I have been lecturing for years that it is important to keep nipple wounds covered, to allow for moist wound healing. However, it is always important for the wounds to not stick to the breast pad. Therefore, I recommend either bacitracin or mupirocin ointment covered with a nonstick pad for wounds that look infected. Vaseline is fine for nipple wounds that look clean. Moist wound healing has clearly been shown via evidence to be superior to open dry healing. As a family physician, I deal with lots of wounds on other parts of the body, and often work with wound care specialists for some of my more complicated patients. You won't see a wound care specialist recommend uncovering a wound for healing.
I find that stopping the cycle of a nipple wound sticking to breast pads by using an ointment and a nonstick cover turns around many nipple wounds very quickly. Women also notice that their nipples feel so much better. A good analogy is a burn. It hurts immensely to leave a burn open to the air.
As for washing twice a day, the only problem is drying out the skin. One option is to use a waterless cleanser such as cetaphil (for those in the states). Otherwise, use a gentle soap with water, rinse, then apply an antibiotic ointment or Vaseline, followed by the nonstick pad. I have some patients who use calendula ointment or coconut oil. I think those are fine on wounds that don't look infected, but again I must stress the importance of a nonstick cover.
I don't use hydrogels because they are expensive, and they should be changed regularly otherwise they become colonized with bacteria. Using the same hydrogel is like constantly putting on the same dirty bandaid.
Anne


Anne Eglash MD, IBCLC, FABM
Clinical Professor, Dept of Family Medicine
University of Wisconsin School of Medicine and Public Health
Medical Director of UW Health Lactation Services
Co- Medical Director, Mothers Milk Bank of the Western Great Lakes
President of The Milk Mob,  A Gang of Breastfeeding and Human Lactation Educators
www.themilkmob.org

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