home Audience 6 The main methods and routes of infection with staphylococcus. Features of infection of infants and young children by Staphylococcus aureus

The main methods and routes of infection with staphylococcus. Features of infection of infants and young children by Staphylococcus aureus

Staphylococcus aureus is a fairly well-studied bacterium today, but this does not make it any less dangerous. It can cause a huge number of all kinds of infectious diseases in any person. How is it transmitted? Who is at risk? How to protect yourself from this microorganism? Let's try to answer all these questions.

There are many ways through which bacteria can enter the human body, but most often this happens through airborne droplets or airborne dust. The microorganism easily penetrates mucous membranes and dirty hands. It is also easy to become infected through open wounds, eyes, blood, burns. Through products, catheters, instruments it enters human body staphylococcus How is the bacterium transmitted sexually and is it possible? Unfortunately yes. The microorganism penetrates the mucous membranes during sexual intercourse genitourinary tract, where it will begin its development.

The bacterium is not afraid of high or low temperatures, nor sun rays, nor many strong chemical substances. It easily survives in the most aggressive conditions and quickly adapts to many antibiotics.

How is Staphylococcus aureus transmitted to other organs after entering the body? Quick and easy - with blood flow. According to statistics, approximately 31% of infections occur in medical institutions.

How is Staphylococcus aureus transmitted, or Who is at risk?

First of all, this group should include people who, for one reason or another, have reduced immunity, those who often give injections, resort to the use of transplants. It should be said that this type Staphylococcus is an opportunistic bacteria. This means that having full and normal conditions life, good food, a strong person will feel great even if it is present in the body. Yes, the bacteria will be there (either on the mucous membranes, or in the intestines, etc.), but it will not provoke any illnesses. A person will not even know about its existence in his body. However, as soon as the immune system weakens due to injuries, dysbacteriosis, or after a course of antibiotics, the microorganism will make itself felt. Also at risk are children who are often sick and women in the postpartum period.

Prevention

So, you know how Staphylococcus aureus is transmitted. Now the logical question is: “How to protect yourself from its manifestation?” It may sound banal, but following basic rules of personal hygiene is the key to health. It is very useful to play sports, strengthen the immune system in all possible ways, and you should also give up destructive bad habits. It is necessary to purchase only fresh and high-quality products and prepare food thoroughly. Never ignore even the smallest scratches or abrasions, because these are ideal “gates” for bacteria to enter. Remember that this microorganism can cause more than a hundred diseases! Take care of yourself and be healthy!

Is Staphylococcus aureus contagious? The disease can develop after a person comes into contact with an infection. Bacteria can be on the surface of food, on medical instruments, on the surfaces of handrails public transport. Therefore, it is recommended to thoroughly wash your hands and heat-process food.

How is Staphylococcus aureus transmitted?

Gram-positive bacteria of the genus Staphylococcus enter the body in several ways: airborne droplets and airborne dust. These bacteria infect organs and cause the development serious illnesses. People who have these factors are at risk:

Reduced immunity, against the background of other viral and infectious diseases;
Postoperative period;
Children and elderly people;
Time of pregnancy;
Breastfeeding period.

Many people are infected with goldenrod and are asymptomatic carriers of the infection. In this case, it is not treated. You can get sick in this way:

After tactile contact with an infected person.
After talking or using the patient's household items.
After eating food containing staphylococcus bacteria.

Thus, there is no doubt whether Staphylococcus aureus spreads from person to person. It is for this reason that patient communication is prohibited in infectious diseases departments of hospitals.

Where does the infection live?

Opportunistic bacteria live in soil, water, on the skin, in the mucous membranes of the nose, throat, and intestines. Infection and spread of staphylococcus can occur anywhere through contact with an infected object, person or product. Especially if a person is at risk and neglects hygiene.

Main sites of infection:

Hospital. According to WHO, Staphylococcus aureus is in first place among hospital infections, in medical institutions About 30% of patients become infected with it.
Tattoo parlor.
Cosmetology salon

Infection occurs when unsterile instruments are used. Injecting drug addicts are also susceptible to infection with staphylococcus.

Symptoms of infection in children under one year of age

Children under one year of age are susceptible to infection with staphylococcus, which leads to inflammation of the mucous membrane or intestines. The infection mainly affects premature newborns or weakened children. If the maternity hospital did not comply sanitary standards, the epidemic will spread.

