What Are Neutropenic Precautions?

Neutropenia is a condition that puts people at increased risk for dangerous bacterial infections. It’s seen in some cancers and diseases but is also a common side effect of cancer treatment. Neutropenic precautions are common-sense protocols that help avoid infections at home and in clinical settings, like hospitals.

Neutropenia is earmarked by low levels of white blood cells called neutrophils. Neutrophils are abundant in people with healthy immune systems. Without enough neutrophils circulating in the blood, dangerous or fatal infections can result.

This article will detail neutropenic precautions you can take that increase your safety from infection.

What Are Neutropenic Precautions?

If you have neutropenia, your body is unable to adequately fight off infection. For that reason, avoiding germs that can make you sick is a priority.

It can be hard to completely eliminate germs from your environment. However, strictly enforcing the use of neutropenic precautions in your home and in other controllable environments can help immensely.

Hygiene at Home

Neutropenic precautions to take at home include:

• Wash your hands often with warm, soapy water. Always wash your hands before you eat and after toileting. You should also wash your hands after blowing your nose or coming into contact with mucous membranes, such as your eyes, mouth, or genitals.
• Wash your hands after coming into contact with other people and after being outdoors.
• Always carry an alcohol-based hand sanitizer to use when you can’t wash.
• Use alcohol-based wipes to clean surfaces that others may have touched and everyday items you use, including debit cards and keys.
• Brush your teeth twice daily with a soft toothbrush. Take care not to make your gums bleed.
• Bathe or shower daily.
• Use electric shavers instead of razors to avoid nicks and cuts.
• To eliminate the possibility of toxic shock syndrome, do not use tampons. Sanitary napkins are OK.
• Do not use anal thermometers or have anal sex.
• Avoid straining during bowel movements, as this may cause hemorrhoids (inflamed veins) and open wounds that can become infected.
• You can enjoy sexual intimacy with a partner, but use condoms plus a water-based lubricant to avoid sexually transmitted infections (STIs) and skin abrasions that might become infected.
• Avoid changing diapers.
• Don’t share towels or clothing.
• Ask anyone who enters your home to remove their shoes.
• Keep germs off your feet by wearing clean socks at all times.
• Avoid contact with refuse and garbage, both indoors and outside.
• Avoid contact with animals, birds, and fish, including your own pets. Don’t pick up or otherwise come into contact with animal feces or urine.
  
• Avoid contact with houseplants, garden plants, and cut flowers.

Hygeine Outdoors and Away from Home

Follow these precautions when outdoors or out in public:

• Avoid public transportation and cabs.
• Avoid large crowds, even if people are masked.
• Wear a high-quality mask if you are out in public and surrounded by people.
• Do not come into contact with anyone who is or may be sick.
• Avoid dusty environments.
  
• Do not get manicures or pedicures at a salon. Thoroughly cleanse manicure equipment for your own use at home.
• Do not wax unwanted hair in a salon.
  
• Avoid water parks and hot tubs.
• Don’t swim in ponds, rivers, or lakes.
  

Vaccines

These vaccines are also recommended for neutropenic precautions:

• You and all members of your household should get vaccinated against the flu annually.
• You and all eligible members of your household should get vaccinated against COVID-19 and stay current with any recommended additional doses or boosters.
• Talk to your doctor about other vaccinations you should take, such as the pneumonia vaccine (pneumococcal vaccine) and the hepatitis B vaccine.

Food Safety and Neutropenic Precautions

Poor nutrition can adversely affect the immune system. It's important to eat healthy food during cancer treatment and at any time when your immune system is depressed. However, even the healthiest foods can contain bacteria and pathogens (organisms that can cause disease). For that reason, neutropenic precautions for food include:

• Never eat raw, undercooked, or unpasteurized food. Foods to avoid include sushi, unpasteurized honey, and rare meat.
• Don't eat eggs if their shells are cracked.
• Fruits and vegetables should be washed or scrubbed before eating. This includes prewashed salads and vegetables.
• Don't eat anything that appears wilted, stale, or old.
• Avoid salad bars and buffets.
• Eat from dishes and glasses that have been washed in hot, soapy water or a dishwasher.
• Don't share utensils or glassware.

