Storage of Water for Forula Milk for Babies in Hospitals

[Matthias Maiwald (SHHQ)]

Dear Colleagues,

May I ask if anyone of you has some established protocols, or is aware of any guidelines relevant to ingredient water for the preparation of formula milk for babies in a hospital setting?

Background is that in a health care setting (other than this is the case in a domestic setting), ingredient water for preparing formula milk is supposed to be either sterilized or at least be heat-disinfected by boiling. The practice here in some units has been that sterilized infant milk bottles have been prepared and filled with boiled water by the hospital kitchen, then distributed to the wards, and then been kept at refrigerator temperature for a maximum of one day, and then prepared by adding the milk powder.

Now some wards have apparently run out of fridge space and ask us if (a) the water can be stored at room temperature for up to one day, and (b) if we in the lab can microbiologically test a sample batch to rule out that the room temperature storage leads to microbiological deterioration.

The main relevant guideline that we could find is that of the American Dietetic Association:

Robbins ST, Meyers R. Infant Feedings: Guidelines for Preparation of Human Milk and Formula in Health Care Facilities. 2nd ed. Chicago: American Dietetic Association; 2011.
http://www.neogenii.com/wp-content/themes/enfold/pdfs/ADA.pdf

These guidelines:
(1) By stipulating that the water should be chilled before preparation indirectly recommend against keeping it at room temperature before preparation.
(2) Clearly recommend against microbiological testing of ingredient water and powder at the point of the healthcare facility.

As a microbiologist, I also would not know exactly what test procedures I should apply, given that boiled water is not technically sterile. Procedures for sterility testing, or those for regular (municipal) drinking water testing?

I was looking for other available information to complement/supplement the information from the American Dietetic Association (such as European, Australian recommendations), but a Google search was unsuccessful.

Is anyone out on this forum aware of any Australian or European or other types of guidelines or practice recommendations pertaining to these questions? Any input would be hugely appreciated.

Best regards, Matthias.

—
Matthias Maiwald, MD, FRCPA
Consultant in Microbiology
Adj. Assoc. Prof., Natl. Univ. Singapore
Department of Pathology and Laboratory Medicine
KK Women’s and Children’s Hospital
100 Bukit Timah Road
Singapore 229899
Tel. +65 6394 8725 (Office)
Tel. +65 6394 1389 (Laboratory)
Fax +65 6394 1387

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