Symptoms of staphylococcus in infants manifest themselves depending on the disease caused by it:

Inflammation of the mucous membrane and lymphoid tissue throats. The child begins to cough, the voice becomes hoarse, a runny nose and watery eyes appear.
Inflammation of the small and large intestine. The baby suffers from colic and vomiting. Diarrhea with mucus and blood begins.
Pneumonia. Symptoms: wet, chills, severe shortness of breath, weakness, drowsiness.
Blood poisoning. This disease develops when concomitant diseases or decreased immunity. Symptoms: general intoxication, internal otitis or purulent inflammation in the navel.
Ritter's disease. Symptoms of this disease are manifested by peeling of the skin on the face and neck, and then its detachment.

If you notice purulent rashes on your baby's skin, which are accompanied by symptoms of one of the listed diseases, consult a doctor. It is possible to detect the presence of staphylococcus only in laboratory conditions. Depending on the symptoms, tests are taken in stool, nasal mucosa or blood.

Localization

Staphylococcus aureus can settle on the mucous membranes of the nose, throat and intestines. Depending on the location of the lesion, the patient develops symptoms of infection.

Staphylococcus aureus in the nose. Staphylococcus bacteria most often settle in this place. If a person falls ill with ARVI, is hypothermic or for a long time used vasoconstrictor drops, he is most susceptible to the growth of pathological bacteria. The consequences of this infection are rhinitis.
Staphylococcus aureus in . Bacteria provoke the development of tonsillitis, pharyngitis or laryngitis. Symptoms vary, but generally, when the throat is infected, the patient feels a general malaise, headache appears dry or wet cough, the temperature rises, the lymph nodes in the neck may become inflamed.
Staphylococcus aureus in the intestines. Development pathogenic microflora manifested by nausea, vomiting, frequent diarrhea with mucus and blood, fever. Sometimes a person develops a rash and diaper rash, general malaise, dizziness and fever.

Infection during pregnancy

Staphylococcus aureus is very dangerous during pregnancy, as it affects not only the mother, but also the child in the womb. Consequences of infection:

Pneumonia;
Inflammation of the peritoneum;
Purulent mastitis;
Development of inflammation and purulent formations on the skin.

Treatment of pregnant women is carried out taking into account their interesting situation. If the site of infection is in the nose, instillation and rinsing of the nose are prescribed alcohol solution Chlorophyllipta. Treatment with quartz and staphylococcal toxoid is also used in therapy. At untimely treatment or lack of treatment, there is a high probability of infection of the child with staphylococcus bacteria.

Degree of damage

If stage 1 or 2 damage is detected, treatment is not prescribed. But if the patient complains of feeling unwell, tests are prescribed to detect other infections in the body.

Degree of damage Staphylococcus aureus

Symptoms of staphylococcus appear when indicators develop above 10 to 4 degrees: purulent inflammation of the skin, peeling, damage to the nasopharynx and heart muscle.

Often tests reveal grade 3 or 4 of the disease. This form is not dangerous, but can be treated. If the bacteria do not interfere or appear in any way, treating staphylococcus with antibiotics is not recommended.

Analysis results: normal

To determine the infection, a bacterial culture of the mucous membrane is done. If pathogenic bacteria are present, within a day the growth of golden-colored colonies is observed. If there is no such growth, then the person is healthy or the disease to which he is susceptible has not developed due to Staphylococcus aureus.

In adults and children after a year of life, Staphylococcus aureus 10 in grades 3-4 is considered normal.

Damage to the face and scalp

The spread of infection on the skin is expressed by the following symptoms:

Purulent rashes on the face and scalp;
Development of seborrhea;
Pimples, carbuncles, appear in large numbers;
Constant temperature body 37.5;
The disease is accompanied by symptoms of colds.

The patient suffers from furunculosis when the redness discharges purulent exudate. The skin may also become swollen and red. If the disease is not treated, the infection penetrates deep into the skin, which is accompanied by tissue death. Purulent lesions of the scalp and neck require urgent treatment, since foci of inflammation are located close to blood vessels brain.

