Cleaning for Those Who Are Immunosuppressed

The following is a guest post by Dr. Alice of Feet First.

Dr. Alice says:
“Cleanliness is next to godliness” is a well-known saying, but my recent experiences have changed my mind: It would be more accurate to say that cleanliness is next to survival. Granted, many readers might not go quite that far, but my recent experience as a caregiver to a chemo patient has been a little extreme. It has been valuable, though. I have learned just how important food hygiene and household cleanliness can be when you live with someone whose immune system is not functional. As a physician I thought I knew everything there was to know about the importance of handwashing, food hygiene and protecting against infection… turns out I was wrong. I thought I’d share a few of my experiences with you in this article.

Let’s talk about food hygiene for those with a compromised immune system. Temperature and food storage are key issues for someone who is sick – you don’t want to run the risk of food poisoning or parasites – but some of these precautions would be valuable for anyone with a contagious illness in the family. Food must be thoroughly cooked, fruits and vegetables must be scrubbed (including bananas, even though you peel them!), prewashed greens must be rewashed before they are eaten. Chopping boards are disinfected daily. We are using a lot of paper plates, towels and napkins as cloth napkins are a no-no and dishtowels are frowned upon. We do have regular dishware and use that, but all tableware and utensils must go through the dishwasher on “sanitize.” Anything which is refrigerated goes right back into the fridge as soon as we are done with it; nothing sits out on the counter. Meat is a tricky issue. Chemo and transplant patients can eat meat, poultry or fish but there are many precautions attached. You must keep meat separated from fruits and vegetables at all times: in the grocery store it should be in a separate part of the cart (or you can put it in a handbasket, which you then put in the cart). At the register it has to be bagged separately from everything else. In the refrigerator meat goes on the lowest shelf to prevent juices from dripping down and possibly contaminating other food on lower shelves. And it is always cooked until well done, not rare.

Microwaved foods should be well stirred to make sure there are no cold spots where food might be incompletely cooked. If keeping food warm it should be held at a temperature of at least 140 degrees (below this point there is a risk of bacteria reproducing in the food).

There are some food precautions I wouldn’t have thought of: miso and other fermented foods aren’t allowed for immunosuppressed patients. Whole-grain or seeded crackers and breads are also off limits, only white bread, saltines and water crackers. Presliced meats and cheeses (i.e., deli) aren’t allowed due to possible contamination from the slicer blade, and you can’t have roasted nuts in the shell, although loose roasted nuts are okay.

Tap water is safe in most large cities, although bottled water is encouraged. There have been some concerns about city water supplies in Los Angeles, and probably other cities as well, being contaminated with low-levels of  a parasite* which at these levels does not affect healthy people but can cause diarrhea in someone who is immunosuppressed. It’s very difficult to get rid of this bug, as chlorine does not seem to affect it and it can pass through water filters such as Brita.  So if you have a member of the household who is at risk for infection, bottled water may be a safer option.
Living quarters and general hygiene are also areas of focus. We have bottles of hand sanitizer everywhere as well as foaming antibacterial soap. I daily spray all surfaces in the kitchen, bathrooms and other areas with a 10:1 solution of water and Clorox.  Bedsheets are washed twice weekly, pillowcases and towels every other day. The telephone and TV remotes, door handles, light switches are all points of communal contact and possible danger zones; these have to be sprayed and wiped daily. We can’t have flowers or plants in the room, and even artificial flower arrangements may be suspect if there is moss on them (it can harbor fungus).

It’s okay to go outside – in fact, the medical center staff encourages patients to exercise – but avoiding crowds is important. We have seen a few people wearing masks in the medical center but they are intended more for someone who has a cough or is already sick than as protection for someone who has no symptoms.

When it comes to cleanliness vigilance is key, I have learned that details are important. When I first read the caregiver handouts I was reminded of nothing so much as Howard Hughes on a really obsessive day. But MRSA and other drug-resistant bacteria infections are becoming almost a universal problem; you don’t need to be ill or weakened to get them. Being a caregiver to my immunosuppressed relative has alerted me to the importance of being more cautious in my daily life, as well. With cold and flu season just ahead, I think I will be emphasizing infection prevention to my patients a lot more this year. I’m hoping that after reading this, you will be encouraged to do the same.

*Heather says:

I’m all too familiar with that parasite and you certainly don’t have to be immunosuppressed to catch it.  My entire family contracted it in 2006 at a water park and we have a nickname for that infamous summer. We’ll just say it doesn’t pass the family friendly test.

Dr. Alice lives, works and blogs in Los Angeles. In her spare time she writes and collects cookbooks and craft ideas.
Be sure to visit her at Feet First.