In a Red Cross CPR class I took last night,  I was concerned that the
new Red Cross manual "Community First Aid and Safety," copyright 2002,
used for a variety of classes, includes in its "Facts About AIDs" on
page 9, the following quote:

"How the Disease is Transmitted:

The virus enters the body in three basic ways:
--Through direct contact with the bloodstream.  Examples of this include
contact with blood, semen, vaginal fluids, or *breastmilk of an infected
mother.*  [emphasis is mine]
--Through the mucous membrane linings in the eyes, mouth, throat, rectum
and vagina.  Example: having sex without a latex condom with an
HIV-positive person -- male or female.
--Through being infected as an unborn child or shortly after birth by an
infected mother.

The virus cannot enter through the skin unless there is a cut or break
in the skin.  Even then, the possibility of infection is very low unless
there is direct contact for a lengthy period of time.  Saliva is not
known to transmit HIV."
[end of quote]

While this last paragraph does clarify that the chance of infection is
low, should breastmilk be equated with blood as a potential transmitter
of AIDs?  This information is going out to the many health-care workers,
baby-sitters and day-care workers who in the U.S. are required to get
CPR/First Aid certification.  And we've already heard enough stories
about day-care providers nervous about storing and giving breastmilk
since they view it as a potentially hazardous substance.

This topic has come up on Lactnet before.  The Center for Disease
Control and OSHA, cited at:

http://www.cdc.gov/ncidod/hip/blood/universa.htm

http://www.osha-slc.gov/OshDoc/Interp_data/I19921214.html

exempt breastmilk from universal precautions as not being a
biohazard (though workers may wear gloves, especially if handling large
quantities of breastmilk as in a milkbank).

But I'd like to make sure I've got the most current facts, and am not
ignoring even the difficult ones (especially if I wanted to write a note
to the Red Cross.)  Has there ever been an incident of breastmilk being
a vector in disease transmission, other than possibly to the infant
directly drinking it (and remembering that even in many such cases the
role of breastmilk is not clear-cut.)

The archives have some interesting discussions of universal precautions,
with some LCs washing and gloving for every contact with a mother, with
others being more relaxed.  But many of these are from several years
back (in the last century!) so it might be interesting to hear updates.
Do you feel that in the current US climate that the mother herself often
prefers that the health worker be gloved?

Margaret Wills
LLLL, IBCLC

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