Question:
What are the issues involved in donating used breast pumps?

I work with a mother support group.  We have a policy against accepting used pump donations. Since we can’t take used pumps, what do you usually suggest that she do with the pump she is finished using?
Thanks!
Faye

Answer:
Barbara and Kay’s response

Unless the pump is a manual pump that can be completely disassembled and sterilized, or is a pump designed for multiple users, pump sharing is not advised. While this sounds wasteful to some, the issue is not about the parts that you can access for cleaning, like flanges, bottles, valves, etc. but the internal parts of electric motors which cannot be sterilized.  Pumps designed for multiple users have hepa-filters or are designed to create suction externally so that motor contamination is not an issue. Pumps with these infection control features are called “hospital grade” pumps and not generally priced for purchase by individuals.

Most of the electric pumps priced for individual users are labeled by their manufacturers as being for single users only.  Consequently, there is a legal liability issue along with an infection control issue.  Warranties become invalidated when instructions for use are ignored, and potential legal exposure exists in the event of any bad outcome.  The pump company is protected in such cases because they have labeled the equipment as single-user; for anyone else to advise a mother to ignore that labeling creates potential legal risk. This is why mother support groups establish policies to warn against pump sharing.

Experiments have demonstrated that when drops of milk splash on the bottom of a bottle, small particles (bacteria and viruses) can be sucked up in an aerosol form into the motor. (Blenkhorn 1989) Tiny amounts of particulate material can accumulate. The next time the pump is turned on, it can blow down small amounts of this material and “re-seed” fresh milk in a sterile bottle. This would not be much of an issue for a woman’s own baby (unless that baby were ill or very premature.) Healthy babies are already exposed to their own mother’s “germs”, and receive specific antibodies in the milk to protect them.  However, if the next person to turn on the pump is a different mom, perhaps with a compromised baby, then there is a risk associated with exposing that baby to new pathogens.  While there is no research to guide us, Kay has wondered whether there is any risk if the mother stores her pump between babies?  Would re-seeding be an issue for the next newborn?

In an effort to explore the phenomenon of aspirated milk potentially contaminating pump motors, Barbara Wilson-Clay purchased several small electric breast pumps at garage sales in the late 1990s.  Upon opening the motor casings with a screwdriver , the insides of these motors were found to contain white flakes and sticky gunk. Kay Hoover has had the same experience removing the white membrane on a well-know “back to work pump.”  When she opened the motor casing, she observed similar material that appeared to be old milk.

Just as casual milk sharing has associated risks that have been poorly documented and appear to be poorly understood, so too with pump sharing. Bad outcomes are under-reported. Most people would not perhaps recognize a bad outcome (a baby becoming ill), or think to associate the illness with pump sharing.  Most people do no know where to report bad outcomes, although the US FDA provides a website to report pump problems.

Finally, legal responsibility aside, there is an ethical component to this discussion.  Does anyone really want to take responsibility for exposing someone else’s newborn to a staph infection or any of the  various forms of hepatitis, all of which live a really long time on hard surfaces? When a mother asks about pump sharing or pump donation, it is always best to be very clear about what kind of pump is involved and whether it is safe to share.

References:

J Hosp Infect. <http://www.ncbi.nlm.nih.gov/pubmed/2564015> 1989
Jan;13(1):27-31.

Infection risks from electrically operated breast pumps.

Blenkharn JI
<http://www.ncbi.nlm.nih.gov/pubmed?term=%22Blenkharn%20JI%22%5BAuthor%5D> .

Source

Department of Bacteriology, Royal Postgraduate Medical School, Hammersmith Hospital, London.

Abstract

Using formula milk seeded with Staphylococcus epidermidis as indicator, bacteria were observed to pass beyond the collecting bottles of three electrically operated breast pumps. Bacteria were recovered from sites distal to the level of visible contamination, the incidence increasing with repeated use of the apparatus. Despite use of a sterile collecting bottle, retrograde contamination of freshly collected milk may occur from previously contaminated components of the pumps. The results suggest that a terminal in-line air filter is essential to ensure aerosols containing potentially pathogenic bacteria do not contaminate the suction source or be emitted to the environment with the exhaust air. Where a single pump is used by more than one person adequate sterilization of all removable components is essential.

J Hosp Infect. <http://www.ncbi.nlm.nih.gov/pubmed/11740876> 2001
Dec;49(4):274-81.

Contamination of breast milk obtained by manual expression and breast pumps in mothers of very low birthweight infants.

Source

Department of Paediatric, Hospital Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur, 56000, Malaysia.
nyboo@mail.hukm.ukm.my

Abstract

The objective of this study was to compare the rates of bacterial contamination of expressed breast milk (EBM) obtained by manual expression and breast pumps in mothers of very low birthweight (VLBW) infants (<1501 g). This was a randomized, controlled study carried out on 28 mothers of such babies and 92 specimens of EBM were collected: 41 specimens from 13 mothers assigned to the manual group and 51 specimens from 15 mothers in the breast-pump group. EBM was cultured quantitatively by the Miles and Misra method. Breast milk expressed by breast pumps (86.3% or 44/51 specimens) had a significantly higher rate of bacterial contamination than milk expressed by the manual method (61.0% or 25/41 specimens) (P= 0.005). When breast milk was expressed in the hospital, there was no significant difference in contamination rates between the two methods. When breast milk was expressed at home, the rates of bacterial contamination by staphylococci (P= 0.003) and Gram-negative bacilli (P= 0.002) were significantly higher in the breast-pump group than the manual group. In conclusion, the rate of bacterial contamination of EBM of mothers of VLBW infants was high, especially when EBM was obtained by the breast pump or when expression was carried out at home.

J Hum Lact. <http://www.ncbi.nlm.nih.gov/pubmed/15886342> 2005
May;21(2):169-74.

Breast pump adverse events: reports to the food and drug administration.

Brown SL
<http://www.ncbi.nlm.nih.gov/pubmed?term=%22Brown%20SL%22%5BAuthor%5D> ,
Bright RA
<http://www.ncbi.nlm.nih.gov/pubmed?term=%22Bright%20RA%22%5BAuthor%5D> ,
Dwyer DE
<http://www.ncbi.nlm.nih.gov/pubmed?term=%22Dwyer%20DE%22%5BAuthor%5D> ,
Foxman B
<http://www.ncbi.nlm.nih.gov/pubmed?term=%22Foxman%20B%22%5BAuthor%5D> .

Source

Division of Postmarket Surveillance, Epidemiology Branch, Center for Devices and Radiological Health, Food and Drug Administration, Rockville, Maryland 20850, USA.

Abstract

Breast pumps are medical devices used to express milk and maintain the milk supply. The purpose of this study was to characterize adverse events reported to the United States Food and Drug Administration (FDA) on breast pumps. Thirty-seven adverse event reports on breast pumps were identified from the Manufacturer and User Facility Device Experience database between 1992 and 2003. Four additional reports were found in the Device Experience Network database from 1992 to 1996. The most commonly reported adverse events for electric breast pumps were pain, soreness, or discomfort; the need for medical intervention; and breast tissue damage. Most frequently reported problems for manual breast pumps were breast tissue damage and infection. Contamination of breast milk during pumping was also reported. Breast pump adverse events are likely underreported to the FDA. Reporting adverse events is important for improving the design and manufacture of breast pumps and subsequently decreasing adverse events.

Barbara Wilson-Clay, BS, IBCLC, FILCA