In Honor of Alon Sugarman,
14 Years Old, Alive and Well

Original Article:

Preparing your Home for the Chemotherapy Patient:
Procedures to Follow and Questions to Ask.

by Barry Sugarman, B.S.ENGR., President, and Dr. Lainie Sugarman, Vice President
The Cure Our Children Foundation

    Many parents ask us how to prepare their home for their child to help ensure that the child does not get an infection or have other problems when they come home and are immune compromised.  We are providing the information on this page as a guide for you, and this is what we used, and it worked very well for us.  As always, you should check with your oncologist to see if additional measures are needed for your particular situation.  Additional measures are usually necessary during and after transplant, and they are not covered here.  Published scientific references which are the sources of the recommendations made in this article are provided at the end of the article.  Here are the items of preparation that we think are important:

1) Surface Cleaning - It is very important to keep all the floors and counter surfaces clean especially in the kitchen and the bathroom.^1,4  A simple disinfectant such as Pine-Sol^® or Lysol^® or another household product that has a disinfection claim on the label should be used regularly.  Use antibacterial wipes on video game controllers, matchbox cars, and other toys between other toy users and the patient.  Vacuum the house regularly using a vacuum with a HEPA filter (High Efficiency Particle Arrestor).¹⁶

2) Hand Washing - Probably the most important thing to be done by both the patient and the family is hand washing.  We recommend adding Hibiclens, a surgical scrub available over-the-counter to each bathroom to be used instead of, or after regular soap and water.  Rinse using Hibiclens like regular soap and wash off.  Hands should be washed for 30 seconds.  One easy way for children to know when 30 seconds is up is to have the child recite sing the alphabet, a, b, c's.  Paper towels should be used to wipe the hands in the bathroom and in the kitchen.^2,4,5,16,17

3) Sick Friends or relatives - During times when the patient has low blood counts, friends or relatives that are sick, or friends or relatives that have family members living with them that are sick should not come over to the house.^16,17

4) No gardening - No chemotherapy patient should be gardening or planting or otherwise contacting soil.  Soil is a huge source of bacteria and mold, which presents an unnecessary danger to the patient.^14,15

5) Remove plants and flowers - All indoor plants and flowers should be removed from the house.  These items tend to shed mold into the air, and can be a source of infection.  Our son loved flowers, so we gave him cloth flowers by his bed side, and we kept them clean.^14,15  It is also especially important not to have cut flowers anywhere in the house because the water in the vase of flowers is known to harbor infectious bacteria, and can evaporate into the air and spread to the patient.²⁷

6) Masks - Masks should be worn by the parent only if the parent is sick, or feels a cold coming on.  Masks are not generally needed unless someone who has to be with the patients has a cold.  Hand washing by the person who has the cold is also essential as described above.^16,17

7) Dishwashing - It is essential that all dishes and eating utensils washed in hot water with soap after eating.  A dishwasher is preferred if possible.  Clean dishes and silverware also can lower the risk of infection during low blood counts.  Alternatively, paper plates, utensils, and napkins may be used.

8) Washing fruits and vegetables - Fresh fruits and vegetables should always be washed and scrubbed in running water.¹⁷  All dirt and other matter should be removed before eating.  All fresh juices should be pasteurized for safety.  Peeled fruit is the safest; apples and oranges should be carefully peeled before eating.  Berries, melons, and peaches are generally a higher risk for mold, and should be inspected very carefully or avoided; canned fruit may be an alternative for these.

9) Mold - Mold can be very dangerous to the chemotherapy patient.^9,10  All mold and sources of mold should be cleaned and/or removed.  All standing water, leaks or other potential mold hazards should be fixed and kept dry.  Numerous studies correlate mold infections with construction, so avoid any construction in the house.^7,8,9

10) Air filter - An air filter is not normally necessary unless you are in a high mold or dust area, or there is another known airborne hazard; however, if you do decide to use an air filter, a HEPA filter is necessary.^6,8,9  They are available at most hardware stores.

11) Pets - Pets should be shampooed and bathed frequently.  Pet litter should be changed frequently, but should not be changed or contacted by the chemotherapy patient.  Areas that house pets should be vacuumed with a HEPA vacuum, and disinfected regularly with a household disinfectant.  Pet snakes, turtles, and lizards are regular carriers of salmonella bacteria, and should not be kept in the house, nor should they come into contact with the patient.^18,19,20

12) Raw Foods - Raw eggs and raw cookie dough are not recommended for eating, and raw eggs should not be added to smoothies that are made.^11,12  All chicken, fish, and meat should be cooked sufficiently so that no portions are raw.¹³  All milk should be pasteurized.

