Preface

3

Introduction

5

SECTION 1

HYGIENE

A

Hand Hygiene at Home

6

B

Hand Hygiene in the Hospital or Child Care Setting

6

C

Alcohol Rubs

7

D

Gloves

7

E

Maternal Hygiene

7

F

Clean Milk Collection

8

G

Bacteriologic Screening of Milk

8

SECTION 2

EDUCATION OF MOTHERS

A

Education

9

B

Hand Expression

9

C

Drip Milk

9

D

Pump Information

9

E

Establishing/Maintaining a Milk Supply with a Pump

10

F

Faltering Milk Supply

12

G

Slow Weight Gain/Increasing Calorie Content

13

SECTION 3

CLEANING PUMP EQUIPMENT

A

Cleaning Pumps

13

B

Sterile Pump Kits

14

C

Cleaning Pump Kits

14

SECTION 4

CONTAINERS & RELATED ISSUES FOR MILK STORAGE

A

Containers for Milk for Healthy Babies

15

B

Containers for Milk for in Hospital Use

15

C

Non-Sterile Containers

16

D

Lids

16

E

Labeling Containers

16

F

Labeling Refrigerators and Freezers

16

G

Freezing Milk

16

H

Adding to a Container

17

I

Refrigerators/Freezers for Storage of Milk:

a

At Home/Child Care

17

b

In Hospital

17

J

Transport/Shipping

18

SECTION 5

HANDLING MILK

A

Handling Fresh, Frozen or Pasteurized Milk

19

B

Thawing

19

C

Warming for Feeding

20

D

Milk with a Soapy Odor/Taste

20

SECTION 6

FEEDING HUMAN MILK IN THE INTENSIVE CARE NURSERY

A

Benefits of Human Milk for Preterm Infants

21

B

Donor Milk

22

C

Gut Priming

22

D

Supporting Milk Production

22

E

Steps to Getting the Infant to the Breast

23

SECTION 7

USE OF FORTIFIERS AND EFFECTS ON STORAGE TIME

A

Adding Fortifiers

24

B

Storage Duration

24

SECTION 8

MANAGEMENT OF EQUIPMENT AND FEEDINGS IN THE INTENSIVE CARE SETTING

A

Preparation of Feedings

25

B

Tubes & Syringes

26

C

Use of Colostrums

26

D

Loss of Fat

27

E

Exposure to Light

27

F

Mixing Milk and Formula

27

Appendix 1

Evaluation Criteria for Evidence Cited

28

Appendix 2

Summary of Storage Duration for Human Milk

28

Appendix 3

Human Milk Errors

A

Information of Health Care Providers

29

B

Information for Parents: When Your Baby Receives Another Mother’s Milk

30

C

Information for Parents: When Your Milk is Given to Another Mother’s Baby

31

D

Plan of Care

32

E

Management of Potential Hepatitis B Exposure

33

F

Management of Potential HIV Exposure

33

Appendix 4

Risk Management Issues for Storage and Dispensing of Human Milk in the Hospital

34

Appendix 5

Summary of HACCP for Handling Expressed Milk in the Hospital Setting

35

Appendix 6

HMBANA Member Banks and Advisory Panel

37

References

38