What Are Neutropenic Precautions? The Complete Guide

neutropenic precautions

What are Neutropenic Precautions?

Neutropenic precautions are the precautions patients and their caregivers need to take to reduce the chances of them developing a serious infection whilst they are neutropenic at home or in hospital.

The primary goal of neutropenic precautions is to take simple preventative measures that will limit the chance that a neutropenic patient will develop an infection. The precise precautions taken often depend on the severity of neutropenia and the type of cancer.

Patients with hematologic malignancies and those undergoing bone marrow transplants often suffer from severe and prolonged neutropenia. So extra care should be taken to reduce your exposure to anything that might pose an infection risk – i.e. pets, live plants, etc. In the case of patients with solid tumor malignancies, their neutropenia often isn’t as severe or as prolonged so the neutropenic precautions are often more relaxed.

Note: It is very important that each patient discuss the personal precautions they should be taking with your doctor so that they can be tailor to your particular needs.

Table of Contents

  1. What is Neutropenia?
  2. Hand Washing: The Single Most Important Neutropenic Precaution!
  3. General Hygiene & Lifestyle
  4. Food Safety For Neutropenic Patients
  5. How to Recognize an Infection

What is Neutropenia?

Neutropenia is a condition where your neutrophils, also known as white blood cells (WBC), drop below normal levels, known as absolute neutrophil count (ANC). Neutrophils are your body’s first line of defense against bacteria and viruses that can cause an infection.

A normal neutrophil count is between 2,500-6,000. The Mayo Clinic defines neutropenia as a neutrophil count below 1,500/µL for adults and the threshold varies with age for children. When neutrophil counts drop below 1,000/µL the risk of a serious infection is considered moderate, whilst when they drop below 500/µL the risk of a serious infection is considered severe. If you have an oral temperature of 100.5°F (38° C) or suspect you might have an infection you need to contact your doctor immediately, as you may need to receive antibiotic treatment.

Neutropenia is a common side effect of undergoing cancer treatments such as chemotherapy and sometimes radiation. Typically, neutropenia occurs 7-14 days after chemotherapy treatment. This is the time when you are most at risk of developing an infection. However, there are a number of precautions you can take to limit the risk of infection during this time.

neutropenic precautions - hand washing

Hand Washing: The Single Most Important Neutropenic Precaution!

It almost goes without saying that hand hygiene is the single most important neutropenic precaution that must be used with any neutropenic patient.

“Wash your hands!” our mothers told us. From an early age, we’ve all been told that washing our hands is the best way to avoid getting sick, because it is true.

Our hands are the main pathways germs and bacteria spread at home and in hospital. So not only is good hand hygiene the most important neutropenic precaution, it is also the simplest to implement.

When you or a loved one is neutropenic, you should take extra care to ensure you, any caregivers and any visitors wash their hands as regularly as possible. Especially:

  • Before preparing or eating food.
  • After going to the bathroom.
  • After blowing your nose, coughing or sneezing.
  • After handling anything that is likely to harbor harmful bacteria – diapers, garbage, pets, animal waste, etc. If it can be avoided, it is better to avoid handling any of these bacteria sources.
  • Before and after you touch any internal body part (inside of the mouth, ear, etc.), cut or wound.

neutropenic precautions - general hygiene

General Hygiene & Lifestyle

With small temporary changes to your daily habits and lifestyle, you can dramatically reduce your chances of developing an infection.

General Hygiene – Along with regularly washing your hands, you should:

  • Shower daily being sure to wash any areas that could harbor bacteria (feet, groin, armpits, and other moist areas). If you have a central line cover it with a waterproof dressing.
  • Gently brush your teeth twice per day with a soft toothbrush, as the mouth is a common place for infections.
  • Avoid sharing towels and personal items with others.
  • Take good care with urination and bowel movements (Girls wipe from front to back). Constipation is to be avoided so if you feel constipated ask your healthcare provider if you should take a stool softener.
  • Do not use tampons and douches or rectal suppositories, thermometers, and enemas as there is a risk they may tear the skin which germs could get into.

Family Members and Visitors – Not only is it important that you look after your own hygiene and health it is also critically important that the people around you are taking precautions as well:

  • Make sure all family members and visitors thoroughly wash their hands before entering your home or room.
  • You should avoid people who have any signs of a cold or flu (sneezing, coughing or sniffling) and anyone with a contagious disease. If a family member has a cold or infection they should ideally stay with a friend or family member whilst they are sick. However, if that isn’t possible they should wear a mask in your home.