13) Clothes Washing - All clothes should be washed regularly with detergent, and preferably after every wearing, and with warm or hot water.  Commercial laundry facilities should not be used.³

14) Play Areas and Toys - All play area surfaces should be kept clean with surface disinfectants.  All toys, games, videos, DVD's, CD's and other items that the patient comes in contact with should be kept clean with a surface disinfectant spray or wipe before use.  Toys that are shared should be thoroughly cleaned before use in the same manner.  Cloth toys should be wiped down also in the same manner, or preferably washed in a clothes washer and dried before use.¹⁶

15) Outdoor Sandboxes - Patients should not play in outdoor sandboxes including the beach because they are frequently  used by cats, dogs, and other animals as their bathroom to urinate and defecate.  Outdoor sandboxes have been documented to carry numerous diseases passed on by animals such as dog roundworm or cat roundworm (Toxocariasis)²¹, and parasites from Toxoplasma gondii (Toxoplasmosis)²².  These diseases can be very serious for the immune compromised chemotherapy patient.

16) Pools, Hot Tubs, and Jacuzzi-type Whirlpools - We recommend that public pools be avoided due a higher potential for infection.²⁶  If the patient swims in a private pool, any central line should be completely covered with Tegaderm (3M Healthcare Products 800-228-3957) and tape, or another suitable water barrier, and the dressing should be cleaned and changed immediately after swimming.  Patients should not use heated hot tubs or jacuzzi-type whirlpool baths due to the potential of harmful infections from bacteria that include Pseudomonas Aeruginosa²³, Legionella²⁴, Staphylococcus Aureus²⁵ and others.

In summary, the main idea here is to lower the risk of infection.  All of the above steps are steps that we took that were very successful for us.  There may be other risks or problems that are unique to your situation, and you should assess your house and living arrangements with the above ideas in mind.  You should also discuss this with your oncologist and others to help you identify any other potential risks that you might have.  As always, we are available to discuss this with you if you need us.  Just contact us using the contact information at the bottom of this page.

The published references used to  research this article are listed at the end of this page.

...Barry and Lainie Sugarman

And, here are some additional resources for you:

Household Disinfectants:
· Pine-Sol Disinfectant, Phone: 800-227-1860
· LySol Disinfectant, Phone: 888-265-3343


Antibacterial Soap and Wipes:
· Hibiclens from drugstore.com, Phone: 1-800-378-4786
· Dial^® Antibacterial Liquid Hand Soapealthgrades.com, Phone: 877-733-5845
· Wet Ones^® Antibacterial Wipes from Drugstore.com, Phone: 800-378-4786
· SoftSoap Antibacterial Soap, Phone: 800-767-6732 or 703-802-9380; TT/TDD: 703-802-9395
· DrugStore.com, Enter Search Term: Antibacterial Soap, Phone: 800-378-4786
· NetGrocer.com, Enter Search Term: Antibacterial Soap, Phone: 888-638-4762

HEPA Air Filters and Vacuums:
· State of California Air Filter and HEPA filter FAQ, Phone: 916-322-8282, Fax: 916-322-4357
· OverStock.com, Enter HEPA Search Term, Phone: 1-800-989-0135 
· Walmart.com, Enter HEPA Search Term, Phone: 800-966-6546


Cloth/Fabric Flowers:
· Stone Hearth Fabric Roses, Phone: 800-553-1840, Fax: 303-632-9264


Organizations and Associations:

Recommended Sites:
· The Center for Disease Control National Prevention Information Network, Phone: 800-458-5231, FAX 888-282-7681, TTY: 800-243-7012
· Association for Professionals in Infection Control & Epidemiology, Inc. (APIC), Phone: 202-789-1890, Fax: 202-789-1899
· Infectious Diseases Society of America, Phone: 703-299-0200, Fax: 703-299-0204
· Organization for Safety & Asepsis Procedures (OSAP), Phone: 800-298-6727 or 410-571-0003, Fax: 410-571-0028
· Society for Healthcare Epidemiology of America, Inc. (SHEA), Phone: 856-423-0087, Fax: 856-423-3420

