Safe Breast Milk Handling and Use in Light of COVID-19

Safe Breast Milk Handling and Best Practices During COVID-19

It is well recognized that human milk provides unique nutritional and immunologic protection to the health and well-being of infants, especially those who are born prematurely. Expressed human milk is often the prevailing way in which premature or sick newborns in the Neonatal Intensive Care Unit (NICU) are fed this liquid gold. However, there are many things to consider with expressing milk, especially in this vulnerable population. There are several steps to breast milk handling and management of expressed milk that are not present with direct breastfeeding. 

Hospitals have been placed under great stress with the recent COVID-19 pandemic, and are working to provide safe and high quality care to their new mothers and infants. In the NICU, it is important to follow strict practices to keep the milk and baby safe. Hospitals have unique policies, procedures, and designs within their facilities, but are all working to deliver safe practices surrounding human milk.

The American Academy of Nutrition and Dietetics has provided comprehensive recommendations for the preparation of human milk in healthcare facilities under general circumstances. These recommendations include the collection, transport, storage, temperature regulation, handling, preparation, and administration - to name a few. If you haven't invested in their newest Infant and Pediatric Feeding; Guidelines for Preparation of Human Milk and Formula in Healthcare Facilities, 3rd Ed., I would highly recommend it. As a NICU clinician, the information and recommendations throughout this publication were fascinating and allowed me to see where guidelines were already being met as well as areas that still had opportunity to improve. It was a cover-to-cover read!

The Human Milk Banking Association of North America has recently published Milk Handling for COVID-19 Positive or Suspected Mothers in the Hospital Setting. In a time where many things are uncertain, taking additional steps when accepting expressed human milk from a mother who is suspected or confirmed positive for COVID-19 is essential. By using the suggested "Bottle Transfer Technique", expressed milk can be safely transferred from mom to baby while protecting the quantity and quality of mother's milk (HMBANA, 2020):

"During routine care, the nurse who cares for the mother performs hand hygiene and dons PPE. The nurse picks up the milk storage container(s) with one clean, gloved hand and opens the patient's door with their other hand. They simply drop the bottles into a clean storage bag being held open by a second 'clean' nurse who is standing outside of the room. The clean nurse transports the bag to the nursery or caregiver for use." (HMBANA, 2020)

As always, hand hygiene remains vital for both caregivers and mother. HMBANA has also provided an Antiseptic Milk Transfer Technique that can be used in the event that the hospital's infection prevention team requires additional precautions to be taken (HMBANA, 2020). 

It is important to note that it is unnecessary and unsafe to apply chemical disinfectants to milk storage containers (HMBANA, 2020). Always be sure to partner with your infection prevention and nutritional teams to identify best practice and policy for your unique facility. 

As recently noted on LinkedIn as part of the Medela roundtable regarding the impact of COVID-19 on breastfeeding worldwide, Lars Bode highlighted the results of a recent research study conducted by the University of California, San Diego, to evaluate SARS-CoV-2 in the breast milk of 18 infected women:

"Having analyzed milk samples from COVID-19 infected mums, there is no evidence of replication-competent virus in human milk. The presence of viral RNA in human milk is rare, and none of the milk samples tested positive for presence of active virus. Even if the milk was contaminated with SARS-CoV-2 during expression and handling, pasteurization inactivates the virus. These data indicate that transmission from mum to the infant via human milk is unlikely." (LinkedIn, 2020)

With so many changes happening in the world today, one thing remains the same: Human milk is the gold standard. Considering the benefits of breastfeeding and the current evidence of the insignificant role of breast milk in the transmission of other respiratory viruses, breastfeeding and breast milk can and should continue to be provided - as backed by research and recommendations from UNICEF, the Academy of Breastfeeding Medicine, WHO, and the CDC.

Personally, as a fellow healthcare professional, I'd like to take a moment to thank all the healthcare workers who continue to show up everyday and provide the highest quality care despite the challenging times we are currently facing. You continue to put others' needs first, and for that we are all so grateful. Thank you!

References:

Steele C, Collins E. (Eds). (2019).  Infant and Pediatric Feedings: Guidelines for Preparation of Human Milk and Formula in Health Care Facilities. (3rd ed.). Chicago, IL: Academy of Nutrition and Dietetics.

Human Milk Banking Association of North America (HMBANA). (2020). Milk Handling for COVID-19 Positive or Suspected Mothers in the Hospital Setting. Retrieved from hmbana.org/file_download/inline/a593dd72-be78-471e-ae5e-6490309108fd

Lars Bode. (August 8, 2020). Medela [LinkedIn page]. LinkedIn. Retrieved August 10, 2020, from linkedin.com/feed/update/urn:li:activity:6697491375690264576/