by Anne Eglash MD, IBCLC, FABM
What is the recommended way to clean breast pump parts, to prevent infant illness? In July 2017, the United States Center for Disease Control (CDC) recently published their pump kit cleaning recommendations.
In April of 2016, a tragic case of infant illness thought to be due to breastmilk contamination led the CDC to develop standard recommendations for breast pump kit cleaning, in order to prevent these events in the future.
The premature infant, born at 29 weeks gestation, developed a blood infection (sepsis) at 21 days of age, which led to severe infection of the brain, resulting in life-long devastating neurologic impairment. The medical team isolated a bacteria called Cronobacter sakazakii as the offending pathogen, and in their investigation of the source contaminant(s), including breastmilk fortifiers, supplements, tap water, etc, they found the same strain of Cronobacter Sakazakii in 11 samples of mother’s expressed breastmilk, and from the valves of her personal breast pump kit.
The mother reportedly placed her breast pump parts in a basin of soapy water after use, and less than 5 hours later would rinse, air dry, and store the pump parts in a plastic bag.
What do you think are true statements regarding the CDC’s new breast pump kit cleaning recommendations? (choose 1 or more)
- Breast pump tubing should be boiled once a day, to prevent bacteria from contaminating the breast pump filter.
- Breast pump tubing that has visible milk or mold inside of it should be thrown away because the tubing is hard to clean properly. Soiled tubing indicates that there is something faulty with either the tubing connection or the pump valves.
- It is safe to store used breast pump parts in the refrigerator until the next pumping, rather than having to clean the parts after each use. The parts should be washed at the end of the day.
- A reasonable strategy is to use a microwave sterilizer bag for un-rinsed, recently used breast pump parts after each pumping.
- All used breast pump parts should be washed, rinsed, and air-dried after each use. In addition, they should be sanitized once a day either by boiling, using a microwave sanitizer bag, or by running the parts through the sanitation cycle of a dishwasher.
See the Answer
The answers are B and E
Here are the CDC Recommendations:
CDC Recommendations
Printable Fact Sheet on Cleaning a Breast Pump Kit
Milk Mob Comment by Anne Eglash MD, IBCLC, FABM
Just like everything else in breastfeeding management, uniform messaging is critical to support breastfeeding dyads wisely and safely. The Centers for Disease Control brought this issue to light, during a time that many clinicians have been confronted with questions about how often breast pump parts really need to be cleaned, and whether it is OK to put used, unwashed parts into the refrigerator until the next use.
The CDC recommends cleaning breast pump parts after each use. This involves rinsing each piece that comes into contact with milk, then scrubbing them with warm soapy water in a basin to remove all milk residue. After rinsing again, the parts should be placed on a clean/unused dish towel or on paper towels to air dry. Once dry, they can be stored in a clean covered container or plastic bag. Dirty or moldy tubing should be tossed and replaced, because they are not amenable to proper cleaning.
For those of us who provide breastfeeding advice and consultation, these recommendations may feel too stringent for some mothers/families who already feel overwhelmed with the task of pumping, let alone the post-pump clean-up.
Advice like this needs perspective. It would be an unintended consequence to have mothers wean prematurely because they are pushed over the edge with stress regarding cleaning pump supplies. Fortunately, in nearly 30 years of clinical practice, I have not hospitalized a healthy outpatient infant for an infection acquired from mom’s pump equipment. And in all honesty I have seen some pretty disgusting looking pump equipment in my exam rooms over the years.
If Cronobacter Sakazakii sounds faintly familiar to you, it used to be known as Enterobacter sakazakii, the notoriously bad boys found in powdered infant formula, that have sickened many infants over the last few decades. In fact, in 2012 the CDC published a set of guidelines regarding the prevention of Enterobacter Sakazakii infection from powdered infant formula. The #1 recommendation was to breastfeed! The FDA still allows a small threshold of Cronobacter Sakazakii in powdered formula, whereas higher levels are considered contamination.
90% of infants who have contracted Cronobacter Sakazakii were infected from contaminated powdered formula. Learn more about this formula problem here. Premature infants and infants under 3 months of age are the most vulnerable because of immune system immaturity. Expressed breastmilk is not typically on the radar as a cause of infection, considering that 90% of these infants are receiving powdered formula.
