Prevention & Control
Getting sick with Cronobacter does not happen often, but infections in babies can be fatal.
Powdered infant formula is not sterile.
Manufacturers report that, using current methods, it is not possible to eliminate all germs from powdered infant formula in the factory.
When a source of a baby’s Cronobacter infection has been found, nearly all have been associated with consumption of reconstituted powdered infant formula. In several outbreak investigations, Cronobacter has been found in powdered infant formula that had been contaminated in the factory. In other cases, Cronobacter might have contaminated the powdered infant formula after it was opened at home or elsewhere.
Very young infants, infants born prematurely, and infants with weakened immune systems are at the highest risk.
Breastfeeding is the best option for feeding your baby. If you use infant formula, try to choose formula sold in liquid form because it is made to be sterile. Practice careful hygiene (e.g. handwashing, cleaning and sterilizing feeding bottles, clean preparation areas, etc.,) when preparing formula and giving it to your baby to help prevent Cronobacter infection. Specific steps you can take to decrease the risk of Cronobacter infection are outlined in more detail below.
To best protect your infant, here are some things you can do:
Breastfeeding helps prevent many kinds of infections among infants. Almost no cases of Cronobacter infection have been reported among infants who were being exclusively breastfed (meaning, the baby was fed only breast milk and no formula or other foods).
If you use a breast pump, practicing careful hygiene can reduce the risk of germs getting into the milk.
- Read all of the instructions that came with your pump, and make sure you understand the manufacturer’s instructions for handling and cleaning your pump’s flanges, valves, and collection bottles. Learn which parts must be washed and the best method for removing, cleaning, and drying parts that need to be cleaned.
- Clean your baby’s feeding bottles in a dishwasher or by hand.
- In a dishwasher, use hot water and a heated drying cycle.
- By hand, scrub in hot, soapy water in a tub or basin reserved for washing bottles, then rinse well and air dry on a clean rack or dish towel.
- Consider using a bottle sterilizer or boiling the bottles after washing and rinsing them by hand.
- Wash your hands with soap and water before pumping, and be sure anyone preparing bottles or feeding your baby washes their hands with soap and water first.
If your baby gets formula, choose infant formula sold in liquid form, especially when your baby is a newborn or very young.
Liquid formulations of infant formula are made to be sterile and should not transmit Cronobacter infection when handled carefully. To prevent contamination of liquid formula:
- Wash hands with soap and water before preparing bottles or feeding your baby.
- Clean your baby’s feeding bottles in a dishwasher or by hand. In a dishwasher, use hot water and a heated drying cycle. By hand, scrub in hot, soapy water in a tub or basin reserved for washing bottles, then rinse well and air dry on a clean rack or dish towel. Consider using a bottle sterilizer or boiling the bottles after washing and rinsing them by hand.
- If your baby does not finish drinking a bottle within 2 hours, throw away the unfinished formula.
If your baby gets powdered infant formula, follow these steps.
If your baby gets powdered infant formula, there are things you can do to protect your baby from infections – not just from Cronobacter infections. Good hygiene, mixing the formula with water hot enough to kill germs, and safely storing formula can prevent growth of Cronobacter bacteria and other germs. These are keys to keeping your baby safe and healthy.
- Clean up before preparation
- Wash your hands with soap and water
- Clean bottles in a dishwasher with hot water and a heated drying cycle, or scrub bottles in hot, soapy water and then sterilize them
- Clean work surfaces, such as countertops and sinks
- Prepare safely
- Keep powdered formula lids and scoops clean (be careful about what they touch)
- Close containers of infant formula or bottled water as soon as possible
- Use hot water (158° F/70° C and above) to make formula
- Carefully shake, rather than stir, formula in the bottle
- Cool formula to ensure it is not too hot before feeding your baby by running the prepared, capped bottle under cool water or placing it into an ice bath, taking care to keep the cooling water from getting into the bottle or on the nipple
- Before feeding the baby, test the temperature by shaking a few drops on your wrist
- Use quickly or store safely
- Use formula within 2 hours of preparation. If the baby does not finish the entire bottle of formula, discard the unused formula.
- If you do not plan to use the prepared formula right away, refrigerate it immediately and use it within 24 hours. Refrigeration slows bacterial growth and increases safety.
- When in doubt, throw it out. If you can't remember how long you have kept formula in the refrigerator, it is safer to throw it out than to feed it to your baby.
Practice proper hygiene
- Always wash your hands carefully with soap and water during key times.
- Before preparing and feeding bottles or foods to your infant.
- Before touching your infant's mouth.
- Before touching pacifiers or other things that go into your infant's mouth.
- After using the toilet or changing diapers.
- If soap and water aren't available, use an alcohol-based hand sanitizer. These alcohol-based products can quickly reduce the number of germs on hands in some situations, but they are not a substitute for washing with soap and water.
- It is also important to keep all objects that enter infants' mouths (such as pacifiers and teethers) clean.
Food Safety and Handwashing:
- WHO: Safe preparation, storage and handling of powdered infant formula guidelines [PDF - 361KB]
- Foodsafety.gov: Baby food and infant formula
- Handwashing: Clean Hands Save Lives, hand- and water-related hygiene tips
- Put Your Hands Together [PODCAST - 3:48 minutes], information on how to help stop the spread of infection and stay healthy
- Page last reviewed: July 5, 2016
- Page last updated: July 5, 2016
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