Hospital Practices and Research

Silent Spreaders in NICUs: Novel Surveillance for Neonatal Infection Control

Articles in Press

Document Type : Letter to Editor

Author

Reza Abdollahi

Department of Nursing, School of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran

10.30491/hpr.2026.548366.1510
Abstract
Neonatal Intensive Care Units (NICUs) face a persistent challenge in controlling healthcare-associated infections (HAIs), with reported rates ranging from 6% to 25% globally. While traditional infection control strategies have focused on symptomatic patients and high-risk groups, a growing body of evidence suggests that “silent spreaders,” asymptomatic carriers of multidrug-resistant organisms (MDROs) among healthcare workers, parents, and neonates themselves may represent a critical blind spot in current surveillance paradigms. If this is the case, then fundamental assumptions underpinning NICU infection control may warrant reexamination. We argue that existing approaches, which rely heavily on active surveillance cultures (ASCs) and hand hygiene compliance, are structurally ill-suited to detect asymptomatic transmission. Emerging genomic, environmental, and data-driven methodologies offer not merely incremental improvements but a necessary reconceptualization of surveillance itself.

Keywords

NICUs
Surveillance
Neonatal
Infection
1.     Schlaeppi C, Minotti C, Bielicki JA. Infection control in the NICU: the roles of surveillance cultures. Pediatr Infect Dis J. 2024;43(5):e175-7. doi:10.1097/INF. 0000000000004293
2.     Tzialla C, Berardi A, Mondì V, Study Group of Neonatal Infectious Diseases. Outbreaks in the neonatal intensive care unit: Description and management. Trop Med Infect Dis. 2024;9(9):212. doi:10.3390/tropicalmed9090212
3.     Nickel N, Brooks S, Mize C, Messina A. Reducing Staphylococcus aureus infections in the neonatal intensive care unit. J Perinatol. 2022;42(11):1540-5.
4.     Johnson J, Malwade S, Agarkhedkar S, Randive B, Rajput UC, Valvi C, et al. Risk factors for health care–associated bloodstream infections in NICUs. JAMA Netw Open. 2025;8(3):e251821.
5.     Price V, Ngwira LG, Lewis JM, Baker KS, Peacock SJ, Jauneikaite E, et al. A systematic review of economic evaluations of whole-genome sequencing for the surveillance of bacterial pathogens. Microb Genom. 2023;9(2):000947.
6.     Kanaujia R, Biswal M, Angrup A, Ray P. Diagnostic accuracy of the metagenomic next-generation sequencing (mNGS) for detection of bacterial meningoencephalitis: a systematic review and meta-analysis. Eur J Clin Microbiol Infect Dis. 2022;41(6): 881-91. doi:10.1007/s10096-022-04445-0
7.     Menezes RP, Melo SG, Oliveira MB, Silva FF, Alves PG, Bessa MA, et al. Healthcare-associated infections in high-risk neonates: temporal trends in a national surveillance system. Early Hum Dev. 2021;158: 105394. doi:10.1016/j.earlhumdev.2021.105394
8.     Keles E, Bagci U. The past, current, and future of neonatal intensive care units with artificial intelligence: a systematic review. NPJ Digital Medicine. 2023;6(1): 220.
McMann D, Scully P, Aneji C. Infection Control in Neonatal and Pediatric Intensive Care Units.  Infection Prevention in the Intensive Care Setting. Springer, Cham. 2024. pp. 125-40. doi:10.1007/978-3-031-67062-6_8
Hospital Practices and Research

Articles in Press, Accepted Manuscript
Available Online from 30 March 2026

Home

Guide for Authors

Submit Manuscript

Reviewers

Contact Us