As a nurse, I wash my hands many, many, many times a day. As prescribed by
Universal Precautions, I wear gloves when in contact with blood and body
fluids. However, I do not wear gloves when assisting moms with breastfeeding.
Nor is wearing gloves part of our hospital policy and procedure for
breastfeeding promotion. Why not wear gloves?
When Elizabeth Glaser, the founder of the Pediatric AIDS Foundation died, all
the news reports mentioned that she had passed HIV to her daughter, Ariel,
through breastmilk. Ariel developed AIDS and died.
My imagination went into overdrive. What effect would these news reports
have? Is breastmilk dangerous? The news reports did not include the fact that
the infectivity of HIV is atypically high during the seroconversion phase.
Ms. Glaser had acquired the HIV virus from a blood transfusion during the
perinatal period, which would account for this transfer of the virus. I felt
as if I needed to provide some information to the maternal-child staff. I
provided articles about HIV and breastmilk and posted a memo. According to
the CDC, Universal Precautions do NOT apply to human breast milk (unless it
contains visable blood).
The reference for this is:
CDC: Update: Universal precautions for prevention of transmission of HIV,
Hepatitis B virus and other bloodborne pathogens in health-care settings.
MMWR 37: 378-87, 1988.
My overactive imagination in reference to this subject was not totally
without basis. For several years, the nurses had stored expressed breastmilk
in bottles or bags in a shoebox-size Rubbermaid container in the freezer
compartment of the unit's refrigerator. The hospital's Infection Control
Nurse had said that breastmilk had to be kept in a separate refrigerator. A
small refrigerator was purchased. After I did this research, I called the
Infection Control Nurse to ask for references. She told me that an OSHA
inspector thought it was disgusting to have a human secretion in a food
refrigerator.  The nurse agreed that it was disgusting, and even though OSHA
said there was no rule about breastmilk storage, she made the decision that a
separate refrigerator was necessary.
Beside emphasizing that milk is food, I also provided some practical (the
milk was kept isolated from other food) and immunological information, to no
avail. We still have the little refrigerator sitting on a counter.
I do not deny that there are times when a lactation consultant would wear
gloves. Emotionally, what does wearing gloves say? It could have a negative
impact on breastfeeding promotion at some hospitals. I follow the CDC
statement that Universal Precautions do not apply to human breast milk. I'll
just keep washing my hands.
Becky Engel, RN, IBCLC