7 Ways to Prevent Infection if You Have Neutropenia

Handwashing. RuslanDashinsky/Creative RF/Getty Images

Neutropenia, a low neutrophil count, can increase your risk of serious infection.  Your risk goes up the lower your neutrophil count is (particularly less 500 cells per microliter) and the longer you are neutropenic.  The reason you are neutropenic also plays a role in your risk for infection.  There are some things you can do to try to prevent as many infections as possible.  

  1. Avoid sick people:  Sounds simple enough, but sometimes it is difficult to tell family and friends to not come over when they are ill, including simple colds.  Since most illnesses last only days, ask them to return when all the symptoms have gone.  
  1. Avoid crowds:  Being around a lot of people increases the opportunity to catch an infection from someone.  Additionally, many viral infections are contagious prior to the presence of symptoms.  This means someone can look well but still pass a viral infection on to you.  Understandably you may need to do some shopping or get out of the house during the time you are neutropenic.  Consider traveling to stores during non-peak hours.  A mask can be worn over the nose and mouth while in crowds to prevent infection.
  2. Hand washing:  Hand washing is also pretty self explanatory.  This allows you to get rid of any germs you may have been exposed to.  Washing your hands more frequently can cause dryness and cracking of the skin.  These cracks in the skin can be an entry point for germs.  Use a moisturizing lotion to prevent this.  
  3. Oral hygiene:  Our mouths are full of germs that do not cause infection when we have normal neutrophil counts.  To prevent infections you should brush your teeth twice a day with a soft toothbrush.  Brushing with a harder toothbrush may cause irritation to the gums giving bacteria a place to cause infection.  Seeing your dentist regularly is also an important part of your care, but you should discuss this with your physician first.
  1. Influenza vaccine: People with neutropenia are more likely to develop complications from the flu if they catch it.  For this reason it is recommended that almost everyone with neutropenia should receive the annual influenza vaccine. If you are receiving chemotherapy, you need to discuss with your oncologist when is the best time to receive your influenza vaccine.  It is NOT recommended for people with neutropenia to receive the nasal spray version as it is a live virus vaccine.  You should receive the injectable form.  Encourage those around you frequently to also receive influenza vaccine as an additional layer of protection.  If you are exposed to the flu, alert your physician as soon as possible so that you can be started on anti-viral medication to prevent infection.  
  1. No rectal temperatures:  This one applies mostly to small children.  Taking a rectal temperature may cause a small tear in the skin which can increase the risk of getting an infection.  The same goes for medications - no rectal suppositories.  
  2. G-CSF:  G-CSF is an injectable medication (sometimes called Neupogen or Neulasta), that stimulates the bone marrow to produce and release neutrophils into circulation. In chemotherapy induced neutropenia, G-CSF may be given shortly after you finish a course of chemotherapy.  This will reduce the length of time you are neutropenic and prevent infections.  In severe congenital neutropenia, G-CSF is used to maintain a normal neutrophil count, thereby reducing infections.

It is important to discuss with your physician all the things you can do to prevent infections while you are neutropenic.  Some other suggestions might include a neutropenic diet, preventative antibiotics, and cooking meats and eggs thoroughly.  Sometimes despite all your efforts to follow these tips, you may still get an infection.  Don't be too hard on yourself, it may have been unavoidable.