Why do I need advice on what to eat?
At this time you are at a greater risk of developing infections from bacteria or fungi which can be found in small amounts in many foods.
Some foods we eat contain small amounts of bacteria or other harmful microbes which for most people this is not a problem. However when your white blood cells are lower than normal you may be more likely to become unwell if you come into contact with bacteria.
This booklet outlines some simple steps to help reduce this risk both at home and when eating out.
How long do I need to keep to these guidelines?
Every patient is unique and the length of time you are encouraged to follow these guidelines can vary. In general we advise that you follow these guidelines during treatment and for three months after your last course of treatment, or until your immuno-suppression medication is stopped if you are taking these.
Note:
Immuno-suppression medication could be started at any given point therefore
these guidelines may need to be restarted as these act on your immune system.
Please discuss with your medical team or dietitian.
Food Safety – General advice
The following food safety and hygiene advice can help you reduce the chances of getting a food borne infection.
Shopping
• Avoid buying food with damaged or broken packaging.
• Check all use by dates and best before dates on packaging.
• Transport chilled and frozen foods home as quickly as possible. Use an insulated container or cool bag to help keep food at the correct temperature.
• Pack raw meats, poultry and fish in a separate carrier bag to other foodstuffs: remember the packaging may be contaminated.
• Avoid buying foods like meat, cheese and bread from open deli counters or sweets and chocolates from pick and mix stalls.
Food preparation
• Always wash your hands with warm soapy water before handling and preparing any foods.
• Wash your hands after going to the toilet, sneezing and after touching any pets, hair, dirty washing, rubbish or raw foods.
• Use a separate towel or use kitchen paper to dry hands. Do not use a tea towel.
• Cover any cuts and grazes with a waterproof plaster.
• Avoid preparing food if you have been unwell with food- related sickness and/or diarrhoea until at least 48 hours after symptoms have passed.
• Wash salad vegetables and fruit (if eaten with the skin on) thoroughly.
• Do not wash poultry under the tap as this can spread bacteria over the sink and work surfaces. Leave unwashed.
Storage
• Check fridge temperature. Fridges should be 0-5°C.
• Store cooked foods at the top of the fridge.
• Store raw or defrosting food at the bottom of the fridge in a covered container to stop it dripping or leaking out into the fridge.
• Use and store food following the manufacturer’s instructions. Use within best before or use by dates.
• Keep eggs in the fridge.
• Check your freezer temperature. Freezers should be below -18°C.
• Do not refreeze thawed foods.
• If food is frozen at home, label and date when put in the freezer and use within freezer star guideline on packet or inside door of the freezer.
Kitchen hygiene
• Keep the kitchen clean.
• Use a food safe sanitiser or disinfectant on food contact surfaces and hand contact surfaces (e.g. Microwave handles, fridge door handles, taps).
• Make sure any cloths or sponges are regularly bleached, disinfected or changed.
• Keep pets away from work surfaces, food and your dishes.
• Avoid cross – contamination of food by changing or washing chopping boards and utensils between raw and cooked foods. Ideally you should have three boards; one for raw meat, one for cooked meat and one for other foods.
Cooking
• Thaw meat and poultry in the fridge and not at room temperature.
• Always cook raw foods thoroughly and ensure the food is piping hot all the way through with juices running clear and with no pink showing.
• Cooking to above 63oC will kill most bacteria, but it is recommended that all cooked food reaches at least 70oC in the centre for a minimum of two minutes.
• Always follow the manufacturer’s cooking guidelines and do not shorten cooking times.
• Pre-heat the oven to make sure food is cooked at the recommended temperature.
• Always wash your hands before eating.
Reheating foods
• Avoid reheating rice and takeaway food.
• For home cooked foods, cover and cool food at room temperature within an hour after cooking and then place in the fridge or freezer.
• Eat reheated home cooked food within 24 hours of preparing or defrosting it. Reheat only once and ensure it is piping hot. Eat immediately.
Eating out
Use reliable / reputable outlets.
• Look for the local council environmental health five star rating guides, with five being the top score for hygiene and cleanliness.
• Ask for food to be cooked fresh rather than anything that has been standing around.
• Avoid salad bars / deli, street vendors, market stalls and ice cream vans.
• Avoid pre-packed sandwiches from shops, supermarkets and garages.
• Any food that needs to travel before you eat it, such as takeaways, should be piping hot when it arrives with you.
This is why it is recommended that friends and relatives do not bring in takeaways / foods for you while you are in hospital. Any prepared food not eaten at the time it is prepared has time for bacteria to grow. This means food that is safe at home is not safe for you in hospital.
Foods which are safe to bring into hospital:
- Breakfast cereal, porridge / oat pots.
- Crisp breads / bread sticks.
- Crackers.
- Crisps / baked savoury snacks.
- Cakes, bakery products (not fresh cream).
- Biscuits.
- Sweets and chocolates.
- Instant noodles, rice or couscous pots.
- Packaged dried fruit, nuts, cereal bars / flapjack.
- Croissants with jam / chocolate spread / peanut butter.
Foods have been divided into two categories
Lower risk foods: foods which are considered safer to eat as long as they have been stored, handled and served appropriately as per manufacturers guidelines.
Higher risk foods: foods which there is a clear risk of infection and therefore encouraged to be avoided.
Note
The live bacteria used in making yoghurts are not harmful. So, yoghurt described as “live” is safe during neutropenia.
However, the bacteria used in bio or probiotic foods cannot be guaranteed as safe during neutropenia.
Note
* It is recognised that on rare occasions, some infections may be transmitted by tap water or private water supplies in Yorkshire and the rest of the UK.
Listen to any advice from health/local authority about the need to boil your water supply.
More information on safer shopping and eating can be found at: Food safety | Food Standards Agency
For any further information please contact your medical team, clinical nurse specialist or dietitian.
Acknowledgment – BDA Oncology Group Haematology Sub group Guidance: Safer eating with Neutropenia 2023.