Systemic infections are the second most common direct cause of neonatal mortality [1]. Sepsis and meningitis also contribute to neonatal deaths due to other direct causes like prematurity, birth asphyxia, and congenital malformations. Hospital-acquired infection (HAI) is a common complication during care of preterm or sick neonates in neonatal units, and is associated with high case-fatality rate, prolonged hospitalization, use of higher generation antibiotics, and adverse neurological outcome [2, 3]. Yet, most neonatal units in low- and middle-income countries may lack a formal monitoring mechanism or systematic strategic response to contain HAIs [4]. In this issue of the journal, Balachander et al. present successful implementation of a quality improvement project targeted at monitoring and containment of infection outbreaks [5]. The study highlights the importance of following a systematic approach for detection and control of an infection outbreak. Important steps followed in the study included 1) surveillance by case definition and listing, 2) cohorting of infected and colonized cases, 3) identification of source of infection and 4) strengthening of infection control practices.

Foremost step in the outbreak control is timely identification of increase in the incidence of infection with a specific microorganism. A visual display of infection-related quality metrics on a dashboard can be a useful tool to monitor the incidence and inform quality improvement initiatives [6]. Table 1 presents a list of variables which can be displayed with such a tool. These variables can be easily collected as part of the census reports. Visual display in the form of a run or control chart and regular review assists in detection of any trends or shifts in the incidence of HAI. For a unit with no previous data, a baseline incidence data will need to be collected over 9–12 mo to get information about natural variation in the incidence. In addition to monitoring for incidence of HAI, the unit also needs to monitor for growth of methicillin-resistant Staphylococcus aureus, multi-drug resistant Gram-negative bacteria and vancomycin resistant Enterococcus. Growth of any of these organisms should be responded to by looking for source of infection, including patients and fomites/equipment colonized by the index bacteria.

Table 1 Monitoring infections in a neonatal unit
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