Always immediately report any signs or symptoms of infection, like fever or swelling, to your doctor.

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1 Food Safety If you eat food contaminated by germs, you can get foodborne illness (also called food poisoning ), which can be serious or even fatal. Safe food-handling practices can help reduce your risk of foodborne illness. Food safety is especially important if you have cancer. A Word of Caution Always immediately report any signs or symptoms of infection, like fever or swelling, to your doctor. Cancer and Your Immune System Cancer and some cancer treatments can weaken your immune system and leave you at increased risk for infection when you are exposed to germs from foods or other sources. To find out if your immune system is weakened, your doctor may take a blood sample to check your absolute neutrophil count (also referred to as ANC ). Neutrophils are a type of white blood cell, and when your ANC is low, your risk for infection is great. Normally, a person s ANC is higher than 2,000/mm³. People with ANC below 500/mm³ are at the highest risk of infection. If your ANC drops too low, your chemotherapy may be stopped until your ANC increases to more than 1,000/mm³. 1

2 If you have been told you have a low white blood cell count or neutropenia (low neutrophil count), take extra care to follow the tips in this handout for safe food preparation. Tips for Safe Food Preparation Always scrub your hands with soap and water (warm or cold) for at least 20 seconds before and after preparing food and before eating. Thoroughly wash fresh fruits and vegetables. Reserve a cutting board to use exclusively for preparing raw meat, poultry, and fish. Use other boards for slicing cooked meat, poultry, and fish; for preparing raw fruits and vegetables; and for cutting ready-to-eat foods like bread or cheese. To be sure you know which board is which, consider buying different color boards for each type of food. After a cutting board touches raw meat, poultry, or fish, never use it for other foods unless it is cleaned first. Wash the board with hot soapy water and rinse well. Then sanitize it with a solution of 1 tablespoon bleach and 1 gallon of water. Cover the board with the bleach solution and let it stand for several minutes. Then rinse the board with clear water and air dry or pat dry with clean paper towels. Nonporous acrylic, plastic, or glass boards and solid wood boards can also be safely washed in the dishwasher. Thaw foods in the refrigerator or microwave. Do not thaw foods at room temperature or in water. Cook foods immediately after thawing. Eat only well-cooked meats, poultry, and fish. Avoid raw, rare, and undercooked foods. 2

3 Use a cooking thermometer to check temperatures and ensure that foods are cooked thoroughly. Red meats (beef, pork, lamb, and veal) should reach an internal temperature of 145ºF. Ground beef and poultry should reach at least 165ºF. Whole or pieces of poultry should reach 165ºF. Casseroles and leftovers should reach 165ºF. Once prepared, keep hot foods hot (above 140ºF) and cold foods cold (below 40ºF). To limit the risk of germs that can make you sick, refrigerate leftover food within 2 hours of cooking. If the room or air temperature is higher than 90ºF, do not leave cooked food out for longer than 1 hour. Throw away food that is left out longer. Discard leftovers if they are not eaten within 24 hours. Eat eggs only if they are thoroughly cooked. Use frozen pasteurized eggs or powdered egg whites instead of raw eggs in recipes such as eggnog, caesar salad dressing, and meringues. Do not taste cookie dough, cake Quick Tip: Herbal Supplements batter, or other uncooked foods made with raw eggs. Like foods, herbal nutritional Check the use by or best by supplements can be contaminated date on packages. Do not buy with bacteria or other substances or use foods that are past these that can make you sick. To avoid dates. this risk, do not take any Do not buy or use cans of food supplements unless your health that are dented, bulging, rusted, care team says they are safe for or leaking. you. 3

4 Throw away foods that have visible spots of mold. Removing mold spots does not make the food safe. Avoid buying foods from self-serve bulk containers or bins as you cannot guarantee the cleanliness or age of these foods. Tips for Eating Out To limit exposure to germs when in public, avoid crowded restaurants. Ask that food be prepared fresh for you. Avoid buffets, smorgasbords, deli counters, potlucks, salad bars, food trucks, and sidewalk vendors. Avoid eating condiments, salsa, or dips served in bowls that many people share. Also avoid public self-serve condiment containers. Choose singleserving condiment packets instead. Making Safer Food Choices Use the following food lists to limit your chances of eating unsafe food that could make you sick. Avoid all uncooked (raw) foods, all undercooked foods, and meals made with ingredients listed in the category. 4

5 High-Protein Foods Well-cooked bacon, beef, chicken, fish, ham, hot dogs, lamb, pork, sausage, and veal Canned fish Well-cooked pasteurized eggs or egg custard Cream cheese Cottage cheese Processed cheeses Pasteurized yogurt Cooked, homemade, canned, dehydrated, or frozen soups Plain peanut butter packaged in a sealed container Meat or fish salads with raw vegetables Raw fish and shellfish, such as oysters Miso Sushi (especially when made with raw fish) Pickled fish Raw or rare meats, such as steak tartare Any game meats Lunch meat or hot dogs (unless first heated to steaming) Raw or soft-cooked eggs (including over-easy, poached, soft-boiled, and sunny-side up eggs) Products made with raw eggs, including caesar salad dressing, homemade eggnog made with uncooked eggs, and raw cookie dough Cold, uncooked soups Raw or roasted nuts Fresh blue or Roquefort cheeses Brie, Camembert, queso blanco fresco, and other raw milk or unpasteurized cheeses 5

6 Grain Foods All breads, bagels, muffins, rolls, and cereals made without dried fruit, nuts, or seeds Crackers French toast and pancakes Noodles and pasta Rice Macaroni or pasta salad made with raw vegetables Breads or cereals made with dried fruits, nuts, or seeds Cereals or grains from a bulk bin Fruits and Vegetables Peeled bananas, citrus fruits, melons, and other thick-skinned fruits (choose fruits free of blemishes) Peeled apples Canned fruits Cooked dried fruits Well-cooked fresh, frozen, or canned vegetables All other fresh or dried fruits; raw vegetables Sprouts Fresh herbs Salads from delicatessens Fresh salsa Beverages Processed fruit juice Pasteurized milk Instant breakfast Soft drinks Coffee Tea Commercial liquid nutritional supplements Fresh-squeezed fruit juice Unpasteurized fruit juice or cider Well water, unless it is tested yearly and found to be free from coliform bacteria Unpasteurized beer and wine Cold-brewed tea and maté tea 6

7 Desserts and Snacks Fruit pies Cakes and cookies without nuts Flavored gelatin Commercial ice cream and sherbet Popsicles and other commercially made frozen fruit pops Homemade milkshakes Packaged pretzels or chips Noncommercial (homemade) ice cream, sherbet, or frozen ice pops Soft-serve yogurt or ice cream from a machine Unbaked cookie dough Cream puffs Miscellaneous Foods Butter and margarine Cooked gravies Mayonnaise, salad dressing, and vegetable oils Salt Herbs, pepper, spices, or honey if added to foods during the cooking process Sugar Jam, jelly, and preserves Syrup, molasses Mustard and ketchup Candy and chocolate Pickles, relish, and olives Nondairy creamer Salad dressings made with raw eggs, blue cheese, or other high-risk foods Herbs, pepper, spices, or unpasteurized honey added after cooking Raw honey Brewer s yeast if uncooked 7

8 Food-Safety Websites Ask Karen: Answers to frequently asked food-safety questions by experts from the U.S. Department of Agriculture. FoodSafety.gov: Gateway to federal government information on food-safety topics. Home Food Safety: Provides information about food poisoning and safe food-handling. Partnership for Food Safety Education: Educational materials on food safety for families. 8