In some instances, your healthcare provider may recommend you follow a neutropenic diet, also known as a low-microbial diet. In addition to common-sense guidelines about choosing and preparing food, it has safety precautions such as not refrigerating hot foods and avoiding shellfish, deli meats, and deli cheeses.

When Are Neutropenic Precautions Used?

Neutropenic precautions are recommended for anyone who has neutropenia, to use both at home and in clinical settings. Neutropenia is diagnosed through a complete blood count (CBC) test. This test provides information about your absolute neutrophil count (ANC). Your risk for infection is based on your ANC number:

• Highest risk: ANC lower than 500
• Moderate risk: ANC between 500 and 1,000
• Lower risk: ANC over 1,000
  

People with certain illnesses, such as human immunodeficiency virus (HIV), may become neutropenic at various points of treatment. Autoimmune diseases (in which the immune system mistakenly attacks your own tissues) and bacterial infections, such as tuberculosis, can also cause this condition.

Cancer and Cancer Treatment

Cancer and the treatments used to fight it can weaken the immune system. Forms of cancer directly affecting the bone marrow, such as leukemia, lymphoma, and multiple myeloma, can result in neutropenia as cancer cells replace normal neutrophil-producing cells in the bone marrow.

Chemotherapy can kill or harm fast-dividing healthy cells (such as those in the bone marrow that produce neutrophils) as well as cancer cells. Neutropenic precautions are recommended for people undergoing chemotherapy.

The greatest risk for neutropenia is from the seventh to the 12th day of chemotherapy treatment. This window varies and isn’t written in stone. If your healthcare provider has recommended neutropenic precautions, it makes sense to err on the side of caution and add a few days, at least, on either side of this window.

Other cancer treatments that may weaken the immune system include radiation, surgery, and bone marrow transplants.

Kostmann’s Syndrome  

Children born with Kostmann's syndrome may require the use of neutropenic precautions throughout their lifetimes. Kostmann’s syndrome is a rare genetic disease that causes severe congenital neutropenia (not having any neutrophils from birth). If your child has Kostmann's syndrome, medications will be given that make this condition more manageable.

What Is Neutropenic Isolation?

Neutropenic isolation may be used in clinical settings to protect people with severe neutropenia from pathogen exposure. If your doctor recommends neutropenic isolation, you may be confined to a hospital room for a period of time.

Guidelines for your stay will include neutropenic precautions in addition to standard precautions. These may include: 

• Hospital staff should wear personal protective equipment (PPE), such as gloves, gowns, and masks when they enter your room.
• Visitors and staff must wash their hands before entering.
• The door to your room must be kept closed.
• Visitation may be limited. Visitors will also be required to wear PPE.
• Your diet may be restricted to exclude uncooked fruits and vegetables.
• Flowers and live plants may not be allowed in your room.
• Cleaning your room may be done with damp dusting rather than dry dusting.
  

When to See a Healthcare Provider

If you feel sick or notice any signs of infection, let your healthcare provider know immediately. These include:

• Fever or chills
• Excessive sweating
• Abdominal pain
• Sore throat
• Stiff neck
• Coughing
• Difficulty breathing
• Vomiting or diarrhea
• Red, swollen, or irritated skin
• Unusual vaginal discharge
• Changes in urination
• New or unusual pain

Summary

Neutropenia is a condition in which you have low levels of white blood cells called neutrophils. Neutrophils are necessary for fighting off bacterial infections and illnesses. Neutropenic precautions are common sense guidelines for reducing exposure to pathogens that can make you sick.

People with cancer and other conditions may be required to use neutropenic precautions at various points during treatment. 

A Word From Verywell

It can be hard to live with a long list of “don’ts.” However, if you are immunocompromised and have neutropenia, it may be necessary to do just that. Some neutropenic precautions, such as washing your hands often, may be easy to adapt to. Others, such as finding a temporary home for your pets, may be harder.

The goal of neutropenic precautions is to keep you healthy and safe. Keeping your eyes on that goal may help you to get through this time.