1. Donor breast milk banks Implementing NICE guidance 2010 NICE clinical guideline 93

2. What this presentation covers Background Scope and definitions Key priorities for implementation Costs and savings Discussion Find out more

3. Research has shown that breast milk is the best nourishment for babies and it is highly beneficial to their health in the short, medium and long term. Donor breast milk is neither widely nor readily available in the majority of hospital or neonatal units. Improvement in the operation of milk banking will increase cost effectiveness Source: Health Technology Assessment (HTA) report 2009 Breastfeeding promotion for infants in neonatal units: a systematic review and economic analysis Background

4. The guideline is for: donor breast milk bank staff healthcare professionals who care for babies who receive donor breast milk organisations who are considering starting a donor breast milk bank. This guideline makes recommendations on the safe and effective operation of donor milk services. Scope

5. Donor breast milk is defined as breast milk expressed by a mother that is then processed by a donor milk bank for use by a recipient who is not the mothers own baby. Definition

6. Areas identified as key priorities for implementation are: quality assurance screening and selecting donors handling donor milk at the milk bank tracking and tracing. The safety of donor milk depends on the implementation of all the recommendations. Key priorities for implementation

7. Use Hazard Analysis and Critical Control Point (HACCP) principles in all quality assurance processes. Validate, calibrate and maintain all equipment used in milk handling and processing and keep records of this. All donor milk administered should be from milk banks that can demonstrate adherence to the NICE guidance. Quality assurance

8. Training All milk bank staff should have ongoing training. Training should cover good practice and ensure that each staff member: –is competent in performing their job –understands the technical processes –understands how the milk bank is organised and how its health and safety and quality systems work –understands the regulatory, legal and ethical aspects of their work.

9. Screening and selecting donors Use the stepped screening process described on page 7 (QRG) At first contact explain that serological testing is mandatory Obtain informed consent before testing Do not routinely repeat serological tests while the donor is donating milk

10. Handling donor milk at the milk bank Before pasteurisation, test a sample from each batch of pooled donor milk for microbial contamination and discard if samples exceed a count of: 10 5 colony-forming units (CFU)/ml for total viable microorganisms or 10 4 CFU/ml for Enterobacteriaceae or 10 4 CFU/ml for Staphylococcus aureus. Test pasteurised donor milk for microbial contamination: either at least once a month or every 10 cycles, and on an ad-hoc basis if any new processes, equipment or staff are introduced.

11. Tracking and tracing At all stages, donor milk containers should be labelled clearly for identification. Clearly identify milk that is ready to be used. Only supply donor milk to hospitals or neonatal units that agree to comply with the tracking procedures for milk outlined by the milk bank.

12. Costs and savings The incremental national cost of implementation is thought to be small. The following areas may have resource implications at a local level: Quality assurance and staff training Screening and selecting donors Tracking and tracing

13. How familiar are we with Hazard Analysis and Critical Control Point (HACCP) principles, and what should we do to ensure these are followed in all quality assurance processes? What changes to our training approach should we make? How should we monitor the effectiveness of the tracking and tracing process? Discussion

14. Visit www.nice.org.uk/guidance/CG93 for: the guideline the quick reference guide Understanding NICE guidance costing statement audit support implementation briefing Find out more