ATTENTION AD Moms: Did you know that the Centers for Disease Control (CDC) just updated their breast pump cleaning guidelines? The change was made in part by the tragic death of a premature infant who contracted a rare infection from what the CDC is stating were improperly cleaned parts.
The CDC now recommends cleaning your pump parts with running water and soap, or in a dishwasher, after every single use. This advice also includes letting the pieces air dry completely before packing them away or using them again. According to the CDC this also means no more of the common practice of tossing your pump parts in the fridge between uses. In addition, the CDC also spelled out several other suggestions: such as washing your hands before handling pump parts or pumped milk; using a brush and wash basin that is used only for the pump parts (i.e., don’t wash the parts in a common sink, don’t use a bottle brush, sponge or washrag used on other dishes); and air-drying the parts thoroughly on a clean, unused dish towel or paper towel before storing the pump kit. It is further recommended to sanitize your pump kit after cleaning to provide extra protection against contamination. (Click here for the detailed guidelines).
However, as AD moms know, using a breast pump in the real world of the military doesn’t always mean you have access to a place to pump let alone a dedicated sink or any way to sanitize parts. Maybe you work at the Pentagon and have access to a sink and a microwave in the fancy lactation room just upstairs, but what are you supposed to do if you’re pumping in the field during a 2 week long training exercise? Or you work the motor pool and the only place to pump is a storage closet with a bathroom sink 5 minutes away as your only option?
First of all let’s look at what happened that prompted these changes:
According to the actual CDC report, the baby was a 29-week premature infant born via c-section who developed sepsis at the age of 21 days. She was being cared for in the NICU and the Mom was pumping her breastmilk with both a hospital-grade pump and her personal-use pump. After swabbing various surfaces at the hospital and home of the infant, the bacteria was found in the kitchen sink and the valves of the personal-use pump. In addition the mom was leaving pump the breast pump parts in a basin of lukewarm water for 5 or more hours at a time between cleanings. It should be stressed that this was a critically-ill, very premature infant, especially prone to contracting infections and disease. Pump cleaning guidelines for premature infants are (and should be) much stricter than for full-term infants. Of note, Cronobactor Sakazakii is found in powdered infant formula and human milk fortifiers (something that virtually every premature infant is placed on, breastfeeding or not) as well as other types of foods. The infection potentially could have come from a variety of sources, not just the pump valves. Finally, there are questions regarding the type of personal-use pump used and whether having an open versus closed system might have contributed to the contamination of the valves in question.
Then lets take a look at the other current recommendations put in place by both the Food and Drug Administration (FDA) and Human Milk Banking Association of North America (HMBANA), as well as current research on pump cleaning and contamination:
- Wash hands well
- Disassemble pump kit
- Rinse with COLD water to remove milk protein residue (creates a biofilm for bacteria to grow)
- Wash with warm soapy water (in a clean basin, NOT a sink)
- Rinse thoroughly
- Drip dry on a clean paper towel
- Or rinsed parts may be cleaned in a dishwasher
- Store dry kit in a clean reusable plastic bag or container with a fitted lid
- A dishwasher cannot sterilize, but will sanitize pump kit parts.
- Steam sterilizing bags do NOT meet FDA definition of sterilization, but will sanitize pump kit parts.
There is not a lot of research or information on breast pump cleaning guidelines or contamination resulting from improper cleaning. There has been no independent, peer-reviewed research on the use of disinfecting wipes and only one that looked at microwavable steam sterilizing bags to clean breast pump kits (Price, E., Weaver, G., Hoffman, P., Jones, M., Gilks, J., O’Brien, V., & Ridgway, G. (2016). Guidelines: Decontamination of breast pump milk collection kits and related items at home and in hospital: guidance from a Joint Working Group of the Healthcare Infection Society and Infection Prevention Society. Journal Of Hospital Infection, 92213-221). However, of note, the HMBANA does recommend that pumps have a barrier between the milk and pump connection, as moisture and aerosolized milk in the tubing can be a potential source of contamination. The Cochrane Review (Methods of milk expression for lactating women., Becker GE, Smith HA, Cooney F., Cochrane Database Syst Rev. 2016 Sep 29;9) looked at studies involving breast pumps, including cleaning guidelines and reported cases of contamination, and found the majority of cases were due to incomplete hand-washing and incorrect cleaning techniques, as well as back flow of milk into tubing and motors.
