Neutropenia occurs when there is a decrease in white blood cells. White blood cells are the bodies main defense in fighting off infections. Neutropenia often occurs after chemotherapy. Neutropenic Precautions are used with patient/residents with an absolute neutrophil count (ANC) of ≤ 500 neutrophils/mcl OR ≤ 1000 neutrophils/mcl and a predicted decline to ≤ 500 neutrophils/mcl over the next 48 hours. To calculate an ANC (% neutrophils + % bands) x WBC / 100.
Neutropenic Precautions include:
- Place the resident in a private room
- Notify a provider of a Temperature > 38.0 C (100.4 degrees F) and/or complaints of chills or rigors
- Perform frequent assessments for signs of infection to include oral temperatures every four hours
- Oral care should occur at least 3 times/day
- Residents should bathe or be bathed daily
- Prevent trauma to the resident’s skin and mucosal membranes:
- Provide meticulous care for all indwelling devices
- Consider risk-benefit ratio for invasive procedures
- Change all water pitchers, denture cups and nebulizers at least daily
- Use electric razors for shaving
- Use a soft toothbrush for frequent oral care
- Protect skin from cuts and burns
- Immediately cleanse and treat any wound that breaks the skin
- Prevent pressure sores
- Prevent constipation
- Avoid rectal manipulation, suppositories, enemas and/or disimpaction.
- Residents should avoid contact with fresh flowers, dried flowers, plants, and animals
- Offer vaccinations
Provide resident education on prevention measures to include:
- Reporting signs and symptoms of infection
- Maintaining personal hygiene including bathing daily
- Frequent hand hygiene
- Avoiding activities that compromise skin integrity
- Frequent oral care and assessment
- Cleaning perineal area front to back
- Avoiding sick people
- Avoiding contact with people who have been vaccinated with a live vaccine with in the past 30 days
- Not sharing food utensils
- Not eating uncooked or undercooked meat, seafood or eggs
- Not eating unwashed fruits or vegetables
- Safe food handling with storage and serving
- Not providing direct animal care
- Not providing direct or indirect care of reptiles, fish and birds
- Avoiding exposures to fresh or dried plants
- Avoiding construction, renovation sites and recently plowed fields.
CDC: Information for Health care Providers >
CDC: Preventing Infections in Cancer Patients: My Pocket Guide >