Vigilância hospitalar: possibilidades e obstáculos de uma prática integrada

Abstract

This study discusses the integration between surveillances in hospitals (epidemiological surveillance and hospital infections control), analyzing the possibilities and impossibilities of such integration. It assesses the historical and political aspects, and the theoretical and practical concepts of services organizations in hospital surveillance, trying to identify the differences and similarities between both surveillances. The initial analysis allowed examining how limits imposed by the specificities of each surveillance help their practice in a non-integrated way. Then a qualitative research was carried out, through interviews with focal groups that work in hospital surveillance and epidemiological surveillance in hospitals, and in the hospital infection controlling committee. The material collected from the focal groups was analyzed through categories that arose from this same material. Hospital surveillances have been trying to change their practices, trying to break with neutralized ways, since there were many conflicts concerning technical issues coming from the differentiated formation of professionals who work in this field. Nowadays the search for new ways has been made possible by the change of perception among these professionals only, not imposed by managers, when they realized the need to reorganize hospital surveillance in a horizontal manner, building a diagnosis with multiple lights/knowledge, as practices committed to transforming reality in their hospital unit. Some point to the need of discussing a new concept for hospital surveillance, able to recognize hospital infection and epidemiological surveillances, as to include environmental surveillance, so the concept of health surveillance in hospital will allow a wider view of hospital surveillance. This one has hardly reorganized its practices, mainly its infrastructure, and human resources are the main problem. They realize that hospital surveillance demands rules, trends, protocols etc. to integrate their practices, and this requires integration. Although they believe integration must not start with changes in the service s structure, but in the work process, they hope that, after this construction, legislation is created to propose integration among surveillances, thus making this proposal affective.