Reduction in bacterial culture positivity rates at a human milk bank facility of a tertiary care hospital: a quality improvement initiative.

Abstract

Background: Human milk banks (HMBs) offer the best feed for neonates after mother's own milk (MOM), especially when MOM is insufficient. Although HMBs are founded on standard protocols, contamination and wastage of milk due to positive milk cultures remain a problem. Present study was planned as a quality improvement (QI) initiative to reduce culture rates at the HMB.

Aims statement: The aim is to reduce the milk-culture positivity rates at the HMB by 50% or more, over a span of 3 months.

Materials and methods: A QI initiative was undertaken at the milk bank of a tertiary-care hospital in Western Maharashtra in 2020. All human milk cultures sent since January 2018 were recorded from the data at HMB registry. The milk-culture rates had increased from 105/4376 to 125/3823 between 2018 and 2019. A fishbone analysis identified sources of contamination of donor milk during 2018-2019. PDSA (Plan Do Study Act) cycles begun from 2020, interventions aimed at reducing milk-culture positivity rates were tried, namely improved hand-hygiene, sanitisation of milk donors before collection, steam sterilisers for breast-pump accessories and recruitment of staff nurses at all stages of milk handling.

Results: Milk-culture growths had increased from 105/4376 (2.37%) in 2018 to 125/3823 (3.27%) in 2019 and then declined to 23/2103 (1.09%) in 2020, 12/2345 (0.51%) in 2021, 9/2985 (0.30%) in 2022 and 1/1322 (0.08%) in June 2023. The unit achieved reduction of over 99% in milk wastage during this period. This improvement was sustained till 2023 with consistent increment in quality of consumable donor milk.

Conclusions: The QI initiative was successful and led to significant decrease in milk-culture rates, which has been well sustained. The measures that led to the improvement in the quality of milk at the HMB were improvement in hand hygiene, use of steam sterilisers and presence of committed individuals at all stages of milk handling. These methods are simple, easily replicated and sustainable with a promise of ensuring a steady supply of high-quality human milk.