Additional Sites:
· American Society for Microbiology, Phone: 202-737-3600, Fax: 202-942-9342
· Certification Board of Infection Control & Epidemiology, Inc. (CBIC), Phone: 202-454-2550, Fax: 202-789-1899
· Community and Hospital Infection Control Association of Canada, Phone: 866-999-7111 or 204-897-5990 , Fax: 204-895-9595
· Hospital Infection Society, UK, Phone: 011-44-1243-788-122, Ext 3548, Fax :011-44-01243-831-631
· Immunization Action Coalition, Phone: 651-647-9009, Fax: 651-647-9131
· Infection Control Nurses Organization, UK, Phone: 011-44-1506-811077, Fax: 011-44-1506-81147
· International Health Care Worker Safety Center, Phone: 434-924-5159, Fax: 434-982-0821
· National Coalition for Adult Immunization & National Foundation for Infectious Diseases, Phone: 301-656-0003, Fax: 301-907-0878
· National Network for Immunization Information, Phone: 877-341-6644, Fax: 703-299-0204
· National Antimicrobial Information Network/Antimicrobial Division of the U.S. EPA Office of Pesticide Programs, Phone: 703-308-0127, Fax: 703-308-6467

Journals:

Recommended Sites:
· CDC's Morbidity and Mortality Weekly Report (MMWR), Phone: 888-232-3228, Fax: 404-639-4198
· PubMed - Healthcare Literature Database/Search Engine, Phone: 888-346-3656 or 301-594-5983

Additional Sites:
· American Journal of Infection Control, Phone: 202-789-1890, Fax: 202-789-1899
· Infection Control & Hospital Epidemiology, Phone: 856-848-1000, Fax: 856-853-5991
· Journal of Hospital Infection, Phone: 800-654-2452 or 407-345-4020, Fax: 407-363-1354

Published Research References:

1) Kagan LJ, Aiello AE, Larson E., J Community Health 2002 Aug;27(4):247-67, The role of the home environment in the transmission of infectious diseases., Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, New York, NY, USA. (Kitchen and bathroom largest source of bacteria.)

2) Fendler EJ, Ali Y, Hammond BS, Lyons MK, Kelley MB, Vowell NA, Am J Infect Control 2002 Jun;30(4):226-33, The impact of alcohol hand sanitizer use on infection rates in an extended care facility. Fendler EJ, Ali Y, Hammond BS, Lyons MK, Kelley MB, Vowell NA., GOJO Industries, Inc., 1 GOJO Plaza, Akron, OH 44311, USA. (Alcohol hand sanitizer can lower infection rates.)

3) Larson E, Gomez Duarte C., Public Health Nurs 2001 Mar-Apr;18(2):116-27, Home hygiene practices and infectious disease symptoms among household members., Columbia University School of Nursing, New York, New York 10032, USA.  ELL23@columbia.edu (No commercial laundry, laundry related to disease transmission.)

4) Rubino JR., Pediatr Infect Dis J 2000 Oct;19(10 Suppl):S123-4, Overview of Lysol scientific studies., Global Surface Care, R&D Support Sciences, Reckitt Benckiser, Montvale, NJ 07645, USA. Joseph.rubino@reckitt.com (When followed, simple hygienic practices such as hand washing and surface disinfection along with proper food handling techniques can have a positive impact on the health of families and individuals in nonmedical settings like homes, day care and long term care facilities.)

5) Guinan M, McGuckin M, Ali Y., Am J Infect Control 2002 Jun;30(4):217-20, The effect of a comprehensive hand washing program on absenteeism in elementary schools., Agnes Irwin School, Rosemont, PA, USA. (Absenteeism data were collected for 3 months. The number of absences was 50.6% lower in the test group (P <.001). The data strongly suggest that a hand hygiene program that combines education and use of a hand sanitizer in the classroom can lower absenteeism and be cost-effective.)

6) Hahn T, Cummings KM, Michalek AM, Lipman BJ, Segal BH, McCarthy PL Jr., Infect Control Hosp Epidemiol 2002 Sep;23(9):525-31, Efficacy of high-efficiency particulate air filtration in preventing aspergillosis in immunocompromised patients with hematologic malignancies., Department of Medicine, Roswell Park Cancer Institute, Buffalo, New York 14263, USA. (HEPA filters are protective for highly immunocompromised patients with hematologic malignancies and are effective at controlling outbreaks due to air contamination with Aspergillus conidia.)

