Not having an immune system is frightening.

July 14, 2011 1:17 PM

Household tips for the immunocompromised?

My husband was recently diagnosed with Stage III Anaplastic Large T-Cell Lymphoma. It is one of the fast-growing, aggressive types of Lymphoma, which responds very well to chemotherapy, and since he is young and otherwise healthy, his oncologists have given him a very good prognosis.

He is currently receiving a chemotherapy regimen called CHOP every three weeks. The doctors have warned him that the second week of the cycle (days 7-14) are when his white blood cell counts will be lowest, and he should consider himself immunocompromised during that week. Today is the start of that second week, and I am freaking out a little.

We have two young children and I am worried about when our oldest starts preschool in September, being that schools are basically huge germ factories. I have never been all that germophobic (I have no problem eating the cookie that drops on the kitchen floor, etc.) so this is new territory for me. I know that frequent handwashing is important, and I am planning on buying a bunch of things of Purell or other alcohol-based hand sanitizer, and keeping one in each car and one in my purse and several in other key places around the house. I was thinking of getting maybe some of those Clorox wipes or something like that too. Does this seem like a good idea?

I know we should clean places like our computer keyboard, our phones, our doorknobs. But how? Spritzing with rubbing alcohol? Wiping with bleach? Is that bad for the keyboard to have bleach on it? Any other germy hotspots I should know about?

The bathroom will be cleaned as often as I can manage. Any advice or tips/techniques to keep things as sanitary as possible?

I know we also need to be careful with food safety, but I am not sure whether I need to change anything about my habits. I know not to use the same knife/cutting board for meat and vegetables. Do the rules about Listeria that apply to pregnant women (i.e., no soft cheese and no deli meats, etc.) also apply to this situation? How about leftovers, are they ok? To what extent? We wipe down our counters daily, but should I be doing it more? What should I be using? Paper towels with bleach instead of our kitchen cloth with soap and water? We have plenty of dishcloths and we currently use at least 4 or 5 fresh cloths every day -- whenever there is a new mess, we get a clean cloth. They are washed in hot water with bleach. Are they clean enough?

Is there anywhere online I can find explicit guidelines about this stuff? I would appreciate any and all advice -- things I may have overlooked, etc.

And is there such a thing as too careful? I am thinking it would be easy to fall down the paranoid rabbit hole of "ZOMG there are germs EVERYWHERE!!!!" and I would like to be reasonable but also, you know, keep my husband from dying of a preventable infection.

posted by fancyoats to Health & Fitness (18 answers total)

The team treating your husband should have given some specific information regarding what he should be avoiding to decrease the risk of any opportunistic infections during this specific time period. In working with freshly transplanted kidney/liver patients, we would discharge them home with very clear instructions of what to be doing when they got home to protect themselves, as well as if they should be wearing a mask when out in public, due to the fact that they are extremely immunocompromised for an acute period of time post-op. So my best advice would be to contact your husband's oncologist for some clarification here. Also, I would try to take all of the live plants (soil based plants, fresh cut flowers, etc.) out of the home for the time being.
posted by Asherah at 1:32 PM on July 14, 2011

Response by poster: We met with the oncologists this morning, and they basically just said to be careful and to call them if he gets a fever, but nothing more specific than that. That is why I am asking.
posted by fancyoats at 1:40 PM on July 14, 2011

I wasn't trying to be rude, just trying to indicate that they should be able to provide more details. As they have not, here's some Googleable information that is definitely translatable to your husbands degree of immune compromise and what he should do to protect himself.
posted by Asherah at 1:48 PM on July 14, 2011

Friends of mine installed motion detectors in the bathrooms so that the light would go on and off without being touched.

I work in schools and can attest to the fact that they are veritable petri dishes. Definitely have the kiddo(s) wash their hands and take off their shoes as soon as they come in the house. I don't know how long bacteria/viruses survive on soft surfaces, but you might also consider a fresh change of clothes when they get home; those sleeves have had noses wiped on them and poo accidents happen in places where the pants have been sitting/kneeling. (Ask me how I know!) If you feel comfortable with it, you can ask the teacher to give you a heads-up when kids are being sent to school sick because it will happen.

(Sorry to sound so grim about the germiness of preschools.)

