Precautions to take
Precautions you can take
Always know when your absolute neutrophil count (ANC) is low. (See “Absolute neutrophil count” .) Ask your doctor or nurse. Here are some things you can do that may help prevent illness during that time:
Be aware of the signs and symptoms of infection. Report any to your doctor or nurse right away.
After bathing, look for redness, swelling, and soreness where any tubes or catheters go into your body.
Get your flu shot every fall. Encourage other members of your household to get it, too. (DO NOT get the nasal mist flu vaccine if you have weak immune function.)
Here are some things you can do to avoid being exposed to infection while your ANC is low:
Wash your hands often with soap and warm water. Be sure to wash your hands before eating and before touching your face or mucous membranes (eyes, nose, mouth, etc.).
Wash your hands after using the bathroom, blowing your nose, coughing, or sneezing.
Wash your hands after touching animals, collecting trash, or taking out garbage.
Use moist cleaning wipes to clean surfaces and things that you touch, such as door handles, ATM or credit card keypads, and any items that are used by other people.
Avoid large crowds of people such as school, travel, shopping, social events, and public gatherings. Wash your hands after visiting a public place or touching items used by others.
Stay away from anyone with a fever, the flu, or other infection.
Keep yourself clean by bathing each day. Be sure to wash your feet, groin, armpits, and other moist, sweaty areas.
Wear gloves for gardening and wash up afterward.
Keep your mouth clean by brushing your teeth twice each day. Ask your doctor or nurse if it is OK to gently floss your teeth. Tell them if your gums bleed. Your doctor or nurse may give you a special mouthwash to help clean your mouth. Do not use alcohol-based mouthwash.
Keep your groin area and anal area clean — use soft moist tissues such as disposable baby wipes or bathroom towelettes after bowel movements. Tell your doctor about any bleeding.
Do not get manicures or pedicures. Do not use false nails or nail tips.
Do not wade, play, or swim in ponds, lakes, rivers, or water parks.
Do not get into hot tubs.
Wear shoes all the time — in the hospital, outdoors, and at home. This helps you avoid injury and keep germs off your feet.
Use an electric shaver instead of a razor. Do not share shavers.
If you cut or scrape your skin, clean the area right away with soap and warm water. Cover the area with a clean bandage to protect it. If the bandage gets wet or dirty, clean the area and put on a new bandage. Tell your doctor if you notice redness, swelling, pain, or tenderness.
Prevent constipation and straining to have a bowel movement by drinking 2 quarts of fluid each day. Exercising each day can help, too. Let your doctor or nurse know if you are having bowel problems. If needed, your doctor may give you medicine that softens your stool. Do not put anything in your rectum, including enemas, thermometers, and suppositories.
Women should not use tampons, vaginal suppositories, or douche.
Use water-based lubricants during sex to avoid injury or abrasion of the skin and mucous membranes. Use latex or plastic condoms to reduce the risk of sexually transmitted infections.
Do not keep fresh flowers or live plants in your bedroom.
Do not clean up droppings from your pets. Do not clean bird cages or fish or turtle tanks. Let someone else do this for you.
Place cat litter boxes away from kitchens and food areas. Litter boxes should be cleaned every day by someone else.
Do not touch soil that may contain feces (stool) of animals or people.
Do not change diapers, but if you do, wash your hands very well afterward.
If you use disposable gloves to avoid touching things like soil or waste, wash your hands after you take off the gloves. (Gloves can have tiny holes that you can’t see.)
Stay away from all standing water, for example, in vases, denture cups, and soap dishes.
Use hot water to clean your dishes.
Do not share bath towels or drinking glasses with others, including family members.
Stay away from chicken coops, caves, and any place where dust from the ground is being blown into the air, such as construction sites.
Talk with your doctor or nurse if you are planning any travel during this time.
Food safety is very important when your ANC is low. Infections can be picked up from food and drinks. A low microbial diet (low-germ or neutropenic diet) may be suggested if your ANC is low. This type of diet and these actions may help you reduce infection risk from foods:
Do not eat or drink any raw milk or raw milk products, or any milk or milk product that has not been pasteurized, including cheese and yogurt made from unpasteurized milk.
Do not eat Mexican-style soft cheese such as queso fresco or queso blanco.
Do not eat cheese containing chili peppers or other uncooked vegetables.
Do not eat raw or undercooked meat, fish, chicken, eggs, or tofu.
Do not eat cold smoked fish, including lox, jerky, kippered, or nova-style fish.
Do not eat miso or tempeh products.
Do not eat hot dogs, deli meats, or processed meats (unless they have been cooked or thoroughly re-heated just before eating).
Do not eat any food that contains mold (for example, brie, feta, or blue cheese, including that in salad dressings).
Do not eat any uncooked vegetables and fruits.
Do not eat uncooked grain products.
Do not eat unwashed salad greens.
Do not eat vegetable sprouts (alfalfa, bean, and others).
Do not drink fruit or vegetable juices that have not been pasteurized.
Do not eat raw honey (honey that has not been pasteurized).
Do not eat raw nuts or nuts roasted in their shells.
Do not drink beer that has not been pasteurized (this is most often home brewed and some microbrewery beers).
Do not drink “sun tea” or cold-brewed tea made with warm or cold water.
Do not drink maté tea.
Do not drink unboiled well water.
Do not eat brewer’s yeast.
Do not eat any outdated food.
Do not eat any cooked food that has been left at room temperature for 2 hours or more. If the food is left where the air temperature is 90° F or above, the limit is 1 hour.
Do not eat any food that has been handled or prepared with unwashed hands.
Talk with your doctor about any dietary concerns you may have, or ask to talk with a registered dietitian.
For more basic food safety information, visit the US Department of Agriculture Web site at www.fsis.usda.gov/ and search “cancer.” Or you can call them at 202-512-1800 for a copy of their booklet, Food Safety for People With Cancer.
Last Medical Review: 11/23/2011
Last Revised: 11/23/2011
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