Symptoms of Staphylococcus aureus in breast milk

Symptoms of the presence of pathogenic bacteria in breast milk appear depending on the location of the infection:

Inflammation of the small and large intestine. The baby's bowel movements are disrupted, vomiting is present, and the temperature may rise.
Pemphigus or pemphigus. The child is covered with a rash of blisters with a cloudy liquid inside.
. The baby's eyes begin to hurt, water and become sour.
Abscess. The spread of purulent inflammations throughout the child’s body, which break out and yellow or green liquid is released from them. In a nursing mother, an abscess develops in the mammary glands.
Damage to subcutaneous tissue. Places of purulent inflammation are painful, the temperature rises, appetite disappears, and the child feels unwell.
Blood poisoning. Possible infection of a child through umbilical wound. Sepsis can also occur as a result of purulent inflammation that is not treated.

Treatment with medications

Treatment is carried out using the following drugs:

Antibiotics to which the bacteria have been shown to be sensitive (Flemoklav, Panklav,).
Immunostimulants to enhance the body's defense mechanisms (Bacteriophage, Taktivin, Polyoxidonium).
In some cases - antihistamines(Tavegil, Diazolin, Zodak).

Select an antibiotic during treatment. If after a couple of days of intramuscular or intravenous injections the temperature does not subside, a drug of a different group is prescribed.

To maintain and enhance immunity it is prescribed staphylococcal bacteriophage, which directly acts on pathogenic bacteria. The patient also drinks a course vitamin complexes. If the patient has swelling of the mucous membranes, antihistamines are used.

Folk remedies

Traditional recipes are used as an addition to the main one. drug treatment. The action of plants and herbs is aimed at improving the body's defense mechanisms. Therapy should be carried out for about a month. Before use folk remedies consult your doctor.

Basic medicinal herbs, which are taken as tinctures:

If Staphylococcus aureus has infected skin, apply baths or compresses with the addition of apple cider vinegar.

Diseases caused by infection

With the pathogenic development of pathogenic bacteria, staphylococcus becomes the causative agent of many diseases:

In addition to damaging the listed organs and systems of the body, staphylococcus can cause toxicity. Most often, the infection is expressed in purulent-inflammatory foci on the skin. If you do not consult a doctor and do not carry out adequate treatment medications, death of the affected tissues and sepsis occurs.

Treatment

Treatment with antibiotics is complicated, since Staphylococcus aureus can develop resistance during the course of therapy. Therefore, after staphylococcus bacteria are inoculated in the tests, a sensitivity test is carried out. various groups drugs. The course of antibiotics is at least 5 days, even if visible signs the illnesses subsided and the patient began to feel better.

Diseases caused by infection are always accompanied by purulent inflammation at the site of bacterial development and an increase in body temperature. If you have these symptoms, you should immediately consult a doctor who will prescribe effective treatment.

The most common opportunistic bacteria is staphylococcus. The microorganism can cause inflammation on the skin, affecting subcutaneous tissue, damage internal organs. To avoid a dangerous infection, it is important to know how staphylococcus is transmitted and whether it is contagious.

Staphylococcus can affect not only internal organs, but also the skin

Staphylococcus - what is it?

Staphylococcus is a gram-positive bacterium that is part of the healthy microflora of human skin. Not a large number of opportunistic microorganisms are present in the nose and throat, which is normal.

Under certain conditions (decreased immunity, accompanying illnesses) bacteria can cause disruption to the functioning of any organ or system. The skin, intestines and genitourinary system are most often affected.

The severity of the lesion and the characteristics of the course of staphylococcal infection depend on the type of pathogen:

Saprophytic staphylococcus. The bacterium affects the genitourinary system of women, causing cystitis and kidney pathologies. Localization of bacteria of this type occurs in the genitals and on the epithelium of the urinary canal.
Staphylococcus aureus– the most common and harmful type of pathogenic microorganisms. The bacterium causes purulent inflammation of the skin layers in adults and children; it can affect the liver, heart, blood vessels and brain.
Staphylococcus epidermidis. Bacteria included in the composition normal microflora skin and all human mucous membranes. At strong immunity cutaneous staphylococcus does not cause harm to health. If the pathogen enters the blood when the body’s defenses are weakened, the focus of inflammation can develop in the heart (in the inner lining).

This infection is very resistant to external factors and is highly resistant to antimicrobial drugs, therefore pathogenic microorganisms difficult to treat and require long-term therapy.

Causes of infection and routes of transmission

Epidermal and saprophytic pathogens are constantly present on human skin.

