Loan of Mobile Breast Pumps from Paediatric Cardiology, Neonates & the Paediatric Intensive Care Unit. - Standard Operating Procedure

Publication: 22/06/2022  
Next review: 22/06/2025  
Standard Operating Procedure
CURRENT 
ID: 7553 
Approved By: Trust Clinical Guidelines Group 
Copyright© Leeds Teaching Hospitals NHS Trust 2022  

 

This Standard Operating Procedure is intended for use by healthcare professionals within Leeds unless otherwise stated.
For healthcare professionals in other trusts, please ensure that you consult relevant local and national guidance.

Standard Operating Procedure on the loan of Mobile Breast Pumps from Paediatric Cardiology, Neonates & the Paediatric Intensive Care Unit.

Objective
The purpose of this SOP (Standard Operating Procedure) is to provide guidance on the use of Mobile Breast Pumps to loan from the Cardiac/Neonatal and PICU (Paediatric Intensive Care Unit) wards to mothers who are resident in Hospital provided accommodation. To be used in conjunction with  “Guidelines for the Preparation and Handling of Expressed and Donor Breast Milk and Specialist Feeds for Infants and Children in Neonatal and Paediatric Health Care Settings” produced by the British Dietetic Association.

Background

Breast feeding is the preferred method of feeding infants as breast milk provides the proper balance of nutrients and transfers immune factors to protect the infant in early life. The provision of breast milk in children who are medically complex is perhaps even more important due to the immunological protection provided (Thomas, 2020) and reduction in all-cause mortality (Ip  et al.,2007).  The development of the Cardiac Feeding Guidelines here at Leeds Children’s Hospital has meant there is a cohort of infants that can only be fed using breast milk, with no option to formula feed, further highlighting the importance of supporting mothers to express and breast feed. It has been identified, however, that in this particular group (Mothers of infants with a congenital cardiac condition) the high stress environment makes establishing a milk supply more challenging (Torowicz, 2015).

There are many barriers which hinder a mothers’ ability to express breast milk while a child is in hospital. A recent study has found that one of the main challenges is a lack of availability of specialist equipment to support complex breastfeeding and breast milk expression (Hookway et al., 2021). Mother’s also require a comfortable dedicated room equipped with electric breast pumps to express their milk (DOH 2009 toolkit) and it is essential that there are sufficient breast pumps for use in hospital (Renfrew et al., 2009).

To combat these barriers mobile breast pumps have been purchased for loan to mothers to allow them to express while resident in hospital accommodation. This will support with providing privacy to express in a comfortable space and access to a breast pump. This document outlines guidance on safely expressing and storing the expressed breast milk (EBM) using the loan mobile breast pumps.

Standard Operating Procedure

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1. Provision of Mobile Breast Pump & Equipment

  • Mothers should be provided with a portable pump from loan stock.
  • Along with the pump they require a copy of the “Handheld Record for Expressed Breast Milk” (Appendix 1)
  • Nursing staff will need to ensure there is a clear log of the pumps on loan and ensure items are returned before the infant is discharged home using the “Mobile Breast Pump Log” template (Appendix 2)
  • The external surface of the pump should be cleaned using a “Clin-ell” wipe or similar before being provided to parents. Breast pumps have been shown to be a potential source of contamination of the user, breast milk, infant and the environment and therefore require rigorous cleaning (Moloney et al., 1987). Drops of milk and aerosols will contaminate surrounding areas.
  • Additional essential equipment should also be given:
    • Individual sterile parent pump tubing set
    • “Clin-ell” wipes or similar wipes (for parent to wipe down the pump and surfaces after use)
    • Sterile storage bottles if needed. Parents may use their own storage bottles as long as sterilised before use.  
    • Storage labels with a clear space to write: Patient Name, Patient NHS Number, Date and time expressed, Date and time frozen, Date and time defrosted
    • A key to access the specialist breast milk storage fridges for overnight storage of breast milk at hospital accommodation
    • Tamper proof labels for the breast milk storage bottles
  • Once all equipment has been provided, the “Parent Contract” (Appendix 3) must be completed. A copy is to be given to the parent, and also stored on the ward, placed in patient medical notes/PPM+ for storage.
  • All electric breast pumps should be routinely checked and maintained by clinical engineering staff in accordance with manufacturers’ instructions and local equipment protocols to ensure they are working safely and effectively and that milk has not been allowed to enter the pump’s casing or its mechanism

