Cleaning for Those Who Are Immunosuppressed

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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.

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11 thoughts on “Cleaning for Those Who Are Immunosuppressed”

  1. When I was taking food safety training in culinary school, I was shocked at what I didn't know. Many of my classmates were young people who'd never run a household, and few ever took home ec or anything like it. I imagined many of them would be uninformed, but I was a bit smug. I was a 'mature' student and had been in charge of food safety at home for nearly 20 years, I thought the class would be a doddle. No. It was not.

    And when I had to re-take the test 5 years later, it was even harder catching up on the updated information on my own. My score wasn't as good as the first time b/c I had a hard time replacing certain memorized facts.

    Finally: If we are supposed to put meats on the bottom shelf, how come home refrigerators put the fruit and veg bins there? The main reason I want a french door type is that long, shallow drawer at the bottom of the fridge. Can't thaw the holiday turkey there, but most cuts of meat should fit in there nicely.

  2. Good point about the fruit and veg bins, Karen – that struck me as well. Most meat would not leak enough to overrun the bottom shelf and drip into the bins, I guess – that was the only explanation I could come up with. And I don't know about the seeded crackers/whole grains, either… I may need to go back and ask. Glad you liked the post.

  3. I'm also caregiving a cancer patient and my learning curve has been shocking as well! I thought myself fairly well up on things, but immunosuppressed is an entirely new ballgame. As a matter of fact, when this was posted, my "ward" was recovering from a very serious round of infections and I'm now able to get caught up on older posts here.

    In addition to things you noted, fresh ground black pepper was another to add to our list of No's. A fungus similar to the one that put a temporary stop to imports of szchuan peppercorns a few years ago is sometimes present on regular black peppercorns. The peppermill was off our table for a time being, although if fresh pepper is ground into the food as it's cooking, that's ok since the heat takes care of the possible mini-critters.

    As for cleaning, I'm allergic to bleach but made the time and effort to get around it since it was so important. Learning about a bug called C. diff. was an educational experience, although we never did have to fight it off. Gloves help for the cleaning and then I do a final rinse afterwards with plain old vinegar to remove the residue and keep my reactions down.

  4. I don't even want to walk back into my kitchen after reading this. There isn't a single rule in there that I don't break flagrantly. The chopping board hasa been reused about 4 times without being cleaned, the cooker needs a real good going over and yes food has been left out, dish cloths are dirty. I feel very grubby now.

  5. Thank you! I’ve been caretaking my husband for about 14 months now,, looking forward to at least 8 more months…had to move temporarily for a bone marrow transplant, 3 months turned into 6… Anyway, it is hard to keep this up when he seems to be doing better but is still immuno compromised. This was the first site I have found that is a specific and where you are experiencing the same thing. Thanks!!!

  6. Thank you! I had a bone marrow transplant in December 2014 and have learned many, many things that I never knew before about food safety and the cleanliness of everything I touch. You don’t usually see cleaning pages discussing the immunosuppressed.

    • Thanks, Sheryl. We are facing BMT and are here looking for tips.

      I’d add that I’m suspicious of water filters like Brita attached to the faucet. If they’re not cleaned/filters changed very regularly, they can become bacteria hangouts. Better stick to bottled water, IMO.

      Thanks Alice!!! Great tips and I’ve learned a lot. Will bookmark this to read when we are out of BMT and looking at keeping our place clean.

      • I am a transplant survivor. I am obsessed some would say with purell. I just don’t want to miss life anymore from being in Yale. I also wipe down everything we buy from anywhere before it is put away. Cold meats, boxed pasta, dog food, everything. It is definitely hard to instill these rituals with family members that don’t live with you but see often. Thank you so very much for writing this!! Peace and Love


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