7) Loo VG, Bertrand C, Dixon C, Vitye D, DeSalis B, McLean AP, Brox A, Robson HG., Infect Control Hosp Epidemiol 1996 Jun;17(6):360-4, Control of construction-associated nosocomial aspergillosis in an antiquated hematology unit., Department of Microbiology, Royal Victoria Hospital, Montreal, Quebec, Canada. (Construction, Mold, and Invasive Aspergillosisare related.)

8) Oren I, Haddad N, Finkelstein R, Rowe JM., Am J Hematol 2001 Apr;66(4):257-62, Invasive pulmonary aspergillosis in neutropenic patients during hospital construction: before and after chemoprophylaxis and institution of HEPA filters., Infectious Diseases Unit, Rambam Medical Center and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. I_oren@rambam.health.gov.il (Construction, Mold, Invasive Aspergillosis are related, and HEPA filters help reduce risk)

9) Ellis M., Mol Immunol 2002 May;38(12-13):947-57, Invasive fungal infections: evolving challenges for diagnosis and therapeutics., Faculty of Medicine and Health Sciences and Tawam Hospital, Al Ain, Abu Dhabi, United Arab Emirates. ellis@emirates.net.ae (Invasive fungal infections (IFI) parallel the explosive increase in the immunocompromized patient population, and are characterized by diagnostic difficulties and extreme mortality.)

10) Marr KA, Bowden RA., Transpl Infect Dis 1999 Dec;1(4):237-46, Fungal infections in patients undergoing blood and marrow transplantation., Fred Hutchinson Cancer Research Center, Seattle, Washington, USA. Kmarr@fhcrc.org (Fungal infections are currently a leading cause of infectious morbidity and mortality in patients undergoing allogeneic blood and marrow transplantation (BMT).)

11) Molbak K, Neimann J., Am J Epidemiol 2002 Oct 1;156(7):654-61, Risk factors for sporadic infection with salmonella enteritidis, denmark, 1997-1999., Statens Serum Institut, Copenhagen, Denmark. (Raw eggs source of salmonella.)

12) Hope BK, Baker R, Edel ED, Hogue AT, Schlosser WD, Whiting R, McDowell RM, Morales RA., Risk Anal 2002 Apr;22(2):203-18, An overview of the salmonella enteritidis risk assessment for shell eggs and egg products., U.S. Department of Agriculture, Food Safety and Inspection Service, Washington, DC, USA. hope.bruce@deq.state.or.us (Raw eggs source of salmonella.)

13) Jimenez SM, Salsi MS, Tiburzi MC, Pirovani ME., J Appl Microbiol 2002;93(4):593-8, A comparison between broiler chicken carcasses with and without visible faecal contamination during the slaughtering process on hazard identification of Salmonella spp., Instituto de Tecnologia de Alimentos, Facultad de Ingenieria Quimica, Universidad Nacional del Litoral, Santa Fe, Argentina. (Chicken meat can carry salmonella.)

14) Clare A. Dykewicz, Hospital Infection Control in Hematopoietic Stem Cell Transplant Recipients,  Emerging Infectious Diseases,  Vol. 7, No. 2, Mar–Apr 2001, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. (Aspergillus spp. have been isolated from the soil of potted ornamental plants (e.g., cacti), the surface of dried flower arrangements, and fresh flowers.)

15) Walsh TJ, Dixon DM. Nosocomial aspergillosis: environmental microbiology, hospital epidemiology, diagnosis and treatment. Eur J Epidemiol 1989;5:131-142. (Aspergillus spp. are ubiquitous fungi, commonly occurring in soil, water, and decaying vegetation. Aspergillus spp. have been cultured from unfiltered air, ventilation systems, contaminated dust dislodged during hospital renovation and construction, horizontal surfaces, food, and ornamental plants.)

16) Clare A. Dykewicz, M.D., M.P.H., Harold W. Jaffe, M.D., Director, Division of AIDS, STD, and TB Laboratory Research, National Center for Infectious Diseases, Jonathan E. Kaplan, M.D., Division of AIDS, STD, and TB Laboratory Research, National Center for Infectious Diseases, Division of HIV/AIDS Prevention --- Surveillance and Epidemiology, National Center for HIV, STD, and TB Prevention, Guidelines for Preventing Opportunistic Infections Among  Hematopoietic Stem Cell Transplant Recipients, Recommendations of CDC, the Infectious Disease Society of America, and the American Society of Blood and Marrow Transplantation, Morbidity and Mortality Weekly Report, October 20, 2000, 49 (RR10);1-128, Center for Disease Control and Prevention, http://www.cdc.gov/mmwr/preview/mmwrhtml/rr4910a1.htm (Mask wearing and hand washing reduce risk of infections, avoid close contact with persons with respiratory illnesses (BIII). When close contact is unavoidable, those persons with respiratory illnesses should be encouraged to wash their hands frequently and to wear surgical masks. Food preparers should keep shelves, counter tops, refrigerators, freezers, utensils, sponges, towels, and other kitchen items clean.)

