Karen writes:
< it seems to me that I recall one of
our learned colleagues in Lactnet discussing the difficulty of obtaining
valid milk cultures, because often what was really being cultured was the
bacteria etc on the skin. Does anyone else remember this, and does it
apply
in the cases being discussed?>
Again, Barbara Wilson-Clay's post, this time July 20, 2000. (Can you tell
I have a separate file marked BWC??) In it, she shared with LN something
sent to her by Melanie Ashworth:
<For
> lack of protocol, in desperation we decided on "clean, mid-stream
catch".
We
> clean the breast, use clean gloves, and get the flow going, and then
try
to
> get a spray into the jar. Getting a spray going first probably helps
flush
> off some skin flora. We collect in a urine specimen container... If we
are
> going for a particular duct that seems infected, we have the mom lean
over
> and try to get as many drops as possible from that duct into the jar.
She
> finds the most painful spots, we palpate the duct line, and express as
gently
> as we can but still getting a flow from that duct - or those particular
ducts
> - and have her lean over rather than have to scoop it up from the skin.
> Because this milk is often inspissated, getting this can be a bit
acrobatic.
> Well worth it, it has led to a total re-think on some antibiotic
regimens.
I
> have found that when I call a doc and make the recommendation they are
> delighted with the option for some quantification and identification of
> organisms. Makes them feel science can be applied to lactation, I
guess.
> (My staff and I love the little light-bulb of a 'duh' that goes on in
their
> brains when we suggest a culture.)
> Excuse the private post - feel free to post to the list if you think it
might
> be helpful.
> Melanie R. Ashworth RN, IBCLC
> Program Director
> Lactation Center, LPCH @ Stanford >
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