When to call the hospital

• Who to contact based on signs and symptoms present
• When first signs or symptoms of infection or neutropenic sepsis (e.g., fever, chills, rigors, diaphoresis) develop
• Report even a low-grade fever
• Report development of mouth sores, dysphagia, abdominal pain, rectal soreness, tenderness of the sinuses, or diarrhoea.
• Report respiratory symptoms (e.g., shortness of breath, cough, or sore throat.)
• Report GU symptoms (e.g., burning on urination.)
• Report redness or swelling of any area of open skin or injury.

Monitoring

• Signs and symptoms for which to observe (as outlined above)
• Temperature monitoring: Check your temperature 1–4 times/day if you are not feeling well or suspect you are ill (note: Fever may be the only sign of infection in patients with neutropenia)

Medication knowledge

• When most vulnerable for infection based on chemotherapeutic agents received (the nadir)
• Effects of chemotherapy on neutrophils.

Knowledge specific to colony-stimulating factors (administered to reduce risk of infection) (See chapter 23)

• Information about colony-stimulating factors (e.g., mechanism of action, rationale for use)
• Timing of administration (i.e., do not take earlier than 24 hours after chemotherapy administration.)
• Side effects management (e.g., bone pain with acetaminophen)
• Side effects are temporary and usually dissipate following discontinuation of therapy.
• Self-injection techniques (e.g., sites to use, rotation of sites, do not aspirate for blood prior to injecting)
• Remove medication from refrigerator 30 minutes prior to administration to help prevent stinging at the injection site
• When to notify hospital (e.g., temperature over 38°C, shortness of breath, increased heart rate, any new rash)

Activities

• Wear gloves when cleaning.
• Wear protective gloves when participating in outdoor work (e.g., gardening).
• Avoid contact with compost heaps, manure, hay, mouldy areas.
• Avoid participating in contact sports or other activities where you can be injured.

Diet

• Check with your nurse regarding any dietary restrictions. (Neutropenic diet is not supported with evidence but you should follow fundamental rules when it comes to being careful, which the dietician has directed). Many foods should be avoided – a sample of foods to avoid include cheeses with moulds (for example, blue, Gorgonzola, Roquefort, and Stilton cheeses), stir-fry foods, fast foods, eggs with a runny yolk, fresh salad, raw nuts, roasted nuts.

Personal hygiene

• Hand hygiene: Wash hands often with soap and water or alcohol-based gel, especially before meals and after touching pets.
• Wash all surfaces of fingers and hands for at least 15 seconds.
• Dry hands thoroughly to prevent bacterial colonisation.
• Personal hygiene: Bathe or shower daily; showers are preferred.
• Wipe the perineum from front to back after toileting (females) to avoid contamination.
• Use sanitary pads versus tampons.

Oral care

• Brush teeth 2–3 times a day, including after eating and before going to bed.
• Use a toothbrush with soft bristles (and small head)
• Use a bland mouthwash (e.g. saline, sodium bicarbonate)
• Keep lips and mouth moist.
• Floss daily if it does not cause trauma or bleeding (but stop if bleeding occurs)
• Importance of dental involvement before chemotherapy starts
• Remove dentures and other orthodontic appliances during the nadir to prevent trauma and infection.

Environmental hygiene

• Do not place fresh flowers or potted plants in the home (e.g. risk of Pseudomonas Aeruginosa in stagnant water)

Skin protection

• Avoid getting scratches or other breaks in the skin.
• Use an electric razor.
• Keep nails trimmed short and clean.
• If breaks in the skin occur, wash thoroughly with soap and water or antimicrobial liquid and apply antibiotic ointment.
• Avoid tampons.
• Use water soluble lubricant during sexual intercourse

Pets

• Avoid contact with pet faeces, urine, or saliva.
• Do not handle used cat litter.
• Do not clean fish tanks.
• Do not clean pet cages.
• No direct or indirect contact with reptiles.
• Wash hands after any contact with animals.
• Prompt hand hygiene of broken or scratched skin or any loss of skin integrity

Environmental exposure

• Avoid people who have a cold, flu or other respiratory tract infection.
• Avoid people who recently (within the past 3 weeks) received a live vaccine.
• Avoid places with crowds (e.g., shopping centres, cinemas, public transportation).
• Care for plants should be performed by those not providing care to the patient. If this is not possible, the caregiver should wear gloves when handling plants and perform hand hygiene after gloves are removed.