The reason for its entry into the blood can be any violation of the integrity of the skin:

scratches, abrasions, microcracks;
wounds after surgery.

The risk of contracting Staphylococcus aureus is much higher. This is explained by the fact that the bacterium constantly lives in external environment and moves seamlessly from person to person.

Main routes of transmission:

Medical instruments and equipment. You can become infected with a staphylococcal infection during intravenous nutrition, ventilation, or hemodialysis. Most often, patients have weakened immunity, so bacteria, once they enter the body, immediately affect internal organs.
Food. Bacteria can be found on dairy products, cakes, eggs, and meat. Once in the body, pathogenic microorganisms poison the intestines, causing severe intoxication.
Airborne (airborne dust) path. Microorganisms are quickly transmitted between people through sneezing and coughing. Sometimes, in order to get sick, it is enough to be near the sick person.
Household way. Pathogen inflammatory processes withstands high and low temperatures, therefore its presence on household items of a sick person is quite possible. It is important to wash your hands after any contact with other people's things.
Nosocomial infections. The source of infection is patients with erased forms of staphylococcus or staphylococcus carriers.
Infection through sexual contact. During unprotected sex, staphylococcus moves from the carrier to healthy person through the mucous membranes of the genitourinary tract.

Staphylococcus can be transmitted by airborne droplets

A favorable factor for the development of staphylococcal infection is reduced immunity. Associated viruses, including pathogens of dysbacteriosis, also contribute to the proliferation of pathogenic microorganisms.

During childbirth

Children have high probability become infected in the maternity hospital through any wounds or microtraumas during childbirth. As a result, the newborn may experience skin rashes purulent in nature, damage to the lungs (pneumonia) and blood (pemphigus, sepsis).

A newborn can become infected through microtraumas

When breastfeeding

If a woman is infected, infection with staphylococcus in infants occurs through breast milk. Once in the intestines, the bacterium can cause dysbiosis of varying severity in a child.

Staphylococcus can be transmitted to a child through mother's milk

A mother can also become infected from her baby during breastfeeding. If bacteria from the baby’s saliva get into the cracks in the nipples, staphylococcus provokes the development of severe inflammation, which develops into purulent mastitis.

Is it possible to get infected through a kiss?

Staphylococcal infection is transmitted through mucous membranes. With saliva, pathogenic bacteria are able to pass from the carrier to a healthy person. Therefore, kissing is another way of transmitting staphylococcus.

The infection can be transmitted through a kiss

Does infection occur from a dog or cat?

Pets can be infected with staphylococcus. In this case, the route of infection is an animal bite, in which saliva with bacteria penetrates the human body.

Animals are also susceptible to infection with staphylococcus

Why is infection with staphylococcus dangerous?

Infection with staphylococcus threatens a person with the following consequences:

pathologies of the urinary system (cystitis, pyelonephritis);
inflammatory processes in the lungs (pneumonia);
skin diseases (dermatitis, eczema, furunculosis);
spicy purulent processes internal organs(abscess, peritonitis);
inflammation in the brain (meningitis);
defeat gallbladder(cholecystitis).

Staph can cause eczema

Staphylococcus produces dangerous toxins that cause acute intoxication body. To avoid severe consequences, at the first symptoms of illness, it is important to go to the hospital.

Prevention of staphylococcal infection

To protect yourself from staphylococcus infection, you need to adhere to basic preventive measures:

maintaining personal hygiene (wash hands often, use your own towels, do not take other people’s things);
timely and thoroughly treat any skin lesions with antiseptics and cover them with bandages (bandage, adhesive plaster);
lead healthy image life to maintain the body’s immune forces;
use condoms during sexual intercourse.

To protect yourself from staphylococcus infection, you must use condoms during sexual intercourse.

Preventative measures not only help to avoid infection dangerous infection, but also make it possible to monitor your health in general.

Among the opportunistic bacteria that people encounter every day, the most dangerous is staphylococcus. The microorganism is capable of infecting not only the skin and subcutaneous layers, but also penetrating organs, causing purulent inflammation in the lungs, brain, genitourinary system, intestines. Staphylococcal infection has many routes of transmission, which makes it especially dangerous for both children and adults.

