Guidelines for the Preparation and Handling of Expressed and Donor Breast Milk and Specialist Feeds for Infants and Children in Neonatal and Paediatric Health Care Settings 1 Contents Contributors and Acknowledgements ...................................................................................................... 5 Contributors ............................................................................................................................................ 5 Acknowledgements ................................................................................................................................. 5 Foreword ................................................................................................................................................. 5 Frequently Used Abbreviations ............................................................................................................... 6 Frequently Used Definitions .................................................................................................................... 6 Section One ............................................................................................................................................ 7 Introduction ......................................................................................................................................... 7 Section Two ............................................................................................................................................ 8 Physical Facilities ................................................................................................................................ 8 2.1 The Special Feed Unit .................................................................................................................. 8 2.2 Facilities without a Separate Feed Preparation Room .................................................................. 9 Section Three ......................................................................................................................................... 9 Equipment and Supplies ...................................................................................................................... 9 3.1 Equipment .................................................................................................................................... 9 3.2 Supplies ..................................................................................................................................... 10 3.3 Facilities without a Feed Preparation Room ............................................................................... 10 Section Four ......................................................................................................................................... 11 Personnel .......................................................................................................................................... 11 4.1 Personal Hygiene and Clothing .................................................................................................. 11 4.2 Training ...................................................................................................................................... 11 4.3 Personnel in Facilities without a Feed Preparation Room ........................................................... 12 Section Five .......................................................................................................................................... 12 Feed Preparation and Handling ......................................................................................................... 12 5.1 WHO Guidelines for safe Preparation, Storage and Handling of Powdered Infant ...................... 12 5.2 Aseptic Technique ...................................................................................................................... 12 5.3 Feed Recipes and Labels ........................................................................................................... 13 5.4 Ingredient Water ......................................................................................................................... 13 5.5 Formula Mixing ........................................................................................................................... 13 5.6 Pasteurisation............................................................................................................................. 15 5.7 Chilling and Storage of Feeds in the SFU ................................................................................... 15 5.8 Care and Maintenance of Facilities and Equipment .................................................................... 15 5.9 Feeds Made Up Outside of SFU Hours of Operation .................................................................. 15 5.10 Irregularities in Feed Preparation and Storage ........................................................................... 16 Section Six ............................................................................................................................................ 16 Storage, Collection and Handling of Maternal Expressed Breast Milk (MEBM) and Pasteurised Donor Breast Milk (PDBM) ........................................................................................................................... 16 6.1 Expressing Breast Milk ............................................................................................................... 16 6.2 Breast Milk Storage .................................................................................................................... 19 6.3 Storing Breast Milk Prior to Arrival at the Hospital ...................................................................... 20 2 6.4 Transporting Breast Milk ............................................................................................................. 21 6.5 Appearance of Breast Milk.......................................................................................................... 22 6.6 Storage and Use of Breast Milk in Hospital ................................................................................. 22 6.7 Thawing and Warming Feed ....................................................................................................... 24 6.8 Continuous Feeds ...................................................................................................................... 25 6.9 Additives to Breast Milk .............................................................................................................. 25 6.10 Medications and Mother’s Milk ................................................................................................... 26 6.11 Maternal Illness and Breast Milk ................................................................................................. 26 6.12 Ante-natally Expressed Colostrum .............................................................................................. 26 6.13 Breast Milk Error ........................................................................................................................ 27 6.14 Donor Breast Milk ....................................................................................................................... 27 6.15 Storage Times for MEBM and PDBM ......................................................................................... 29 Section Seven ....................................................................................................................................... 30 Delivery of Feeds and Storage at Ward/Unit Level ............................................................................ 30 7.1 Delivery of Feeds ....................................................................................................................... 30 7.2 Discarding Formula .................................................................................................................... 30 7.3 Feed Storage ............................................................................................................................. 30 Section Eight ......................................................................................................................................... 30 Feeding the Child and Feed Management at Ward/Unit Level ........................................................... 30 8.1 Feed Handling ............................................................................................................................ 30 8.2 Warming Feeds .......................................................................................................................... 31 8.3 Feed Administration.................................................................................................................... 31 8.4 Discharge Planning .................................................................................................................... 31 Section Nine ......................................................................................................................................... 31 Infection Prevention and Control........................................................................................................ 31 9.1 Hazard Analysis Critical and Control Point Plan ......................................................................... 32 9.2 Microbiological Sampling ...........................................................................................................