Hi Laurie,
There is not really a protocol for breastmilk cultures. I would say 
expert opinion + protocols used in studies could be summarized as such:  
apply some sort of sterilizing fluid to the nipple/areolar area ( I used 
alcohol wipes), discard the first few squirts of milk, and collect the 
milk in a sterile fashion via manual expression, about 1 tsp, into a 
sterile container such as a urine cup. I usually collect this culture 
myself using gloves, to keep it as sterile as possible.
The trick is sending the milk as a sterile body fluid culture so that 
all bacteria is considered a pathogen. Usually when cultures are done, 
they are considered 'wound' cultures, so that 'skin flora' is considered 
contamination. Well, for breastmilk, the skin flora 
(coagulation-negative staphyloccocus)  is usually what is causing the 
infection, so the only way to get the lab to grow this bacteria & to 
check sensitivities is to tell the lab to consider it a sterile fluid.
I hope this is not confusing. If you share this information with 
doctors, they should understand.
Let me know if you need further clarifications. Anyone should feel free 
to copy and share with health care providers.
Anne

Anne Eglash MD, FABM, IBCLC
Clinical Professor
Dept of Family Medicine
University of Wisconsin School of Medicine and Public Health
600 N. 8th St.
Mount Horeb, WI, 53572
608-437-3064 (O)
608-437-4542 (fax)
608-550-3054 (pager)

On 5/30/2012 2:37 PM, LACTNET automatic digest system wrote:
> Hi Anne,
> Can you tell us how you would recommend doing a breastmilk culture?
> I thought it would be collected like a clean catch midstream urine culture.
> Something like this: mother washes hands, mother washes breast with some sort
> of antiseptic? Mother expresses streams of milk but does not collect, then mother
> catches stream of milk into sterile container. Mother is instructed not to touch the
> nipple or the inside of the container.
> Is that close? This would be important if we had to suggest this to one of our docs, with
> a pt whose breast pain or other s/s were not resolving.
> Laurie Wheeler RN MN IBCLC
> Mississippi USA

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