It sounds like your husband is in very good hands. All the best to you guys.
posted by corey flood at 1:53 PM on July 14, 2011

When I was taking care of an immunocompromised cancer patient, I was told to make liberal use of Oust and Lysol. Wash your hands as often as possible, etc. Apart from being careful and thorough, there's not much one can do. I'm not a doctor, but I know how hard your position is because I've been in it. I wish you the best.
posted by vincele at 1:53 PM on July 14, 2011

Make sure that everyone else in the household stays as healthy as possible – eat lots of (washed and scrubbed) veggies and fruit and exercise daily. Do you have the option of handing off your preschooler to family for a few days if he or she starts exhibiting signs of an infection?
posted by halogen at 1:54 PM on July 14, 2011

Don't worry about things like leftovers as long as they are cooled from their cooking temperature quickly, refrigerated at proper temperatures, and eaten within a couple of days.

Segregate the stuff your kid will be bringing home from school. When I worked in a bookstore with a large children's section, I always caught colds after it was my turn to pick up toys and games and re-shelve books - books and papers seem to "keep" germs pretty efficiently, and are awfully hard to wipe down with alcohol.
posted by rtha at 2:08 PM on July 14, 2011

Can you consider not sending the kid to preschool, at least until chemo is over?
posted by mareli at 2:14 PM on July 14, 2011

When I volunteered at a children's hospital, toys had to be washed with a brush in warm soapy water and then dried on a rack after every use. Assume that all toys that aren't currently on that drying rack are covered with saliva, snot and other bodily fluids, and are not to be taken outside the children's room. Soft toys, for reference, were never reusable (i.e. we encouraged kids to take them home or disposed of them, bagging them before ever taking them out of the patient's room).
posted by halogen at 2:22 PM on July 14, 2011

I am not a health care professional. Years ago, my brother was ill, and here's what we did. Clean the fridge really well and kitchen really well to start out. Cook meat to well done, esp. ground meat. Wash or cook veggies. Wash fruits and /or peel them. Be more fussy than usual about food safety and hand washing in the kitchen.

Take off shoes at the door. Wash hands immediately on getting home. Keep some hand sanitizer in the car and at the door; the kids can sanitize hands when they are picked up. Husband gets his own towel & wash cloth and toothbrush is kept in the medicine cabinet.

Kids' friends don't come to visit the house for the duration. Family showers daily.

best wishes for a speedy recovery.
posted by theora55 at 2:31 PM on July 14, 2011 [2 favorites]

When I was going through chemo my docs told me to be careful of dealing with any sort of pet waste... which meant that (awesomely) I didn't have to deal with dog poop for nearly six months. So if you have any pets, your husband should likewise be off the hook for doing any related chores.

I hesitate to mention this, lest it start any sort of argument about vaccinations, but you may want to check with your child's preschool to find out what their policy is about allowing unvaccinated kids, so that you have a heads-up.

Best of luck... glad his prognosis is good.
posted by scody at 3:32 PM on July 14, 2011 [1 favorite]

A high capacity HEPA air filter in each major room he occupies (living room, bedroom) could cut air borne dust and some pathogens. These units completely filter the air in an average 9' x 12' room 5 to 8 times an hour. They do use a fair amount of electrical power to move all that air, and they do generate some white noise doing it, but there is no substitute for high capacity HEPA filtration in clearing indoor room air. Running the units 1 hour in 4 on high setting is probably enough to keep things pretty clean, while minimizing average noise and power usage. Alternatively, you can run them continuously on the "low" setting, but you'll get a less vigorous movement of air into room corners, for somewhat greater overall power use.
posted by paulsc at 4:11 PM on July 14, 2011

Also, if you are using a replaceable bag type vacuum cleaner, look for "micro allergen" or "premium allergen" type bags. These type bags cost a bit more, but they trap a lot of small particle dust that standard bags don't, and although you'll have to change them more frequently than standard bags, because of the extra dust they'll collect, you'll be living with less airborne debris.
posted by paulsc at 4:28 PM on July 14, 2011

Depending on how long the term of the chemo is (three sessions vs. 20), maybe the kids could stay with friends for the second weeks?

Also - if you have cats, don't let your husband clean the litter box.
posted by amtho at 7:08 PM on July 14, 2011

When you are dusting or cleaning or vacuuming, have him stay out of that room while you're doing it and for maybe half an hour afterward, to give all the particles that get disturbed a chance to settle back down out of the air. You might also want to ask his doctors about whether there are certain foods he should avoid during this time, specifically fresh produce. Even if not, make sure to wash any fruits or vegetables really well. If he is thirsty, have him get a fresh glass of water rather than sipping from the same one that's been sitting out for hours -- this is doubly true for any drinks with sugar in them. And seconding the recommendation to move any potted or cut plants outside for the duration. Good luck!
posted by vytae at 10:29 PM on July 14, 2011

Response by poster: Thanks for the input, everyone. There are several issues here that I hadn't though of.

