Preventing Food- and Water-Borne Illness
Guidelines for Immunocompromised Patients
About This Article
Article Details
Published: Mar. 28, 2007
Updated: Mar. 28, 2007
These diet guidelines are for adult patients who are at risk for infection because of compromised immune systems.
Germs that cause infections can be found in food and water. The care you need to take depends on how well, or poorly, your immune system works.
- All patients and family members should follow the safe food handling instructions.
- Cancer patients on standard doses of chemotherapy or radiation therapy should follow the instructions given by their health care team. Your ability to fight infection will depend on several factors, including your disease, type and dose of treatment, age, and other risk factors.
- Stem cell transplant patients on high dose chemotherapy or immunosuppressive agents are at higher risk for infections from food and water. These patients should carefully avoid high-risk foods and beverages.
Safe Food Handling Instructions
A few simple precautions can reduce the risk of food borne diseases:
- Buy refrigerated foods that are cold and frozen food that is solid. Shop for these last and get them home quickly
- Buy only produce that is not bruised and that does not have broken skin
- Place raw meat and poultry in separate plastic bags to prevent dripping on other foods
- Wash your hands with soap and running water before and after preparing food and before eating
- Cook meat and poultry to a temperature greater than 165º F and eggs until firm
- Put cooked meat and poultry on a clean platter
- Separate raw and cooked foods to avoid cross contamination
- Be careful not to use the same cutting board for meats and vegetables
- Wash cutting boards and food preparation surfaces thoroughly with soapy water and dilute bleach
- Refrigerate leftovers promptly do not leave food out of the refrigerator for more than two hours
- Reheat leftovers to greater than 165º F
- Bring soups, sauces and gravies to a rolling boil, then simmer for ten minutes before serving
- Avoid preparing foods for others if you have an illness
High-Risk Foods / Beverages to Avoid
For cancer patients receiving standard dose treatments, the risk for infection needs to be balanced with the need to maintain adequate intake when you are not feeling well and some foods may taste unappealing to you.
Your cancer care team will advise you about when you need to avoid high risk foods. You may always choose to stick with the safer options.
For patients receiving stem cell transplant treatment, the risk for infection is higher. All stem cell transplant patients need to avoid high risk foods and beverages.
- For patients having an allogeneic transplant -- follow these guidelines until off all immunosuppressive drugs. Allogeneic patients should avoid dairy products that contain lactose. Lactose free milk and some dairy products may be consumed.
- For patients having an autologous transplant -- follow these guidelines for three months after transplant.
| High Risk Foods/Beverages | Safer Substitutes |
|---|---|
| Unpasteurized dairy products | Pasteurized dairy products (lactose free for allogeneic stem cell transplant patients), instant hot cocoa mix, individually packaged creamer Even safer: ultra-heat-treated milk, commercial sterile canned shake products |
| Cheeses with molds | Pasteurized processed American cheese Lactose-free cheese (allogeneic stem cell transplant patients) |
| Raw and undercooked eggs | Cooked pasteurized eggs until yolk and white firm or hard boiled. |
| Undercooked or raw poultry and meat | Well-cooked meat and poultry |
| Fish and seafood | Should be avoided |
| Deli meats and processed meats | Should be avoided. May have cooked hot dogs |
| Unpasteurized fresh squeezed fruit and vegetable juices | Pasteurized juices |
| Raw fruits with rough texture (i.e. raspberries, blackberries) | Should be avoided |
| Smooth raw fruits Dried fruits |
Should be washed under running water, then peeled or cooked. Canned fruits OK |
| Raw vegetables Avoid all sprouts |
Should be washed under running water, then peeled and cooked. Canned vegetables OK |
| Undercooked or raw tofu | Cooked well (boil in water or broth for 5 minutes). |
| Unroasted nuts or roasted nuts in the shell | Canned or bottled roasted nuts |
| Raw or unpasteurized honey | Pasteurized honey |
| Herbs and spices likely to be contaminated include allspice, black pepper, caraway, celery seed, chili peppers, cumin, onion powder, paprika, thyme, and turmeric | Herbs and spices less likely to be contaminated include cloves, fennel, garlic powder, and mint, which originate from plants that produce natural antimicrobial substances, as well as cinnamon, mustard, and nutmeg. |
| Tap water, bottled spring water, well water | Filtered water or water boiled for 1 minute and placed in clean bottle |
| Ice from ice machines | Fill clean ice cube trays with boiled water |
These guidelines are based on published recommendations from the Center for Disease Control, the Infectious Disease Society of America and the American Society of Blood and Marrow Transplantation, as well as published research literature.
They reflect recommendations for avoiding food borne illness and are not meant to serve as recommendations for a nutritious diet.
This article is intended as a resource for patients receiving their cancer care at Duke University Hospital or Duke Clinic. It is not intended to substitute for medical advice from your healthcare team. If your doctor’s instructions differ from the information in this article, please talk with your doctor before making any changes.
