Preventing infections at home during treatment — infection precautions every parent needs to know

Soap and water for at least 20 seconds remains the most reliably effective measure for removing bacteria and viruses from hands. During chemotherapy, handwashing applies not just to your child but to every adult and sibling in the household. Hands should be washed before meals, after using the toilet, after contact with animals, before and after dressing changes or central-line care, after returning from any public space, and after sneezing, coughing, or blowing the nose. Where soap and water are not available, alcohol-based hand sanitiser with at least 60% alcohol content is a useful substitute — but soap and water are always preferred when hands are visibly dirty or after certain exposures such as contact with faeces. The habit of handwashing before touching your child should become second nature for every visitor as well. A small sign on the front door reminding visitors to clean their hands before entering is not an overreaction — it is a practical, normal part of home infection control during active treatment.

Food-borne bacteria that cause mild illness in a healthy person can cause a severe, life-threatening infection in a child whose neutrophil count is low. Standard food-safety guidance for children on chemotherapy includes avoiding raw or undercooked meat, poultry, fish, and eggs in any form — including raw egg in batters, runny yolks, and sushi or sashimi. Unpasteurised dairy products should be avoided: raw milk, soft cheeses made from unpasteurised milk, and unprocessed paneer from unverified sources. Unwashed raw fruits and vegetables with soft or broken skin carry a higher bacterial load — washing thoroughly, peeling, or cooking is recommended. Foods from buffets, roadside stalls, or catering settings where temperature control cannot be confirmed should be avoided entirely during low-count periods. Preparing food at home with clean hands, on clean surfaces, and using separate chopping boards for raw and cooked food substantially reduces risk. When in doubt about whether a specific food is safe, ask your CION nutritionist — the team can give you a personalised food guide based on your child's current treatment phase.

Crowded indoor spaces — shopping centres, public transport, places of worship, cinemas — concentrate respiratory viruses and bacteria in the air and on surfaces. During the nadir window of each chemotherapy cycle, your oncologist may advise keeping your child away from such spaces. This is temporary and specific to the low-count period; it is not a permanent lifestyle restriction for the full duration of treatment. More important than avoiding all public spaces is avoiding anyone who is currently ill — a household member with a cold, a relative with chickenpox, a classmate with influenza. Some viruses, such as varicella (chickenpox), can cause an extremely severe illness in an immunocompromised child and should trigger immediate contact with your oncology team if exposure occurs. If a sibling gets sick, try to limit close contact with your child on chemotherapy, encourage the sibling to wash hands frequently, and inform your oncologist. You deserve clear, specific guidance on which situations require caution and which do not — bring your questions to your 45-minute consultation.

Many children receiving chemotherapy have a central venous catheter (CVC), peripherally inserted central catheter (PICC), or implanted port to make treatment administration easier and less distressing. These devices provide a direct entry point into the bloodstream, which means that bacteria introduced at the catheter site can reach the bloodstream very quickly — a complication called catheter-related bloodstream infection (CRBSI) that requires emergency treatment. At home, the most important measures are keeping the dressing over the catheter clean, dry, and intact; never touching the catheter insertion site or the needleless connector with unwashed hands; inspecting the site daily for redness, swelling, warmth, or discharge; and contacting your oncology team immediately if the dressing falls off or the site looks abnormal. Your CION team will train you in the specific dressing-change and flushing protocol for your child's device before discharge, and will provide written instructions. Follow that protocol exactly — do not improvise with different supplies or skip steps. If you are unsure about any aspect of catheter care, call the team rather than waiting until the next scheduled appointment.

A child on chemotherapy does not need to live in a sterile environment — that is neither possible nor necessary. But a few specific household practices significantly reduce the environmental burden of organisms that could cause infection. Clean bathrooms and kitchen surfaces regularly with standard household disinfectants. Replace damp sponges or cloths frequently, as they harbour bacteria. Ensure drinking water comes from a reliable, treated source — boiled and cooled water or sealed packaged water is recommended when the safety of tap water is uncertain. Mould and construction dust can carry fungal spores, particularly Aspergillus, which can cause serious lung infections in immunocompromised children. If any room in the home has visible mould, or if building work is underway nearby, discuss this with your oncologist — they may advise relocating your child to a different part of the house or temporarily staying elsewhere during renovation dust exposure. Fresh flowers and potted plants in the soil of indoor plants can also carry fungi; your team may advise keeping these out of your child's room during treatment.

Pets are an important source of comfort for children during treatment, and most families do not need to remove a pet from the home. What changes is how contact is managed. Dogs and cats should be kept away from the child's face, not allowed to lick wounds, port sites, or skin breaks, and should be regularly dewormed, treated for fleas, and kept up to date with veterinary care. Litter boxes, bird cages, and fish tanks carry specific organisms — including Toxoplasma in cat litter and Salmonella in reptile faeces — that can cause serious illness in children with low immunity. These should be cleaned by another adult, not by the child or a primary carer who then handles food or dressing changes. Reptiles (lizards, snakes, turtles) carry Salmonella reliably and close contact with these animals is generally not recommended during active chemotherapy. If you have concerns about a specific pet, raise them at your next CION consultation — the team can give tailored advice based on your child's current immunity level.

Intact skin and mucous membranes are the body's first physical barrier against bacteria and fungi. Chemotherapy can affect both. Mucositis — soreness and ulceration of the mouth and throat lining — is a common side effect that creates an entry point for organisms into the bloodstream. A gentle oral hygiene routine, as advised by your oncology team, helps keep the mouth as healthy as possible during this phase. Moisturising skin and lips regularly prevents cracking, which can also allow bacteria to enter. Your child should avoid activities with a high risk of cuts or skin breaks during low-count periods — vigorous play that risks grazing, handling sharp objects unsupervised, or activities in environments with contaminated soil such as gardening. Minor cuts that do occur should be cleaned promptly with clean water, covered with a clean dressing, and monitored for signs of infection — increasing redness, warmth, swelling, or discharge. Any wound that looks infected in a child on chemotherapy should be reported to the oncology team the same day, not managed at home with over-the-counter antiseptics alone.