Neutropenic Precautions

Your white blood cell count may decrease significantly once you start treatment, but you can prevent exposure to infection-causing germs in your environment by following specific precautions.

If your white blood cell count drops to 1,000 per mm3 or below, you are neutropenic and a nurse will contact you. Until your count rises, it will be necessary for you to take these additional measures, known as neutropenic precautions, to decrease your risk for infection.  These additional measures are:

  • Take your temperature by mouth two times each day.  Call your doctor immediately if your oral temperature is above 100.5° Fahrenheit.
  • Eliminate foods which may contain germs, from your diet, including:
    • Cold soups made from fresh fruits or vegetables
    • Raw meats or fish salads
    • Natural cheeses
    • Uncooked eggs
    • Fresh, frozen and dried fruits
    • Uncooked herbs, spices and black pepper
    • Instant iced tea, coffee or punch
    • Sushi and sashimi
  • Avoid fresh flowers and plants that may have germs in the soil.
  • Avoid enemas, rectal suppositories and rectal thermometers.
  • Except in an emergency, do not have any dental work performed. If you have an emergency that requires dental work, inform your dentist at the time you schedule your appointment that you are receiving chemotherapy and what your most recent white blood cell count is. You may want to suggest that your dentist contact your oncologist prior to your scheduled dental work.
  • Always wear shoes to prevent cuts on your feet.
  • Protect your hands from cuts and/or burns.  When doing dishes, wear rubber gloves.  Always use potholders or some other protective covering when cooking or baking.  Wear gloves when gardening.
  • Wear sunscreen with a sun protection factor (SPF) of at least 30 to avoid getting sunburned.
  • When shaving under your arms or your legs, use only an electric razor to avoid breaks in the skin.
  • Ask your family and friends who are sick not to visit you until they are well (so that you won’t get sick too).
  • Ask all your visitors to wash their hands with an anti-bacterial soap (in the hall restroom or in your bathroom) before they come into your room.
  • Perform thorough and careful personal hygiene.
    • Do not use deodorant, cream, lotion, make-up, cologne, perfume and aftershave (these can clog the pores in your skin and lead to infection). Your nurse will supply you with skin lotion.
    • Wash your hands frequently, especially before eating or after using the bathroom.
    • Do not cut or pick at cuticles.  Use a cuticle cream instead.
    • Bathe thoroughly each day.
    • Perform mouth care three times a day, and use an antiseptic mouthwash that does not contain alcohol daily.
    • When menstruating, use sanitary napkins rather than tampons, which may promote infection in neutropenic patients.
  • Do not get vaccinations without approval from your oncologist.  Also, avoid contact with anyone who has recently received a vaccination, including infants or children, as well as persons with colds or infections.
  • Avoid fresh vegetables and salads in your diet and fresh plants and flowers in your room. (These carry a fungus called aspergillus that can cause a serious lung infection when your white count is down.)
  • Keep active with exercise or walking.
  • If hospitalized, stay in your room when your white blood count is low. (Your nurse will tell you when you need to stay in your room.)
  • If you are home and your counts are low, limit exposure to large crowds (i.e., movie theater, malls, restaurants, etc.).
  • Stay away from public transportation is possible.  If you must use public transportation, travel during off-peak times.
  • Avoid activities that may lead to falling and/or injury, including – but not limited to – bicycling, roller-blading, skating, and skiing.
  • If you cut or scrape your skin, immediately clean the area with soap and water and bandage as necessary.

Besides preventing outside exposure to infection, it’s important to know that infection can come from inside exposure. People carry germs in their mouths, lungs and intestinal tracts. As long as your white blood cells can prevent infection to these germs, you stay healthy. If your white blood cells drop in number or are immature, then these germs cause infection.

When should I call my doctor?

Even though you may take special care to prevent infection, it is still possible to get one. If any of the following signs or symptoms of infection occur, call your doctor or nurse immediately. Do not take any medications – even aspirin or other products to lower your temperature – before talking to your doctor.

  • Oral temperature above 100.5 degrees, which indicates a fever.
  • Cough, mucous production, shortness of breath or painful breathing
  • Soreness or swelling in your mouth or throat, ulcers or white patches in your mouth or a change in the color of your gums.
  • Pain or burning with urination or an odor to your urine.
  • Change in the odor, character or frequency of your stool, especially diarrhea.
  • Redness, pain or swelling in any area of your skin.
  • Redness, pain, swelling in the area surrounding any tube you may have (e.g., Hickman, port catheter, J-tube, urinary catheter).
  • Pus or drainage from any open cut or sore or from any tube you may have (e.g., Hickman, port catheter, J-tube, urinary catheter).
  • An overall feeling of being sick, even if you don’t have a temperature.
  • Shaking, chills or sweating.
  • Mental confusion
  • Fatigue
  • Loose bowel movements
  • Chest pain
  • Abdomen pain
  • New rash or aching, painful joints