There is a principle of capitalism (don't look at me, I'm an emotional socialist) that translated from the Latin states:  Let the buyer beware. We can't control nor can pump companies control how people decide to use products. However, I do think health care professionals have an obligation to read the existing literature on infection control, and it is an ethical responsibility to take precautions to protect the patients one serves. Are people aware, for example, that fake fingernails are a documented risk in terms of spreading fungal infections into open incisions of surgical patients? (Hedderwick SA, McNeil SA, Lyons MJ, Kauffman CA. Pathogenic organisms associated with artificial fingernails worn by healthcare workers. Infect Control Hosp Epidemiol 2000; 21(8):505-9.) By the way, the nurses were gloved.

 What is more of an issue than one mother packing up her own (hopefully cleaned up) equipment in between babies is for two different mothers to share equipment which may have been ineffectively sterilized or which may be impossible to sterilize.  I don't think we need to worry much about HIV, which, as others have pointed out is fragile outside of it's host.  However, lots of other possible contaminants could be problematic. Within a family, members are exposed to and have developed antibodies.  Other people's germs are more likely to be a problem.

 It is not much of an argument to say where are the documented cases?  Who knows?  No one tracks these things in breastfeeding (altho they sure track it in bovine science.)  Read the dental infection control data and discover how much they are still learning about the contamination risks of vacumn and suction devises.  You may never get your teeth cleaned again.  Frankly, in spite of my efforts to always get the earliest appts at the dentist possible so as to always get the stuff straight out of the autoclave, I have noticed over the years how often I wind up with a respiratory infection in the month post-dental work, and now refuse to schedule such work if I have some big committment that might get fouled up if I'm sick.  You just have to hope for the best in terms of your immune system being competant to handle the onslaught.

New mothers have compromised immune systems. (See an interesting discussion of how this effects sore nipples in W Pray. Consult your pharmacist:  Dermatitis causes are diverse. U.S. Pharmacist 2000; 25(8):14-24.)  They are more vulnerable to opportunistic infection .  This plays into the recent discussion of hard-to-clear infections that may (or may not be) fungal in nature.  Why are we so dilligent in having women, on the one hand, decontaminate their entire homes and take powerful medications to treat one type of infection (candida) that hasn't been cultured or documented in any way and take such a cavilier attitude about the possibility that they may (in the effort to save a few bucks) borrow their neighbor's unsterilizable pump?

I think the economics are impt. and I agree with Anne Merewood that there ought to be recourse to pump funding, and with Teresa who teaches people to hand express. Someone wanted to know how to present the news to mothers about the risk of pumps:  Straight out, pleasantly, factually, non-judgementally, and without illusion that you get to control any aspect of their behavior.  All you get to control is your own ethics, which requires informed consent.  Risk assessment is part of that.

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



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