Crowded Places – While you are neutropenic you should avoid crowds of people as much as possible. You don’t know what germs they are carrying.

Sexual Intercourse – During periods of very low neutrophil counts, it is advised that you don’t have intercourse. You should consult your nurse or doctor when it is safe to have intercourse again as there is no defined neutrophil count. When having intercourse use a water-soluble lubricant (such as K-Y Jelly) and avoid oral and anal sex to limit the chances of infection.

Keep Your Skin Safe

When neutropenic it is vitally important that you avoid cuts or open wounds that allow bad bacteria enter the body. As your immune system is so compromised due to the low neutrophil count it will have a hard time healing any cut or wound and fighting off any bacteria that enter the wound.

  • Take care of any wounds or IV sites.
  • Avoid activities that have a high chance of breaking the skin:
    • Use of razor blades (use an electric razor instead of a wet razor blade).
    • Accidental cuts or needle sticks.
    • Gardening or cleaning without gloves.

neutropenic precautions - neutropenic diet

Food Safety For Neutropenic Patients

Food safety is crucial for people with neutropenia as certain foods and drinks can harbor harmful bacteria that could lead to an infection. You need to be selective about the foods you eat and how you prepare and store them.

One thing to note is that every cancer center follows different rules regarding the dietary restrictions of neutropenic patients. Typically, patients undergoing more severe treatments (bone marrow or stem cell transplants) have stricter dietary restrictions than other cancer patients because they are often more neutropenic. So only use these recommendations as guidelines for your prescribed dietary restrictions.

Even though you mightn’t feel up to it sometimes, when you are neutropenic or undergoing cancer treatment you want to be eating a diet full of healthy high-calorie foods that have all the nutrients and vitamins your body needs to fight and recover from your treatment. However, we need to be careful not to eat foods that might contain bad bacteria. As your immune system may have a hard time protecting you from these bacteria.

Certain foods pose a higher bacterial risk to neutropenic patients than other foods. In general, the foods that are the most likely to contain harmful bacteria or viruses fall into four categories:

  • Uncooked or unclean fresh fruit and vegetables.
  • Uncooked or unpasteurized animal products (unpasteurized milk, raw eggs, soft cheeses, smoked salmon).
  • Pre-cooked meats that are eaten cold or that have to be reheated (deli meats).
  • Out of date food or foods that have been exposed to the air for a while.

As a general rule, you should only eat fruit, vegetables, and meats that have been thoroughly cleaned and recently cooked until piping hot. This will ensure that any bacteria on your food has been killed.

Check out this article if you’d like more in-depth information and guidance on the neutropenic diet.

neutropenic precautions - fever

How to Recognize an Infection

The suspicion of an infection is considered a serious and potentially life-threatening condition if you are neutropenic.

As fever is the body’s natural response to an infection, it is often the first sign of an infection if you are neutropenic. You should keep track of your temperature, taking your oral temperature twice daily with a digital thermometer. If your temperature reaches 100.5°F (38°C) or higher contact your doctor or nurse immediately, as you may need to receive antibiotics to treat the infection.

As fever is often the first of an infection patients notice, it is critically important that you don’t take any medications that may cover up a fever. These medications include steroids, aspirin, and aspirin-containing products (like Bayer), acetaminophen and acetaminophen-containing products (like Tylenol and Percocet), ibuprofen and ibuprofen-containing products (like Advil and Motrin).

Along with fever, you should look out for some of the other signs and symptoms of infection:

  • Not feeling well.
  • A cough or shortness of breath.
  • Soreness or swelling of the mouth and/or throat.
  • Pain or burning when during urination.
  • Redness, pain or swelling at the site of your chemotherapy catheter.
  • Redness, pain or swelling at the site of an injury.
  • A general feeling of weakness, or flu-like symptoms.
  • Chills.
  • Mental Confusion.
  • Chest pain or Abdominal pain.
  • Skin rash.
  • Low blood pressure.

If you notice any of these signs or symptoms contact your nurse or doctor immediately.

The guidelines in this article are intended to be general guidelines. Your doctor or nurse may give you different precautions to follow so always follow the advice of your healthcare providers.

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