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Nutrition and daily life

Food safety: four simple rules

During treatment immunity is weakened, so germs carried by food are more dangerous. Food safety rests on four rules: clean, separate, cook and chill. This section sums up the neutropenic eating rules from “Handwashing: the simplest protection” and “Eggs and dairy: safe choices”.

Last updated: ~1 min read
Soap, two boards, a thermometer, a fridge.
Figure 1.Four rules — Food safety: four simple rules

01Short answer

Clean: wash hands with soap before eating and cooking, and keep surfaces and dishes clean. Separate: keep raw meat, poultry, fish and eggs away from ready-to-eat food, with a separate board. Cook: cook meat, poultry and eggs thoroughly; a thermometer is the most reliable check. Chill: refrigerate cooked food within 2 hours, eat leftovers within 1–2 days and reheat until steaming. Avoid unpasteurised milk, raw eggs, raw or undercooked meat and fish, and sprouts.

02Simple explanation

Clean.

Separate.

Cook thoroughly.

Chill within 2 hours.

03Scientific explanation

WHO Five Keys: cleanliness, separation, proper cooking and temperature control are the basis of preventing foodborne infection.

ESPEN: enough energy and protein matter for preventing weight and muscle loss in people with cancer, and nutritional status should be assessed regularly.

NCI: practical eating tips exist for treatment side effects such as nausea, taste changes and mouth sores.

04What happens in the body?

Who needs it most?

Neutropenia, transplant and steroid treatment; your team will tell you your own rules.

Separate boards
Figure 2.Separate boards — Food safety: four simple rules

Eating out

Avoid buffets, street food and salad bars with raw items.

A thermometer in cooked chicken.
Figure 3.A thermometer — Food safety: four simple rules

Dietitian

If you are losing weight, have no appetite or need a special diet, ask to see the hospital dietitian.

Food safety

Food-safety rules for neutropenia (see “Handwashing: the simplest protection” and “Eggs and dairy: safe choices”) apply at every stage.

05Nutrition: four steps

Assess, swap the risky, cook safely, eat regularly.

Assess — Weight and appetite.1AssessWeight and appetite.
Swap — A safe choice.2SwapA safe choice.
Cook — Hot throughout.3CookHot throughout.
Eat regularly — Small portions.4Eat regularlySmall portions.
StrengthEnergy.
ProteinFor muscle.
SafetyFood rules.

06Key points at a glance

TopicIn brief
Who needs it most?Neutropenia, transplant and steroid treatment; your team will tell you your own rules.
Eating outAvoid buffets, street food and salad bars with raw items.
DietitianIf you are losing weight, have no appetite or need a special diet, ask to see the hospital dietitian.
Food safetyFood-safety rules for neutropenia (see “Handwashing: the simplest protection” and “Eggs and dairy: safe choices”) apply at every stage.

07Key terms

Cross-contamination
Germs passing from raw to ready-to-eat food.
Pasteurisation
Heat treatment that kills germs.
Dietitian
A nutrition specialist.
Protein
A nutrient for repairing muscles and tissues.
Neutropenia
Low neutrophils.

08Key points

  • Four rules.
  • The 2-hour rule.
  • Avoid raw and unpasteurised.
  • A diet is not a treatment.
  • Talk to a dietitian.

09Frequently asked questions

How long do these rules apply?

Your team will say; after transplant it may be longer.

How do I wash fruit and vegetables?

Thoroughly under running water; see “Meat and poultry: safe cooking and temperatures”.

Can a special diet cure leukemia?

No. Good nutrition helps you cope with treatment, but it does not cure.

10Questions for your doctor

Take these questions to your appointment. The ones you save are collected on the “My questions” page and stay on this device only.

  1. How long do these rules apply?

  2. How do I wash fruit and vegetables?

  3. Can a special diet cure leukemia?

My questions

12Sources

  1. WHO. Five Keys to Safer Food
  2. National Cancer Institute. Eating Hints: Before, During, and After Cancer Treatment
  3. ESPEN. ESPEN practical guideline: Clinical Nutrition in cancer (2021)
  4. Leukemia & Lymphoma Society. Food and Nutrition
  5. World Health Organization. Healthy diet fact sheet
  6. U.S. FDA. Talking About Juice Safety: What You Need to Know
  7. IDDSI. Framework
  8. FDA. Refrigerator Thermometers
  9. National Cancer Institute (NCI). Complementary and Alternative Medicine (CAM)
  10. National Cancer Institute (NCI). Oral Complications of Chemotherapy and Head/Neck Radiation (PDQ®) – Patient Version
Medical disclaimerThis information is for educational purposes only and does not replace medical advice.
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