I am new in my position as the Lactation Consultant in a level 3 NICU and have continued some of the practices the previous LC started, but several things have not set well with me.  I really am interested in hearing your wise input/advice/practices and any research you may be aware of. 
 The first thing that has concerned me is the practice of cleaning the breast....the instructions given to mom are to clean the breast/nipple daily w/ liquid body wash ( because bar soap harbors bacteria)  and then to apply bactoshield (chlorhexidine)  to breast and nipple area and let sit for 1 min before washing it off.  This goes against everything I have read.  My concern is that this 'washing' may messing up the normal protetive flora and thus creating an overgrowth of bad bacteria?  What are your thoughts?  Do any of you know of any research I could use for or against this practice in the NICU setting? What are the procedures used in your institution keeping in mind we have a very uneducated population? The thought behind that was that our very early babies are more suseptible to pathogens so we need to go to extremes to keep from contamininating the EBM.  
My second concern is regarding culturing breastmilk.  It is not routinely cultured here, but if baby is having issues then they will culture.  Breastmilk will be held for 5 days while mom applies Avaguard x2 daily and then the breastmilk is recultured.  I might add here that it seems to be our very cleanest of moms that has + breastmilk cultures! ( messing up her normal flora??)  My other concern is the use of Avaguard on the breast nipple area!!  My guess is that if we cultured every mom that was pumping and providing breastmilk, the majority of them would come back w/ positive cultures.  
I do not want to just change things because I am uncomfortable with it. I do realize that practice may be different in the NICU from the term babies I am most familiar. Just wanting some currrent/evidenced based information so as to do it the 'best' way.  
Appreciate any and all input. :)
Kim Reaser BSN, RN, IBCLC

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