Human Milk Bank Processes: YOUR FACILITY AND LOCATION

Gillian WeaverMilk Bank ManagerPresident; European Milk Bank Association (www.europeanmilkbanking.com)

Gillian.weaver@yahoo.com

QCCH Milk Bank

The world’s longest continually operating milk bank

Our primary goal

93% discharged receiving breastmilk,

60% exclusively breast/breastmilk feeding

Background info

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Brief description

How did your human milk bank (HMB) began? When?

1935 but officially established in1939

Who provided initial funding? How are ongoing operations funded? Integrated into government services?

Originally funded by ‘The National Birthday Trust Fund but is now funded by Imperial College Hospital NHS Trust (ICHNT). Some income is generated by reimbursement of costs by other hospitals who are provided with donor breastmilk.

Who regulates /oversees HMB in your country/region (if any)?

NICE guideline – implementation is audited

How many HMBs are part of your system? Where are they?

17 milk banks in the UK

Is there a central HMB that processes milk and distributes or many HMBs that process milk and distribute? (Centralized vs de-centralized)

Several are more like a centralised model but most are decentralised.

How many NICU/Neonatal wards/community homes does each bank serve? Are they collocated?

It varies between 1 and 36

How many babies does your facility/system serve annually?

Approximately 400 babies per year at ICHNT

How many liters/year does your facility/system process annually?

Processes 500 – 700 litres per year.

How many donor mothers initiate donation to your facility/system annually?

150 +

A NICE Guideline

Published in February2010 with:UNGQRGBaseline Assessment Audit Support

ProcessBrief description of processes

Staffing • 1 x full time manager• 1 x 0.8wte assistant (mainly administrative)• 1 x 0.5wte assistant (mainly technical)• 1 x volunteer for 2 hours per week (audit)

Donor recruitment • Donors contact the milk bank via the UKAMB website (www.ukamb.org), via local health care professionals or through word of mouth.

Donor screening • Telephone or face to face initial interview• Detailed health questionnaire via email or post• Blood tests (usually blood taken by local GP and posted to the ICHNT laboratory.• Ongoing screening via health declaration made with each donation.

Recipient eligibility and selection

• Preterm less < or = to 30/40• More mature babies who meet the pre determined criteria

Handling and storage of donor milk (from donation to feeding)

• If in mothers’s home she is required to monitor and record freezer temperature• If stored ina hospital in monitored freezer• In milk bank: stored according to the stage in the milk banking process ie raw milk is

stored separately from pasteurised milk, screened milk is separate from unscreened milk. All milk is stored separately according to the donor in demarcated and labelled baskets.

ProcessBrief description of process

Transport of milk • Via medical couriers, Via ‘Blood Bikes’ , Milk Bank staff• Use thick walled polystyrene containers sold for the purpose and with detachable

outer carrying case. • Tamper evidence is maintained and milk must be labelled with ID number of mother,

date expressed and any medications taken.

Pasteurization • Purpose designed and built human milk pasteurisers (fully automated) with built in printer and in built milk cooling system.

• Have two. Pasteurise in 50ml and 100ml aliquots to prevent wastage.

Tracking and record keeping

• Combination of electronic and paper. Use Excel spreadsheets to maintain records and to audit activity

Assessing milk quality and safety (ie. microbiology assays)

Pre pasteurisation• Every pool of milk (500 – 800mls, single donor only) is tested• Acceptance criteris are <100,000 cfu’s per ml in total• < 10,000 cfu’s per ml staphylococcus aureus, enterobacteriaceaePost pasteurisation• Sample from every batch should be <100cfu’s per ml.

Quality assurance • HACCP• Audit of implementation of NICE guideline• Double checking and authorisation of all test results• Annual calibration of equipment and follow maintenance schedule

Preparing to test the donated breastmilk

Equipment/LocationBrief description of process

What is used/how many? • Pasteurizer 2, Freezers 5 in the milk bank (lockable)• Refrigerators 1 in the milk bank

Additional HMB equipment requirements?

• 3 Secure rooms (1 only accessed by milk bank staff and 2 only accessed by milk bank or neonatal staff)

• 2 Computers• Printer and label printers

Referral/feeder/depot facilities?

• Other neonatal units in hospitals within the same perinatal network (6)

• Equipment requirements – monitored freezers

Neonatal ward equipment requirements?

• System for tracking usage – no but every container of DBM has unique ID number and comes with spare self adhesive number labels that are peeled off and placed in baby’s medical notes and on separate tracking sheet.

• Freezer and fridge

Other? • Tamper evident containers, laminar flow cabinet, insulated transport containers with washable outer cases and handles,

Organizational Successes

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Brief description of top 3-5 successes

Policy • Success of UKAMB nationally and UKAMB guidelines• National guideline funded by Department of Health (NICE guideline

CG93)• DH Neonatal Toolkit (2009) – recommends access to DBM • BLISS Standards for Neonatal Care - recommends access to DBM

Operational • Of the 46 Level 3 Neonatal Units in England the top five in terms of breastfeeding rates on discharge all have an attached milk bank

• Only 7% of infants are discharged from QCCH NNU (level 3) exclusively formula fed and 60% are exclusively breastmilk fed.

• Involvement of SERV groups (Blood Bikes – Volunteer motorcyclists, trained and co-ordinated to collect DBM from donors’ homes and transport to milk bank and deliver pasteurised donor milk from milk bank to other neonatal units

• QCCH – longest continually operating milk bank in the world

Technology

Transporting DBM

SERV (Service by Rider Volunteers)

Freewheelers

White Knights

Organizational Challenges

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Brief description of top 3-5 challenges

Policy • Developing a robust donor milk use policy that optimises support for breastfeeding and supports all mothers to provide their own breastmilk whilst at the same time ensuring stocks aren’t compromised due to too liberal use nor stocks too plentiful due to too constrained use

Operational • UKAMB – attracting funding • QCCH Milk Bank – maintaining consistent demand for DBM from other

hospitals to enable further growth and development of the bank• Space – very limited and restricts operations

Technology • introducing electronic testing and reporting systems into the milk bank at QCCH•Introducing bar code tracking into the milk bank at QCCH

Fail proof identification and traceability are essential components of the 21st century milk bank in the UK

Issuing DBM to the neonatal units of Imperial College Healthcare and to other hospitals

DONOR BREASTMILK:A very valuable resource!

Making every drop count …..

and never forgetting where it all starts....