We couldn't live without microbes, and breastmilk supports a flourishing
healthy microflora in humans.  This microflora helps protect the individual
against pathogens, such as salmonella, Giardia, even pathologic E.coli, all
of which in vulnerable hosts can be fatal.  Keeping pump parts clean is not
necessarily a sign of obsessive-compulsive disorder.  It's good practice.
There is a difference between simple absence of germ phobia and
slovenliness.  Depending on where our hands have been before we handle
infant feeding equipment, there may be all kinds of residue containing
microorganisms we really don't want to expose the baby to, and these can get
on the pump parts too.

Also, you can wipe all the disinfectant in the world on a surface but if you
do not mechanically remove any biological material from that surface first,
it is possible for microbes to survive in that material and all your
disinfection efforts are wasted.  There is no substitute for running water,
a cleansing agent and a brush for getting rid of things that otherwise could
foster growth of pathogens, especially in a hospital where pathogens and
resistant microbes abound. 
We all have our own standards for cleanliness at home.  Standards for
institutions are stricter than what I practice in my own kitchen or bathroom
ot laundry room, but I wouldn't have it any other way.  We had a salmonella
outbreak in my hospital a few years ago while I myself was on holiday.
There was an employee in the kitchen who was infected with salmonella but
not ill.  The salmonella got from this person's hands, into patient food.
The only way for salmonella to get on your hands is by fecal contamination.
This person was conveying matter from their own excrement into the patients'
food trays.  Simple hand-washing would have prevented it, but they had to
take measures to decontaminate the whole food service department because
anything this person touched, was a potential reservoir for future
outbreaks.  

If we cultivate a complete disregard for the notion that some microscopic
organisms pose a threat to human health, we are neglecting our
responsibility to practice based on evidence.  The problem is, you can't
just wash away the salmonella and leave the good bugs alone.  You have to
get your hands, or your pump parts, *clean*.  

I have on one occasion observed behavior in a mother that turned my stomach.
She had absolutely no sense of what was clean and what was dirty.  She
could, and did, sit on the toilet and pump milk.  Coincidentally and most
unfortunately she cultured positive from a perineal abscess for methicillin
resistant S.aureus.  It was also cultured from her expressed milk and you
didn't have to have a lot of imagination to figure out how it got there.
I'm proud to say that despite caring for her most intimate physical needs
and having lots of direct contact with her over several shifts before the
MRSA was diagnosed, I did not get inoculated with her bugs.  I attribute it
in part to incredible good luck and in larger part to good hand washing.

Not sure where I am going with this, except to say that there are microbes
and there are Microbes.  Or something.

Rachel Myr, disciple of Semmelweiss
Kristiansand, Norway

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