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2. Parental Information

On loaning a breast pump, mothers should be educated by the ward team on:

  • Hand-washing: Procedure for correct hand washingprior to and after expressing breast milk is an effective means of minimising contamination of the milk with harmful micro-organisms. In addition, washing the breasts daily and a daily change of bra that has been washed using a hot machine cycle or in hot water is recommended.
  • Guidance on labelling, storage and handling of expressed breast milk. (see Section 3 below)
  • Storage containers: Each mother should be provided with her own sterilised storage bottles, for which it is the responsibility of the member of staff looking after her or her baby to ensure is she has enough. A different container should be used each time breast milk is collected.
  • Cleaning: External surfaces of electric breast pumps and surrounding surfaces in hospital need to be cleaned with a ‘Clin-ell” wipe’, which should be easily accessible in the ward/NNU area. This should be carried out by the mother, each time after use. Breast pumps have been shown to be a potential source of contamination of the user, EBM, infant and the environment and therefore require rigorous cleaning (Moloney et al., 1987). Drops of EBM and aerosols will contaminate surrounding areas.
  • Sterilisation: Breast pump tubing does not need to be sterilised or decontaminated between each use, however the outside of the tubing should be cleaned with a sanitised wipe and mothers advised that if EBM or moisture enters the tube this should immediately be brought to the attention of staff and the tubing replaced. If EBM has entered the tube whilst the breast pump is in use the pump should be taken out of action to await investigation by the clinical engineering department or the manufacturer. As mentioned above, pre-sterilised bottles should be provided by the ward, unless parents have their own storage containers, which must be appropriately sterilised before use.
  • Mothers should be directed to the Start4Life and unicef websites to support further with information and safety advice when expressing breast milk and breast feeding.

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3. EBM (expressed breast milk) Storage

  • Bottles containing EBM should be labelled with labels provided by the ward, which need to have a clear space to write: Patient Name, Patient NHS Number, Date and time expressed, Date and time frozen, Date and time defrosted.  
  • When not intended to be used immediately, EBM should refrigerated immediately after being expressed.
  • EBM can be stored in a fridge for 48 hours (Martinez et al., 2007), ensuring at hospital accommodation the specifically assigned breast milk fridge is used, not the communal fridge. The time of expression must be included on the label, to ensure safe storage. Daily, any EBM in the fridges in hospital accommodation should be brought to the ward for storage, meaning no EBM should be left off the ward for more than 12hours.
  •  If milk is to be used within 48 hours, it should be stored in a refrigerator at a temperature of 2-4 °c. This is essential for the safe storage of feeds. Cronobacter spp can grow very quickly at temperatures between 6-47°C (Kandhai et al., 2006).  When putting any EBM in the fridge, mothers must document in their “Handheld Record for Expressed Breast Milk”, ensuring they note down the fridge temperature at the time of storage. If the fridge temperature is >4°c the milk must be taken immediately to the ward for storage. If this situation occurs, any breast milk in the fridge that is currently being stored must be discarded. Mothers should only discard their own milk and alert the ward to ensure they can discuss with any other mothers who have milk in that fridge and ensure they discard their own milk.
  • The fridges located in the accommodation are monitored via the remote continuous temperature monitoring system that is in place. This can be accessed at any time via the appropriate software portal. Alarms are in place to alert the trust if the temperature moves out of the desired range for more than 20minutes. The fridges are also required to have a temperature spot check performed daily by staff from the Cardiac unit/L51 via the software portal. This daily spot check is to be documented in the temperature log.
  • EBM which has not been used/is not going to be used after 48 hours should be stored frozen at -20°c for a maximum of 3 months on the ward (Garcia-lara et al., 2012)
  • EBM from different mothers should be kept separate at all times using individual labelled trays, plastic boxes with lids, sealable plastic bags and separate drawers in freezers. This will help to prevent milk errors. If it is not possible to separate milk in this way due to lack of fridge or freezer storage space, plastic bags should be used to separate the milks and consideration given to increasing such storage.

