Public Health

Issue: In our Neonatal Intensive Care Unit (NICU), a neonate was found to have meningitis. The neonate's mother was concerned that she had transmitted an organism to her baby through breast milk. To allay the mother's concerns, an Infectious Disease (ID) physician had the breast milk cultured. The breast milk cultured positive for multi-drug resistant Acinetobacter baumannii, which was not the same organism that caused the meningitis. The ID physician classified the positive culture as colonization. Our institutions' infection control policies did not address isola-tion of breast milk. What is the best practice for isolation of breast milk? Project: A literature review conducted by Infection Prevention and NICU nurses to determine best practice for isolation of breast milk, which showed that refrigeration of breast milk at 4oC up to 96 hours did not significantly alter breast milk integrity, including bacterial colony counts, and thus, refrigeration would not destroy any organisms present in the breast milk. Additionally, the literature showed that common exposure of both the mother and the infant were not predictive of infection in premature infants. The Infection Prevention Coordinator placed the neonate in con-tact isolation under the assumption that the baby could be colonized from the mother. Since the breast milk was confirmed to be colonized with this emerging multi-drug resistant organism (MDRO), Infection Prevention and the NICU nurse also created a process to isolate the breast milk. The breast milk was placed in a storage refrigerator and freezer, which included labeling the containers of milk with the patient's identification label, placing the containers of milk in a biohazard bag, and labeling the breast milk storage bin as contact isolation. Separation of breast milk in the shared refrigerator from other breast milk through distance and biohazard bags was maintained until the neonate was discharged. The NICU physician allowed the neonate to con-tinue to breastfeed and receive the expressed breast milk. Since breast milk culture results were not predictive of infection when evaluated prior to the occurrence of infection, the breast milk was not routinely cultured during the infant's stay in the NICU. Results: The neonate did not develop any Acinetobacter baumanni infections. No other cases of Acinetobacter baumanni were identified during the neonate's admission or in the month follow-ing discharge. Our facility has adopted this technique of isolation for breast milk as standard of care in NICU. Lesson Learned: Infection Prevention needs evidence-based guidelines for storage of breast milk for NICU patients in isolation. In the future, a research project will be conducted to evaluate the risk for transmission of MRDO organisms in breast milk storage refrigerators and freezers.