Neutropenic Precautions

Neutropenic precautions refers to limitations or preventative measures placed upon a patient who is neutropenic (diagnosed with neutropenia) in the hope of preventing a serious infection. When a patient is neutropenic, the level of white blood cells in their body is considered low. These cells are the body’s natural defences against infections and bacterias and therefore a low level of these cells means the patient has more difficulty fighting these infections. Consequently, neutropenic precautions need to be taken to ensure that the patient isn’t exposed to nor does anything that could potentially cause an infection.

Neutropenic precautions – Medical Institution Protocols

Currently in medical institutions, there is no standard protocol for neutropenic precautions and hence, practises can vary between different institutions. Generally, medical institutions employ a threefold strategy for neutropenic precautions;

Dietary – It is recommended that the following foods should be avoided (neutropenic diet guideline);

  • Raw fresh fruits, meats and vegetables
  • Uncooked peppers
  • Raw or unpasteurized dairy products
  • Deli foods
  • Raw or partially cooked egg

The patient should also consume a high quantity of fluids such as water and juice to avoid dehydration.

Clothing – Clothing can help prevent germs and microorganisms from coming into contact with the patient. Patients should be fully clothed at all times and these clothes should be changed daily. Additionally, depending on how neutropenic the patient is, masks should be worn. Masks are advised if the patient ventures near a hospital construction area.

Environment – Commonly as a neutropenic precaution, the patient should be placed in a private room, or semi private room depending on the approval of the attending physician. The patient should not under any circumstances be visited by anyone with a transmittable disease, for example the flu. Hence, visitors should be screened for illness and staff should not care for neutropenic patients and patients with a transmittable disease at the same time. Furthermore, there should not be any fresh flowers or plants in the room or near the vicinity of the patient.  This is because anything grown/growing in dirt contains bacteria.

In addition to these 3 strategies, general handwashing protocols should be adhered to at all times. This involves regular and good handwashing by both the patient anyone who come into contact with them.

Possible Symptoms of infection

  • Temperature greater than 38 degrees Celsius (or whatever temperature the physican advises)
  • Burning or pain when urinating or a cloudy urine
  • Difficulty swallowing
  • Dizziness or weakness
  • Redness, swelling or tenderness
  • Shortness of breath
  • Sores in the mouth
  • Sore throat
  • Stuffy/runny nose and/or coughing


Neutropenic precautions – Other tips to help avoid infection

  • Take temperature if feeling unwell or experiencing chills
  • Avoid crowded areas eg shopping centres and movie theaters
  • Avoid construction areas. These areas contains could contain fungus in the air that could be harmful to the patient
  • Avoid cuts, punctures or scratches on your skin
  • Avoid anyone who has received a vaccination within the last three weeks
  • Daily shower or baths
  • Drink lots of fluids (water, juice, etc.) to prevent dehydration
  • Limit exposure to pet feces e.g. litter box
  • Maintain a well-balanced diet
  • Regular gentle mouth care using a soft tooth brush
  • Rinse mouth with warm salt water, prescription mouth wash or baking soda and water. Commercial mouth wash contains alcohol that can dry the mouth
  • Women should wipe front to back after a bowel movement
  • Women should use pads rather than tampons