17) Caring for Someone with AIDS at Home, U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, Revised: June 2001, http://www.cdc.gov/hiv/pubs/brochure/careathome.htm (Importance of hand washing, masks, washing of fruit, keeping sick people away when immune system is comprimised).

18) Jafari M, Forsberg J, Gilcher RO, Smith JW, Crutcher JM, McDermott M, Brown BR, George JN., Salmonella sepsis caused by a platelet transfusion from a donor with a pet snake., Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City 73190, USA., N Engl J Med 2002 Oct 3;347(14):1075-8. (Pet snakes can carry Salmonella bacteria).

19) Rodgers GL, Long SS, Smergel E, Dampier C., Salmonella infection associated with a pet lizard in siblings with sickle cell anemia: an avoidable risk., Department of Pediatrics, MCP Hahnemann School of Medicine, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania 19134, USA. gail.rodgers@drexel.edu, J Pediatr Hematol Oncol 2002 Jan;24(1):75-6. (Pet lizards can carry Salmonella bacteria).

20) Geue L, Loschner U., Salmonella enterica in reptiles of German and Austrian origin., Bundesforschungsanstalt fur Viruskrankheiten der Tiere, Institut fur Epidemiologische Diagnostik, Seestr. 55, D-16868 Wusterhausen, Germany. lutz.geue@wus.bfav.de, Vet Microbiol 2002 Jan 3;84(1-2):79-91. (Turtles can carry Salmonella bacteria).

21) Toxocariasis, Author: Sun Huh, MD, PhD, Chairman, Professor, Department of Parasitology, Hallym University College of Medicine, Korea, emedicine.com, July 5, 2002 (Toxocariasis, cat and dog roundworm from Sandboxes)

22) Public Health Watch -- Focus On -- AGRICULTURE, Toxoplasmosis caused by the protozoan parasite Toxoplasma gondii, V-1221, November 2001, Neil W. Dyer, DVM, DACVP Director, NDSU Diagnostic Laboratory, Charles L. Stoltenow, DVM, DACVPM Extension Veterinarian (Cats, Dogs, and Wild Animals defecating in sandboxes can cause Toxoplasmosis).

23) Rolston KV, Bodey GP., Cancer Invest 1992;10(1):43-59, Pseudomonas aeruginosa infection in cancer patients. Department of Medical Specialties, University of Texas M.D. Anderson Cancer Center, Houston. (Hot-tub- or whirlpool-associated folliculitis from Psuedomonas aeruginosa)

24) Fields BS, Haupt T, Davis JP, Arduino MJ, Miller PH, Butler JC., Respiratory Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA., J Infect Dis 2001 Nov 15;184(10):1289-92, Pontiac fever due to Legionella micdadei from a whirlpool spa: possible role of bacterial endotoxin. (Legionella bacteria in Whirlpool Spas).

25) Meldrum R., Food, Water and Environmental Section, Cardiff Public Health Laboratory, PHLS in Wales, Health Park, Cardiff CF14 4XW. richard.meldrum@phls.wales.nhs.uk, Commun Dis Public Health 2001 Sep;4(3):205-8, Survey of Staphylococcus aureus contamination in a hospital's spa and hydrotherapy pools. (Staph infections from spas).

26) MMWR Morb Mortal Wkly Rep 2001 May 25;50(20):410-2, Prevalence of parasites in fecal material from chlorinated swimming pools--United States, 1999. (Public Pool Infections)

27) Rutala, William A., PhD, MPH; David J. Weber, MD, MPH, Water as a Reservoir of Nosocomial Pathogens, Volume 18 (9) * September 1997 * Editorial, Infection Control and Hospital Epidemiology. (Cut Flowers can harbor Infectious Bacteria).

© Copyright, 1998, 1999, 2000, 2001, 2002, 2005
Barry Sugarman, B.S.ENGR., All Rights Reserved.
Phone 310-355-6046, FAX 310-454-9592

URL: http://www.cureourchildren.org

This site last updated on May 22, 2005