1. Human Milk Bank – Jaipur Experience
Dr. Sheela Sharma
Incharge, Jeevan Dhara

2. In 1980 the World Health Organization and UNICEF jointly declared: “Where it is not possible for the biological mother to breastfeed, the first alternative, if available, should be the use of human milk from other sources. Human milk banks should be made available in appropriate situations.”

3. INAUGURATED ON 26th March 2015

4. This unit has been the result of collaborative project of Fk-Norway and Govt. or Rajasthan

5. CONSTRUCTION Expression Room 12 X 12 ft. Pasteurization Room
Deep Fridge Room
10 X 10 ft.
Office Room
8 X 10 ft.
Waiting Room
12 X 8 ft.
Expression Room
12 X 12 ft.

6. DONORS Our focus is on education and guidance using CPD protocols
C=Counseling of mothers
P=Use of Breast Pumps
D=Donation of mother’s milk

7. Milk counselors go to the post natal wards to detect mothers facing lactation problems and direct them to the milk bank known as “Jeevan Dhara”

8. Heat treatment for relief of engorged breast

9. DONOR SCREENING
We screen mother’s general health, donor’s child’s information, medications, environmental exposure, infection exposure and vaccination.
Serological testing of donor is being done (HIV, Hepatitis B, Hepatitis C, Syphilis) and results are acceptable if the test have been done within last 3 months.

10. We exclude mothers as donors if they have consistent alcohol intake, are smokers, take recreational drugs.
Our Milk bank uses recommended standard registration forms.

11. DONOR EDUCATION / SUPPORT / TRAINING
We train mothers in hand washing and hygiene, expressing milk and breastfeeding
Emphasize hygiene and hand washing

12. Cleaning and disinfection procedures are exclusively being done by the Milk Bank Staff

13. Emphasis on cleaning of dust collection points

14. Floor cleaning by lysol and supermop

16. Cleaning of door handles which are a ready source of infection

17. Cleaning of the switches with spirit swab

18. The door latches which are touched by everyone

19. Chair handles

20. Concealed dust collecting areas normally overlooked

21. Sink where regular handwashing and breastwashing is done

22. DONATION Hospital grade breast pumps are used for donation
We express at least 6, but preferably 8, times every 24 hours

23. Cleaning practices are vigorously adhered to, in our unit

24. Cleaning of the wires with spirit swab

25. Cleaning of pump knobs with spirit swabs

26. Cleaning of the breastpump tubes with spirit swab

27. A donor using double breastpumps

28. Sterilizer is used for sterilization of bottles

29. POST DONATION PROCESSING
We emphasize hygienic conditions for processing
Wear sterile gloves when handling milk

30. STORAGE OF MILK Milk is stored in food grade plastic containers
Storage containers are labeled with name of donor, date of collection/expression, date of pasteurization, donor’s number, batch number

31. Format of Labeling on post-pooling containers
Name of Donor_____________________________
Registration number of donor__________________
Date and time of donation_____________________
Volume of donation__________________________
Format of Labeling on storage containers for donation
Batch______________________________________
S.No.______________________________________
Date of Pasteurization_________________________
Date of Expiry_______________________________
Format of Labeling on post-pooling containers

32. A bottle being labeled

33. AREA 3: Pasteurized milk awaiting culture
AREA 4: Pasteurized milk ready for distribution
AREA 3: Pasteurized milk awaiting culture
AREA 2: Unpasteurized pooled milk
AREA 1: Fresh unpooled milk

34. Daily collection stored at 4ºC

35. POOLING Frozen raw milk is thawed in refrigerator
Containers are sealed
Acceptable raw breast milk from 5 – 6 donors is pooled.

36. MILK SCREENING PRE-PASTEURIZATION
Every batch of milk is bacteriologically screened prior to pasteurization
We have a policy to discard the donated breast milk if it does not meet criteria. Till now, no batch has been discarded.