Finally, let’s look at what is the best practice and do-able in the real world of the military regarding breast pump cleaning for the average Active Duty mother of a full-term healthy infant who is returning to work at 12 weeks with a few likely scenarios. As always you should make a decision based on accurate information and weighing the risks versus benefits for your situation and comfort level. Download the Breast Pump Cleaning Guidelines handout for easy reference.
Designated Lactation Room with cleaning area in or nearby:
- Wash hands with each pumping session and before cleaning pump kit
- Rinse parts with cool or cold water
- Reduces milk proteins that lead to biofilm on parts
- Disassemble and wash pump parts after every use with soap and running hot water
- Use a clean, separate basin with a brush used only for your pump.
- Air dry parts on a clean surface
- Such as a paper towel
- Sanitize parts at home each evening via dishwasher or steam clean bags
Undesignated pumping area with NO cleaning area nearby:
- Wash hands with each pumping session and before cleaning pump kit
- Keep 2-3 extra pump kits (flanges, valves, membranes and tubing) and use a fresh set each pumping session
- Disassemble and wash and sanitize all parts at home each night
- Air dry on a clean surface
- Use steam clean bags after each pumping session to clean kit (if you have access to a microwave).
- Disassemble all pump parts before steaming
- Air dry as able
- Refrigerate pump kits between uses
- Disassemble and wash and sterilize all parts at home each night
- Air dry on a clean surface
In the field, aircraft, or other area with no electricity or limited/no water:
- Clean hands before each pumping session and before cleaning pump kit using hand sanitizer
- Use 2 one-gallon Ziplock bags to wash and then rinse pump kit(s) between uses
- one with soap for washing, and one without for rinsing
- with water from water buffalo or cooks/mess/galley
- Disassemble all pump parts before washing
- Air dry on a clean surface, if possible, and store in a resealable container
- Use Medela cleansing wipes to clean pump parts if no water is available
- Disassemble all pump parts before cleaning
- Use 3-4 (or more) pump kits throughout the day.
- Wash all kits at end of day
- If possible, heat the water and use soap in a clean basin
- Disassemble all pump parts
- Air dry on a clean surface if possible
Here at Breastfeeding in Combat Boots we believe that this new breast pump cleaning guideline is overkill for average mother of a 2-3 month old healthy full-term infant returning to work. Creating a very strict guideline based on ONE incident that will potentially impact hundreds, if not thousands of AD breastfeeding moms already struggling with finding the time and place to pump, often without the added time needed to follow these cleaning guidelines, is ludicrous. In our experience we have not come across a single full-term healthy baby that has *ever* gotten sick from refrigerated and/or reused pump parts. While we encourage you to follow the guidelines to the best of your ability, we will not enforce these new strict guidelines for healthy infants and mothers because we believe that it MAY dissuade a lot of moms from pumping upon their return to work who don’t have the option of following these guidelines or feel that this is too much to do in a workplace that already does not value breastfeeding and pumping. In our opinion, the benefits of theoretical contaminated breastmilk from pump parts far outweighs the known risks formula (which is contaminated far more often).
In addition we are concerned about the possible repeal of the ACA and how that might impact TRICARE coverage of needed extra breast pump supplies (beyond the two now covered), and the provision of reasonable break times and places to pump (as moms will need extra time for this new proper cleaning protocol, and adequate cleaning spaces, not a communal bathroom sink). These provisions are already difficult to come by regardless of the military policies in place, and these guidelines only serve to make a hard situation even harder.
As Amy Smolinski, Executive Director of Mom2Mom Global says, “This is extremely poor public health action. This was a single isolated incident of a very rare disease. Cronobacter was also found in the drain of the sink of the infant’s home–suggesting that it’s possible it was the water, not the pump, that was the source of the contamination. These guidelines are a knee-jerk reaction and literally impossible to follow for most families, not to mention working moms, creating yet another unnecessary obstacle to mom’s meeting their goals and/or the AAP and WHO recommendations for breastfeeding. Moms are still fighting for closed doors on lactation spaces, there’s no way employers are going to install separate sinks–nor should they have to. These recommendations are based on fear and a single isolated tragedy, not on appropriate research or actual risk vs benefit.”
What are your thoughts regarding the new CDC breast pump cleaning guidelines? Right on target or overkill? Will you be able to adhere to these guidelines at your workplace? Leave a comment below!