Vadapalli Sailusha, Valvi Chhaya, Dawre Rahul M, Bhagat Vaishnavi, Chivale Sangeeta, Pawar Sameer, Kinikar Aarti A
Department of Paediatrics, Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, Pune, Maharashtra, India
Pediatrics, Grant Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India.
BMJ Open Qual. 2025 Jan 25;13(Suppl 1):e002775. doi: 10.1136/bmjoq-2024-002775.
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.
The aim is to reduce the milk-culture positivity rates at the HMB by 50% or more, over a span of 3 months.
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.
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.
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.
母乳库（HMBs）为新生儿提供仅次于母亲自身母乳（MOM）的最佳喂养方式，尤其是在母亲自身母乳不足时。尽管母乳库是基于标准协议建立的，但由于乳汁培养阳性导致的乳汁污染和浪费仍是一个问题。本研究计划作为一项质量改进（QI）举措，以降低母乳库的培养率。
目标是在3个月内将母乳库的乳汁培养阳性率降低50%或更多。
2020年在西马哈拉施特拉邦一家三级护理医院的母乳库开展了一项质量改进举措。从母乳库登记处的数据中记录了自2018年1月以来所有送检的人乳培养结果。2018年至2019年间，乳汁培养率从105/4376上升至125/3823。通过鱼骨分析确定了2018 - 2019年期间供体乳汁的污染源。从2020年开始的计划 - 实施 - 研究 - 改进（PDSA）循环中，尝试了旨在降低乳汁培养阳性率的干预措施，即改善手部卫生、采集前对母乳捐赠者进行消毒、对吸奶器配件使用蒸汽灭菌器以及在乳汁处理的各个阶段招聘护士。
乳汁培养阳性率从2018年的105/4376（2.37%）上升至2019年的125/3823（3.27%），随后在2020年降至23/2103（1.09%），2021年为12/2345（0.51%），2022年为9/2985（0.30%），2023年6月为1/1322（0.08%）。在此期间，该单位的乳汁浪费减少了99%以上。这一改进持续到2023年，供体乳汁的质量持续提高。
质量改进举措取得成功，导致乳汁培养率显著下降，并得到了很好的维持。导致母乳库乳汁质量提高的措施包括改善手部卫生、使用蒸汽灭菌器以及在乳汁处理的各个阶段有敬业的人员。这些方法简单、易于复制且可持续，有望确保高质量人乳的稳定供应。
