Do you have _Breastfeeding Answers Made Simple_?"  This publication recommends once a day soap and water washing and rinsing after every feed when nipples are damaged (with any type of tissue breakdown).  On page 650 there is this paragraph-

"When bacteria enter a wound, they create a sticky goo called a biofilm, which protects the bacteria and can prevent topical treatments from reaching the wound.  A baby's saliva stimulates biofilm production.  But gentle washing (known as wound debridement) dislodges this biofilm to help prevent infection and promote healing (Ryan 2007)"

The next paragraph goes on to recommend that mothers with nipple trauma use water or saline rinses after every feeding and references _The Breastfeeding Atlas_ which bases its recommendation on a Cochrane review article.

-Laura Spitzfaden

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