37. PASTEURIZATION Holder’s method of pasteurization is being used.
In Holder pasteurization, a temperature of 62.5ºC (±0.5ºC) is maintained for 30 minutes and then cooled to 4ºC. Milk is rapidly cooled to at least 25ºC or below within 10 minutes.
We monitor process and record treatment/ pasteurization temperatures during treatment

38. Graphical representation of the temperature monitoring of pasteurization process

39. MILK SCREENING POST-PASTEURIZATION
Post-pasteurization microbiological cultures are done for every batch
We have a policy to discard milk that has any number of viable microbial content post-pasteurization. Till date, no batch has been discarded on the basis of post-pasteurization report.

40. DISTRIBUTION
Donor milk is transported in sealed bottles over ice-packs.

41. RECIPIENT PRIORITIZATION
Donor milk is given only by prescription. Physician is in charge of prescribing or initiating provision of donor milk

42. Prioritization of preterm newborn or low birth - weight newborn
Prioritization of infants with necrotizing enterocolitis
Prioritization of infants without access to their own mother’s milk or when the mother has a contraindication to breastfeeding/expressing milk (contraindicated medication, sickness, etc.)

43. DELIVERY TO RECIPIENT Defrosted in refrigerator.
For preterm infants milk is provided at 37ºC [Gonzales et al., Significantly improved feed tolerance and smaller gastric residue 6% (37ºC milk), 18% (24ºC milk), 22% (10ºC milk)]

44. RECORD KEEPING Tracking is judiciously done.
All donor milk and containers are labeled at each stage
Records are being kept for donor, container before pasteurization, batch
Receiving hospital records / documents how donor milk is used

45. INFORMED CONSENT
Before accepting donor’s milk, informed consent is necessary from donor
Before administration of donor milk, informed consent is required from recipient’s mother

46. STAFFING AND STAFF TRAINING
HMB staff includes one medical officer, milk bank counselors, milk bank manager and support staff.
Staff are updated and trained continuously
Staff training includes hygiene, quality control, safety, and tracking/tracing, technical procedures like collection, storage, pasteurization, infant nutrition and breastfeeding

47. Present Statistics Lactation counseling to 1902 patients.
Total Donors: 500
Total number of donations: 1279
Volume of milk collected: Ltr.
Volume of milk administered: Ltr.
Number of babies benefitted: 123

48. HUMAN MILK BANK
COUNSELING CENTRE
COUNSELING CENTRE
COUNSELING CENTRE
KMC UNITS
KMC UNITS
KMC UNITS
One Human Milk Bank should have multiple counseling centres with KMC Units which can also be the collection centres

49. FUTURE PLANS
Stress on Breastfeeding education and management centre rather than Human Milk Donation Bank.
Regular lactation education of mothers before delivery
Breastfeeding within the first hour of birth can be ensured by putting the baby on the chest of the mother immediately after birth

50. There should be universal policy and standard guidelines to be followed by all the chain of Human Milk Banks in the country.
Expensive equipments like the pasteurization machine and the breastpumps should be indigenously manufactured in our country.
Government of India should promote projects and research into manufacturing these devices.

52. What we learnt?
Our experience in “Jeevan Dhara” has shown that after the opening of Human Milk Bank, and introduction of lactation counselors the lactation failure rate has gone down and infact surprisingly in our unit, all the babies admitted are getting their own mother’s milk.
Creating a team of lactation counselors would go a long way in our primary objective of achieving 100% breastfeeding.

53. Use of breast pumps which are mother friendly for solving the initial problems like breast engorgement etc. goes a long way in motivating the mothers to donate their own excess milk to the bank.
We did not have to motivate them to donate and I recommend that we promote the concept of breastfeeding management centres rather than Milk Bank.

54. Our mother and father friendly nursery at JK Loan hospital providing KMC

55. Human Milk Bank team with full aseptic precautions in the pasteurization room during the training period

56. Thank you