The Pennsylvania Department of Health (PADOH) recognizes human milk as the ideal nutrition for infants. Human milk is associated with a decreased risk of many illnesses. For premature and sick infants, human milk may offer critical immune support. However, microorganisms can multiply rapidly in human milk. Severe illness has been documented in premature infants subsequent to feeding with human milk contaminated during expression or by using improperly cleaned and disinfected breast pumping parts, bottles, or equipment. Safe preparation, handling, and storage of human milk will prevent adverse outcomes associated with contamination.
PADOH is advising hospitals and healthcare facilities to closely review their infection prevention and control procedures for preparation, handling and storage of human milk for infant feeding. Policies and procedures should align with existing standards and be developed by an interdisciplinary group of infection preventionists, physicians, nurses, dieticians and lactation professionals. In a healthcare facility, human milk should ideally be prepared in a dedicated space by a trained milk preparation technician. Regular competency review and evaluation should occur.
Small amounts of bacterial contamination in water can lead to contamination of equipment used to prepare human milk for consumption. Premature and sick hospitalized infants are particularly vulnerable to these infections. Improperly cleaned equipment used to measure or prepare human milk will provide a reservoir for bacterial proliferation, with the potential for patient harm. This includes items such as bottle brushes, measuring cups or cylinders, and storage bins. For more information on reducing risk from water in healthcare settings, CDC resources are available at https://www.cdc.gov/hai/prevent/environment/water.html.
PADOH recommends review of the following resources to develop facility-specific infection prevention and control policies for preparation, handling and storage of human milk.
- Grota P, et al, eds. APIC Text Online. 2014. Available at https://text.apic.org/the-apic-text-online
- Jones, F. (2019). Best Practice for Expressing, Storing, and Handling Human Milk in Hospitals, Homes, and Child Care Settings. (4th edition). Human Milk Banking Association of North America, Fort Worth, TX.
- The Centers for Disease Control and Prevention (CDC) infant feeding hygiene guidelines available online at: https://www.cdc.gov/healthywater/hygiene/healthychildcare/infantfeeding.html
Although there are many aspects of infection prevention and control that should be considered for human milk preparation in a healthcare setting, the following are key recommendations:
- Wash hands with soap and water before handling human milk, feeding equipment, or breast pump equipment;
- Prepare human milk in an aseptic manner;
- Wash and sterilize all feeding equipment designed for multiple users per manufacturer’s instruction;
- Wash and disinfect all feeding equipment designed for single users per manufacturer’s instruction;
- Express and store human milk intended for hospitalized infants in sterile containers;
- Provide education to mothers and other caregivers about proper practices for milk expression and handling of human milk, especially for premature or sick infants, or healthy infants under 3 months old.
For educational resources for parents and caregivers, review CDC publications for infant feeding hygiene. Handouts for caregivers on human milk expression with a breast pump and human milk safety are available at https://www.cdc.gov/healthywater/hygiene/healthychildcare/infantfeeding/breastpump.html.
PADOH reminds you to always report outbreaks or unusual clusters of illness to the Bureau of Epidemiology by calling 1-877-PA-HEALTH or your local health department.
Originally released by the Pennsylvania Department of Health on December 6, 2019.