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A. Appropriate environment

Neutropenia alone is not a sufficient indication for hospitalization; the exposure to antibiotic-resistant nosocomial organisms would put the patient at additional risk. If the patient is afebrile and has no other evident medical problems, he or she should stay out of the hospital, but careful attention should be given to total body (especially oral) and environmental hygiene.

When hospitalization is necessary, place the patient in a private room or with another patient who has no active infection. The patient need not be restricted to the room, but must avoid contact with patients who have active infections.

3. Hospital staff, families, and visitors should wash their hands carefully before and after contact with the patient.

B.     Hygiene

1.     Dietary precautions

In view of the lack of evidence that dietary manipulation reduces the incidence of serious infection, the patient may eat a regular diet. The improvement in nutritional intake may compensate for any increased exposure to food-related organisms. Some prudent modifications to consider are:

a.     Have the patient avoid raw fruits and vegetables (especially salads).

b.     Have the patient avoid processed meats.

c.     Thoroughly wash the lids of canned foods and beverages with antiseptic soap and hot water before opening.

2.     Cleanliness

a.     Have the patient bathe and shampoo daily.

b.     Have the patient and all who come in contact with the patient wash their hands with antiseptic soap.

c.     Pay meticulous attention to skin, and practice asepsis

with Betadine or a comparable agent before venipuncture or finger prick.

Dental hygiene

Catheters (in blood vessels, urethra, nose, and elsewhere)

a.     Use catheters only when absolutely necessary.

b.     Use meticulous care during dressing changes, flushing, and connecting.

c.     Change peripheral intravenous (IV) lines at least every 4 days.

C.     Activities

The patient can attend school when the absolute neutrophil count (ANC) is > 200/mL and likely to increase.

D.     Protection of the anal-rectal mucosa

Prevent constipation with age-appropriate diet and, if necessary, a stool softener [(e.g., sodium docusate, 1-3 mg/kg/dayPO)].

Avoid rectal suppositories to minimize the chance of fissures and proctitis.

Do not insert thermometers into the rectum.