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4. EBM Handling

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5. Transfer of infant to another ward/hospital/home

  • If transferring to another ward at Leeds Children’s Hospital, with care still being provided by the Cardiac team, discuss with the Ward Manager to determine if it is appropriate to continue to loan the mobile pump to the parent to support with provision of appropriate nutrition. 
  • If the infant is transferring to a different hospital or being discharged home, the pump must be returned to L51 and discussions with family around obtaining a home pump should be performed.
  • Any EBM in storage should be retrieved, verified and transferred with the staff or parents to ensure it stays with the infant. Documentation of this verification and transfer should be present. Where appropriate coolbags/ice packs should be used.

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6. Cleaning the pump on return from loan

  • Breast pumps have been shown to be a potential source of contamination of the user, breast milk, infant and the environment and therefore require rigorous cleaning (Moloney et al, 1987). Drops of milk and aerosols will contaminate surrounding areas
  • On returning the pump to the ward it should be disinfected by cleaning external surfaces of electric breast pumps and surrounding surfaces the pump has touched with a Chlorine wipe (e.g. Sanichlor or Chlorclean) which should be easily accessible in the ward area.
  • Any tubing returned by parents is to be disposed of as per trust disposal policy, as this cannot be used for multi-parent use.

Declarations of Interests

No declarations of interest.

Provenance

Record: 7553
Objective:
Clinical condition:
Target patient group:
Target professional group(s): Midwives
Secondary Care Doctors
Secondary Care Nurses
Adapted from:

Evidence base

Berkow SE, Freed LM, Hamosh M, Bitman J, Wood DL, Happ B, Hamosh P. Lipases and lipids in human milk: effect of freeze thawing and storage. (1984) Pediatr Res. 18:1257-62

García-Lara NR, Escuder-Vieco D, García-Algar O, De La Cruz J, Lora D, Pallás-Alonso C. Effect of Freezing Time on Macronutrients and Energy Content of Breast milk. (2012). Breastfeeding Medicine  7 (4) 295-301. doi: 10.1089/bfm.2011.0079

Hookway L, Lewis J & Brown A (2021). The challenges of medically complex breastfed children and their families: A systematix review. Maternal & Child Nutrition. DOI: 10.1111/mcn.13182

Ip S, Chung M, Raman G, et al.(2007) Breastfeeding and maternal and infant health outcomes in developed countries. Rockville, MD, USA: Agency for Healthcare Research and Quality.

Kandhai MC, Reij MW, Grognou C, van Schothorst M, Gorris LG, Zwietering MH. (2006). Effects of preculturing conditions on lag time and specific rate of Enterobacter sakazakii in reconstituted powdered infant formula. Appl Environ Microbiol. 72(4) 2721-2729.

Martinez Costa C, Silvestre MD, Lopez MC, Plaza A, Miranda M and Guijarro R. (2007) Effects of Refrigeration on the Bactericidal Activity of Human Milk: A Preliminary Study. Journal of Pediatric Gastroenterology and Nutrition  45 275-277.

Moloney AC, Quoraishi AH, Parry P Hall V. A bacteriological examination of breast pumps. (1987). J Hosp Inf 9:169-174

Renfrew MJ, Craig D, Dyson L, McCormick F, Rice S, King SE, Misso K, Stenhouse E, Williams AF. (2009) Breastfeeding promotion for infants in neonatal units: a systematic review and economic analysis. Health Technol Assess. 13(40) 1-146, iii-iv. doi: 10.3310/hta13400

Thomas V (2020) Breastfeeding sick babies. In  A. Brown and W. Jones (Eds). A Guide to supporting breastfeeding for the medical professional. Routledge.

Toolkit for High Quality Neonatal Services. Department of Health October 2009. www.dh.gov.uk/publications

Torowicz LD, Seelhorst A,  Froh EB &  Spatz DL. (2015) Human milk and breastfeeding outcomes in infants with congenital heart disease. Breastfeed Med. doi: 10.1089/bfm.2014.0059. Epub 2014 Nov 6.

Approved By

Trust Clinical Guidelines Group

Document history

LHP version 1.0

Related information

Appendix 1- Handheld Record for Expressed Breast Milk

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Appendix 2- Mobile Breast Pump Log

 

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Appendix 3- Parent Contract

Equity and Diversity

The Leeds Teaching Hospitals NHS Trust is committed to ensuring that the way that we provide services and the way we recruit and treat staff reflects individual needs, promotes equality and does not discriminate unfairly against any particular individual or group.