databases was used to detect underreporting.

No mention was found of the participation of hospital epidemiology units in Epidemiological Surveillance in developed countries.

The main component is surveillance of hospital-acquired infections 4 4. Healthcare Epidemiologist Skills and Competencies.

Infect Control Hosp Epidemiol ; 36 4: The practice of hospital epidemiology. Yale J Biol Med ; 55 The new era of hospital epidemiology:

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