The HAI is the major preventable AEs, as observed in other developing countries. Despite the limitations of the study, the characterization of preventable AEs indicates that known and effective actions available to reduce HAI, such as hand hygiene, to prevent pressure ulcers, to encourage adherence to protocol and clinical guidelines and to create continuing education programs for health professionals, should compose the list of priorities of hospital managers and health professionals involved in the care of hospitalized patients.

A study on surgical adverse events (AE) is relevant because of the frequency of these events, because they are in part attributable to deficiencies in health care, because of their considerable impact on patient health and economic consequences on social and health expenditures, and because this study is an assessment tool for quality of care. We aimed to evaluate the incidence and the contributive factors of surgical AE in hospitals of Rio de Janeiro. This retrospective cohort study aimed to perform a descriptive analysis of secondary data obtained from the Adverse Events Computer Program, which was developed for collecting data for the assessment of AE in three teaching hospitals in the state of Rio de Janeiro. Incidence of patients with surgical AE was 3.5% (38 of 1,103 patients) (95% CI 2.4 - 4.4) and the proportion of patients submitted to surgery among patients with surgical AE was 5.9% (38 of 643) (95% CI 4.1 - 7.6). The proportion of avoidable surgical AE was 68.3% (28 of 41 events) and the proportion of patients with avoidable surgical AE was 65.8% (25 of 38 patients). One in five patients with surgical AE had a permanent disability or died. Over 60% of the cases were classified as not complex or of low complexity, and with low risk for care-related AE.

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Descentralização das ações de Vigilância Sanitária Cohen, M.M. et al. Descentralização das ações de Vigilância Sanitária Cohen, M.M. et al. *O questionário foi desenvolvido pela equipe do NPDI/CVS/SES-RJ, tendo como referência o instrumento "Levantamento da Situação dos Órgãos de Vigilância Sanitária dos municípios" 5,16 , e as Resoluções SES 562/90 6 e 1262/98 7 , assim como a NOAS/ SUS 01/2002 8 . Descentralização das ações de Vigilância Sanitária Cohen, M.M. et al.

The report published in 2015 by the Lancet Commission on Global Surgery 1 considers the provision of surgical care an essential component of health systems and a major public health problem. The report defends the inclusion of access to surgical care on the health agenda, based on the principles of universal coverage, equity, and justice. Six indicators were selected, along with a structure for drafting a national plan to assess the current situation: access to timely essential surgery; specialist surgical workforce density; surgical volume; peri-operative mortality rate; risk of impoverishing expenditure; and risk of catastrophic expenditure.The application of these indicators in Brazil identified huge geographic inequality and regional differences in the supply of surgical care and the availability of qualified professionals, namely surgeons and anesthetists. Brazil's hospital network is considered inefficient, with 57% of hospitals having 50 or fewer beds and 35.72% of hospitals concentrated in the Southeast region 2 . The population in remote locations has to travel large distances to access a hospital that provides timely and effective care, including in emergency situations. Meanwhile, the number of beds in a hospital influences the quality of care provided, particularly surgical care, with a higher risk of adverse surgical events in small hospitals 3 . Studies suggest an inverse relationship between volume of high-risk surgical procedures and mortality 4 . The authors also emphasized the performance of simultaneous procedures by surgeons and anesthetists or by untrained professionals. Such practice definitely leads to negative results in the quality of surgical care and patient safety.The peculiarities of the Brazilian Unified National Health System (SUS) and the country's large territory affect the supply of low, medium, and high-complexity surgical procedures. As highlighted by the authors, planning for increases in the coverage of low and medium-complexity surgeries should consider outpatient surgeries. Outpatient surgical centers should be designed to perform low and medium-complexity procedures in patients with good clinical status and who do not require staying more than 12 hours in the health service, leading to a reduction in operating costs. Adverse events, including deaths, raise concerns over patient safety and the need for government regulation. Quality improvement efforts in outpatient surgical care should seek adherence by surgeons and anesthetists to Brazilian Federal Board of Medicine (CFM) Resolution 1,886/2008 5 , which sets minimum standards for functioning of medical offices and surgical centers for short-stay procedures. To guarantee that the patient can recover and be discharged within a reasonable time frame, standards