-We have quite a few potted plants, yikes!
-We do have two cats, and he was scooping the litterbox while I was pregnant, but I had taken back that chore a while ago, so I'll continue to do that. I'll also handle any trash and compost duties.
-We have a Dyson vacuum with a HEPA filter already, but I hadn't considered the idea of an air purifier, or the idea that regular dust and such could affect him in this way. I am, um, really not very good about dusting frequently.
-I am handling all the diapers for our younger daughter.
-Both of our girls (3.75 years and 7.5 months) are fully vaccinated, but I will inquire about whether there are any students in her class who have exemptions. I don't know whether they will be able to legally tell me that information, but it's worth a try.
-Not having our elder girl attend school this fall isn't an option for us, however. We have already paid the tuition (a significant amount of money for us) and this school is not like a daycare center in that we would be able to just defer a couple months until this is all over. Not to mention that she is just really...ready to go to school. Good idea to segregate all paper materials that come home with her, though. I am definitely interested in hearing more suggestions of how to mitigate the germiness that comes home with her.
-Unfortunately, it's not really an option for us to send either or both the kids away for any length of time (however much I would love to exercise that option, ha!). We don't have family in the area, nor does that seem like a reasonable request to make of our friends. The doctors said that he will require 6-8 rounds of chemo, and he has completed only one so far. So this situation will last likely until November or December.

Does anyone have any thoughts on the specific questions I had about kitchen cloth and cleaning techniques/materials? I would also appreciate specific responses about what constitutes "fussier than usual" about food safety.

Thanks in advance.
posted by fancyoats at 2:31 PM on July 15, 2011

"... We wipe down our counters daily, but should I be doing it more? What should I be using? Paper towels with bleach instead of our kitchen cloth with soap and water? We have plenty of dishcloths and we currently use at least 4 or 5 fresh cloths every day -- whenever there is a new mess, we get a clean cloth. They are washed in hot water with bleach. Are they clean enough? ..."

This seems a big concern for you. Do your cats ever get up on your kitchen counters? If so, their feet are likely a main mechanism for bacteria transfer, and if they're constantly jumping up, almost no amount of wiping down counters will keep the counters food-service clean. Otherwise, if its just you and the kids touching counters, and food prep, where you wipe 'em down before and after, I wouldn't worry too much about them, beyond what you're currently doing, with the exception of exchanging your washable cloths with throwaway Clorox wipes, to make sure that contamination you wipe up is never unintentionally re-deposited (Clorox wipes aren't strong enough to do much scrubbing, so encourage being thrown away frequently).

You could also consider using a spray that leaves behind an anti-bacterial agent when wiping down your counters, instead of just your kitchen cloths with soap and water, or a straight chlorine bleach solution. Such measures can help with controlling even stubborn bacteria, but may not directly kill viruses; the frequency of wiping, and switching to throwaway wipes or paper towels as your primary wipe (instead of your kitchen cloths) at least during his most immunocompromised week might help most with minimizing viruses.

You can also microwave damp kitchen cloths to heat them hot enough to sterilize them immediately before use. The problem with this is consistency of sterilization, given home kitchen microwaves, and variable dampness in the cloths. A sterilization regime that isn't 100% consistent is only partially effective in disease prevention.

"... I would also appreciate specific responses about what constitutes "fussier than usual" about food safety. ..."

Given the ease and availability of single portion frozen convenience foods of all kinds, good quality canned soups, canned fruits, refrigerated single serving puddings, yogurts, milks, cereals, chips, and such, why don't you just encourage your husband to eat such foods as much as possible during the weeks he's most vulnerable, and cook/store leftovers normally for the rest of the family? You can afford to toss out any partially eaten food he leaves, and there is near zero risk of cross contamination via food prep, dishes, or utensils, if he eats these foods with throwaway plastic utensils and paper/plastic plates and bowls.
posted by paulsc at 7:09 AM on July 16, 2011

We know someone in a similar position who like you, hasn't gotten much useful info about household precautions. Reading between the lines I think there is not a ton of research into this that focuses specifically on home environment, so docs don't have firm evidence based guidelines. Our friends were told to check the LLS - Leukemia and Lymphoma Society - message boards.
posted by LobsterMitten at 11:10 PM on July 16, 2011