OK, this has been a long comment, so here my approach to my change in practice: I will suggest to mothers of NICU babies that they follow these CDC recommendations, and also the advice of their infant(s)’ medical team.
For my healthy outpatient breastfeeding dyads, I will be more conscientious about asking how they are cleaning their equipment. I plan to point out that it is a good idea to put their pieces into the dishwasher once a day if they have one. If no dishwasher, I will advise that they use hot soapy water to clean their equipment after each use, if possible. For busy moms who are mostly pumping, I already suggest having 2-3 pump kits to lessen the frequency of cleaning. I am not fond of gambling, but I would bet that germs from breast pump equipment would lose in a bad-guy germ competition if challenged by germs harbored in dog slobber, runny nose secretions from a sibling, or hands that have playing in a sandbox.
Lauren Elliott PA-C
I am not going to lie I kind of had mini heart attack when I saw these new recommendations about washing your breast pump parts. I am due in 4 weeks. With my last child I pumped at work until about 13 months. I would bring two sets of pumping parts to work and would refrigerate the parts after the 1st pumping session and use a new set of parts for the 3rd pumping session. I am very limited on time at work and would clean all of my pumping parts at home. Typically this meant rinsing, soaking in a large bowl, then scrubbing and finally rinsing with hot water. I rarely used the sterilization bags and never put my bottles in the dishwasher. I mostly used the sterilization bags if my child had recently been sick. We never put plastic in the dishwasher because even though bottles are BPA free washing them in the dishwasher can release chemicals from the plastic that can cause cancer. My breast milk was extremely greesey and you really needed to scrub to get the greese off of them. I really don’t believe my dishwasher could do this job. I don’t plan to change my pumping routine too much after this pregnancy. I will possibly no longer refrigerate the parts and just buy more parts which means more dishes. But I don’t plan on sanitizing them daily or placing them in the dishwasher.
Yoo-Mi Chung
CDC guide said,
For extra germ removal, sanitize pump parts, wash basin, and bottle bruth at least once daily after they have been cleaned.
I understood this as pump parts including breast pump tubing should be sanitized using boiling water, etc.
A.Breast pump tubing should be boiled once a day, to prevent bacteria from contaminating the breast pump filter.-Isn’t is a correct answer?
MilkMob
The CDC does not include breast pump tubing in its cleaning recommendations, just the parts of the pump kit that come into direct contact with the milk.
If milk leaks into the breast pump tubing, the tubes are considered contaminated and should be tossed and exchanged for new tubing. My understanding from the CDC guideline is that it is too difficult to clean dirty tubing adequately to prevent bacteria and mold overgrowth.
mamasitamama
I have seen frequent washing of tubing to encourage growth of mold as it is difficult to get them dry. The only time I suggest washing tubing is if milk gets inside the tubing. A major pump company suggested you rinse them with cold water and wash with hot, soapy water and allow them to air dry.
Rubbing alcohol can be run through the tubes to dry them or a blow dryer held at the opening of the tubing. Additionally, for small amounts of moisture, the tubes can be left plugged in with the pump running to dry condensation.
mamasitamama
I agree! My heart sank a bit upon reading this. Many mothers pump quite frequently and washing the parts after every pumping session is a lot of work! Also, using parts that haven’t fully air dried introduces water into the tubing inviting mold growth.
Thank you for the voice of reason, Anne! We don’t want strict instructions to discourage already stressed mothers from pumping.
Jeanna S.
Was the fortifier tested for contamination?
MilkMob
Yes, according to the report, the fortifier was also checked for the Cronobacter Sakazakii bacteria.
Flossie Rollhauser, IBCLC, RLC
These are essentially the recommendations I have been giving for years! What is the big fuss?
nanoo
Excellent post. I definitely appreciate this website.
Continue the good work!
k
appreciate the knowledge. want to keep all things in perspective!
Allison Zulawski
This is a post expecting mothers should read, even parents in general! The health of the baby would depend on how well cleaned the items used for the baby would be. Thank you for taking the time to make this post.
Dee
So many things to learn when your a first time mom like me. I’m paranoid when it’s comes to cleaning baby stuff I felt like these little germs are so sneaky.