Staphylococcus aureus is a bacterium that almost everyone has heard of. It has a spherical shape and is very resistant to external influence and persists in the environment for a long time. Most people will say with absolute certainty that this bacterium is dangerous to the body, but only a few can accurately answer how infection occurs. It is for this reason that infection often occurs, since a person, without attaching importance to some of his actions, introduces the bacterium into the body. Children and people suffering from severely weakened immune systems are most often susceptible to Staphylococcus aureus.

What is the danger of Staphylococcus aureus

The particular danger of Staphylococcus aureus is associated with its increased aggressiveness. Doctors most often call it the most persistent bacterium. The danger of this causative agent of a number of diseases is explained by its following properties:

increased resistance to antiseptic effects - the bacterium can survive boiling for 10 minutes, repeated freezing and treatment with various antiseptic drugs, with the exception of greenery;
resistance to antibiotics penicillin series: the bacterium produces special enzymes - penicillinase and lidase, which allow it to withstand the effects of antibiotics and easily melt the skin, penetrating the body;
production of endotoxin - it quickly causes food and general poisoning, and in some cases even provokes infectious-toxic shock.

After being infected with Staphylococcus aureus, the patient does not develop lifelong immunity, and re-infection can easily occur.

Ways of infection with Staphylococcus aureus

Today, doctors identify 4 ways of infection with Staphylococcus aureus.

Aerogenic infection

In this way, the disease is transmitted from person to person if the mucous membrane of the nasopharynx is affected by staphylococcus. When breathing, the patient secretes environment bacteria that, together with microscopic particles of saliva, remain in the air for a long time. Highest probability infection is observed when being in the same room with a sick person.

When inhaling contaminated air, bacteria extremely rarely remain on the mucous membrane and penetrate directly into the lungs, which is why the infected person develops rapid pneumonia, which is quite difficult to cope with due to the fact that the antibiotics that are used to routinely treat the disease are practically ineffective. It is for this reason that the mortality rate from pneumonia caused by Staphylococcus aureus is very high. With aerogenic infection, the maximum fatal outcome is observed.

Contact infection

Staphylococcus aureus bacteria often live on human skin, but they do not cause diseases as long as the immune system is good and there are no extensive wound surfaces. However, such a carrier of infection is dangerous for others, since upon contact with it, as well as through common household objects, they pass from it to a healthy person. pathogenic bacteria. If there are no wounds on the skin, then nothing will happen, but if staphylococcus gets on damaged skin, then it will not be possible to avoid infection. Quite often, this is how infection with Staphylococcus aureus occurs in medical institutions. This method of infection is the most common. It extremely rarely leads to the death of the patient.

Infection through food

Since Staphylococcus aureus tolerates freezing and heat treatment, then it quite often enters the body along with food of animal origin. You can get the bacteria by consuming the following foods:

meat;
fish;
dairy products;
eggs.

Once in the stomach, the bacterium releases a large amount of toxic substances that cause severe poisoning, but she herself, in the absence of wounds on the mucous membrane, quickly dies under the influence of hydrochloric acid. If there is damage to the gastric mucosa, then the entry of staphylococcus into the body ends extremely heavy defeat organism, quite often leading to the death of the patient even with timely seeking medical help.

Artificial infection

Since Staphylococcus aureus is very resistant and tolerates many chemical antiseptics and high temperatures, then in case of poor-quality sterilization of instruments in medical institutions, it is easily transmitted from a sick person to a healthy one. According to statistics, 70% of all cases of infection with Staphylococcus aureus occur in medical institutions.
The consequences of Staphylococcus aureus entering the body are very dangerous and require long-term and complex treatment. It is for this reason that doctors call the bacterium the most dangerous of all types of widespread pathogens.

Infection with staphylococcus in a newborn and older baby occurs in three ways:

food, when a nursing woman or the child himself eats contaminated foods;
household, in which the bacteria enters the body through dirty toys and various accessories, as well as non-sterile medical instruments used during the treatment of the baby;
airborne if the child is in close contact with a sick friend or adult.

The reasons for the defeat of children lie in frequent colds, dysbacteriosis and weakened immunity. Infection of a baby can occur through a poorly healed umbilical wound. Sometimes infection occurs during breastfeeding, if a woman has cracked nipples or her body itself suffers from the bacteria (the strain passes into breast milk).

Staphylococcus appears in a newborn due to the influence of various factors. These may be fetal malnutrition and premature birth, problematic pregnancy and difficulties with childbirth. In the first months of life, the baby catches staphylococcal diseases due to improper care, poor immunity and contact with infected adults.

