Infections in People With Cancer

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Precautions to help prevent infection during cancer treatment

You are more likely to get a serious infection when your absolute neutrophil count (ANC) is low. You can ask your doctor or nurse what your ANC is, so that you know when it is low. Here are some things you can do that might help prevent illness during that time:

  • Be aware of and watch for signs and symptoms of infection. Report any to your doctor or nurse right away. (See the section “Signs of infection people with cancer should watch for.”)
  • 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 your immune system is weak.

To help avoid being exposed to infection while your ANC or white blood cell count is low (see the section “Immunosuppression and neutropenia”), you can:

  • 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’s 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 at salons or spas (you can use your own personal and well-cleaned tools at home). 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 to avoid cuts and nicks. 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. If you have dentures that you store in a cup, wash the cup and change the water with each use.
  • 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 for the person with cancer

Food safety is very important when your white blood cell count, especially neutrophils, are low (see the section “Immunosuppression and neutropenia”). Infections can be picked up from food and drinks. 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, or tofu.
  • 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 unwashed fresh vegetables and fruits.
  • Do not eat unwashed salad greens.
  • Do not eat uncooked 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 foods containing raw or undercooked eggs, including homemade Caesar salad dressing, raw cookie dough, and eggnog
  • Do not drink unboiled well water.
  • 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.

Some of these precautions are just good food safety, while others are part of a low-microbe diet (low-germ or neutropenic diet).

Some additional precautions are recommended for people recovering from a stem cell transplant:

  • Do not eat raw nuts or nuts roasted in their shells.
  • Do not drink wine or 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 eat cold smoked fish, including lox, jerky, kippered, or nova-style fish.
  • Do not eat miso or tempeh products.
  • Do not eat uncooked grain products.
  • Do not eat brewer’s yeast.

About eating fresh fruits and vegetables: Fresh fruits and vegetables can have germs on the outside which can cause illness. Some doctors tell their patients who have suppressed immune systems not to eat any fresh fruits or vegetables to help lower the risk of infection. Others allow their patients to consume fresh fruits and vegetables if they are washed thoroughly first. It’s important to know that even when the outer part of a fruit (such as the peel or rind) isn’t eaten, it still needs to be washed. If it isn’t, germs can get on the part that is eaten when the peel or rind is cut. It may also be a good idea to avoid certain foods that have been linked to outbreaks before, such as raw vegetable sprouts, fresh salsa, and berries.

Talk with your doctor about any dietary questions or concerns you may have, or ask to talk with a registered dietitian.

For more food safety information, visit the US Department of Agriculture website 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: 11/06/2013
Last Revised: 11/06/2013