I routinely suggest rinsing off nipples after feeding if the skin is broken.
The skin is an effective natural barrier against invasive pathogens.  Intact
nipple tissue doesn't need zealous washing because the integrity of the skin
and the natural secretions are sufficient to protect the health of the
nipple.  Normal cleansing in the shower, i.e. water running over the
nipples, would be sufficient.  However, if I had a cut on my finger and let
someone suck on that broken skin, I'd definately wash afterwards due to the
fact that the mouth harbors many bacteria/fungii, and viruses.

 Verity Livingston has identified  infectious mastitis as resulting from
ascending impetigo (i.e. a staph infection of broken, contaminated nipple
tissue  ascends the ducts).  Impetigo is treated with antibiotics and
washing.

When I see broken nipple skin, I suggest that the mother briefly suspend her
nipples/areolae in a solution of warm water and salt (mixed to the strength
of a normal saline solution) so that the nipples are rinsed after each
feeding. I've been considering using mild soap, but haven't yet.   I then
initiate dicussion with the doctor to obtain some topical antibiotic -- and
to consider oral abx if the nipple is purulent.  I certainly focus on
positioning and latch problem as the CAUSE, and consider the cracks the
RESULT.  The mother is definately advised to keep breasts flowing to avoid
stasis.  I'm willing to listen to argument, but given the un-cleansed
nipples I have seen that are dripping pus, I don't see how one can argue
against the first aid of wound cleansing  when the wound occurs on the
nipples.

Barbara Wilson-Clay BSEd, IBCLC
Austin Lactation Associates
http://www.lactnews.com

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