How to recognize a staphylococcal infection in a child

The clinical condition of a baby when infected with Staphylococcus aureus depends on the behavior and localization of the bacterium and the degree of protection of the body. Diseases develop within 3–4 days. They occur in localized and generalized forms. Let's consider the signs indicating the activity of bacteria in different parts of the body.

Skin and mucous membranes

Parents can recognize skin lesions by festering lesions on the body and enlarged regional lymph nodes. The disease manifests itself as acne, characteristic of furunculosis, pyoderma, folliculitis, hidradenitis. The skin of most infected children will show symptoms of pemphigus. A sore throat or purulent conjunctivitis develops on the mucous membranes.

Damage to the nasal cavity

The activity of the pathogen in the nasopharynx causes rhinitis and nasopharyngitis. The process of bacterial reproduction triggers mild inflammatory forms without signs of intoxication. The main signs of strain activity in the nose are: prolonged runny nose, lack of appetite, weight loss.

Throat and pharynx

The so-called staphylococcal sore throat develops with sepsis or acute respiratory infections or in acute period chronic tonsillitis. Several symptoms indicate a throat infection:

strong pain;
redness of the throat;
lymphadenopathy;
increased body temperature;
purulent plaque on the tonsils, palatine arches and uvula.

Treatment of children for staphylococcal sore throat begins after receiving answers laboratory tests. Therapy is carried out for 5–10 days.

Staphylococcus in the lungs

As a continuation of acute respiratory infections, pneumonia often develops in infants. Its symptoms are similar to those of general intoxication. The child becomes pale, lethargic, he often spits up or regurgitates food masses completely. There is an increase respiratory failure. Staphylococcal pneumonia develops acutely. When examining the lungs, air cavities measuring 1–10 cm are visible.

Staphylococcus aureus in the mouth

When activated in oral cavity Staphylococcus causes stomatitis in newborns and children under 1 year of age. The pathology is manifested by severe redness of the mucous membranes and ulcers that form on the palate, tongue, inside cheeks

Scarlatiniform syndrome

The condition develops when there is an infectious focus in the body. Staphylococcus penetrates into burned and injured surfaces and enhances pathological processes occurring with phlegmon, osteomyelitis, lymphadenitis. The syndrome is recognized by a rash on red skin, peeling that replaces the rash, and a feverish state.

The danger of Staphylococcus aureus

How dangerous is Staphylococcus aureus for a child’s health? In addition to provoking the above and other diseases, the bacterium causes various complications. It contributes to the expansion of colonization of opportunistic flora and the exacerbation of congenital or chronically ongoing pathologies. Most dangerous condition considered sepsis. If the disease progresses unfavorably, death is possible.

Diagnosis and treatment

If staphylococcus is suspected, Dr. Komarovsky advises that both the baby and the mother be examined. A woman's breast milk is taken for analysis. In infants and older children biological material take in different places taking into account the manifestations of the disease.

A smear from the mucous membrane of the pharynx, throat, nasal passages - for acute respiratory infections.
Urinalysis - in case of damage to the genitourinary system.
Examination of intestinal contents - if there are signs of tract damage.

If staphylococcus is detected in a newborn, he is admitted to the clinic. The baby will be treated in a separate box. At mild damage cost symptomatic therapy. Complex forms require an integrated approach.

Experts develop treatment regimens for Staphylococcus aureus from different drug groups:

Antibiotics of a number of penicillins and cephalosporins.
Specific drugs against Staphylococcus aureus - Anatoxin, Immunoglobulin, Plasma, Bacteriophage.
Probiotics – Bifikol, Bifidumbacterin.
Detoxification solutions – intravenous administration glucose or saline.
Vitamins in different forms.

If the infection occurs through food, before treating staphylococcus, the child’s stomach is washed, measures are taken against dehydration and infusion therapy is carried out.

How to prevent staph infection

The main preventive measures are based on strengthening the child’s immunity and observing personal hygiene rules. The body’s defenses are increased in different ways – for as long as possible breastfeeding, hardening, walks in the fresh air.

The essence hygiene measures boils down to the following points:

correct attachment to the breast;
timely healing of cracked nipples;
washing the breast before each feeding;
washing and sterilizing children's dishes and toys.