General Precautions

On this Page:

• General Infection Precautions
• Precautions Inside Your Home
• Precautions Outside Your Home

You play an important role in the success of your recovery after transplant. Although you will be seen as an outpatient at Dana-Farber for your follow-up care, you should take an active part in your care and keep in touch with your care team if you have any questions or experience any problems.

In this section, you will find information on:

• General infection precautions (hand hygiene, masks, personal hygiene, mouth care, etc.)
• Precautions in your home (visitors, home cleaning, laundry, pet care)
• Precautions outside your home (outdoor activities, shopping, going to public places, dining out, travel, return to work)

Follow these guidelines for 100 days after your stem cell infusion (Day 0) unless noted or directed otherwise by your care team. Speak with your care team about any specific questions you have.  

You are at highest risk of infection during the first year post-transplant. It can take 12 to 18 months for your immune system to recover from your transplant. Your immune system is your body’s infection-fighting system. The best way to prevent infection is to prevent germs from entering your body in the first place.  The most common ways germs enter your body are through your:

• Skin (touching things, wounds)
• Respiratory tract (breathing)
• Gastrointestinal (GI) tract (eating)

You can help reduce your exposure to germs by maintaining good hygiene practices.

Hand Hygiene

One of the best ways to prevent infection is hand hygiene. Hand hygiene includes washing your hands (with soap and water) and hand sanitizer (using an alcohol-based hand rub such as Purell®). Wash your hands frequently (and have family/friends do so as well) with soap and warm water. Carry a small bottle of hand sanitizer (such as Purell®) to make hand sanitizing easy wherever you go.

Handwashing: Wash your hands with soap and water:

• When hands have visible soiling (you can see the thing that has come in contact with your hand)
• Before eating or preparing food
• After using the bathroom
• After touching a pet
• After you sneeze or cough
• If you are around others who are sneezing or coughing
• Before touching your eyes, nose, and/or mouth

Reference: How to Handwash (PDF)

Handrubbing: Use hand sanitizer:

• No visible soiling
• After you come into contact with things other than yourself
• Other people
• Objects outside your own environment (Elevator buttons, handrails, car doors)

Reference: How to Handrub (PDF)

Gloves

Gloves work as a barrier for your hands. Gloves are only effective if they are clean. Once your gloves are dirty, remove them, use hand sanitizer, and replace with a new pair of gloves if needed. Do not eat while wearing gloves and avoid touching your eyes, nose, or your mouth.  Wash your hands when you take off your gloves.  

Wear gloves when you are:

• In places that are exposed to many people
• Touching things that have likely been touched by many people.  
• Traveling to and from Dana-Farber Cancer Institute (especially if using Uber® or Lyft®)  
• Handling anything high risk (e.g., changing a dirty diaper)

Carry clean gloves with you to use in case you come in contact with someone who is ill or has been exposed to an infection, or if they become dirty or wet. Replace your gloves if they become soiled or wet, and after each use.

Respiratory Hygiene

Many infections can happen through breathing in germs from other people or your surrounding environment. Germs spread by coughing and sneezing are examples.  Construction sites or places that are damp are another risk because mold/fungus can be carried in the air.  

The best way to prevent the spread of respiratory infections is by:

• Avoiding crowds of people
• Avoiding anyone who is or may be sick, or is high risk of being sick
  • Do not bring a sick child into your bed.  
  • Avoid settings where you are likely to come in contact with people who are sick or ill (shopping malls, supermarkets, and enclosed spaces).
  • Avoid people who have been ill within the last few days.
• Staying away from construction areas

Masks

Avoiding people who are sick or public places is the best way to prevent the spread of infection, but if you cannot avoid it, wear a clean, surgical or simple mask to reduce your risk to exposure. Like gloves, the mask only works if it is clean. If the mask gets soiled or wet, replace it with a new one. Carry a clean mask with you in case you need to replace one that becomes dirty or wet.  

You should wear a mask when you are:

• Traveling to and from the clinic and in public areas of the clinic
• Out in public and there is a risk of contact with many people
• In all enclosed (indoor) public places
• At areas of construction or dusty areas
• Damp or moldy areas
• Walking outdoors and passing areas where lawns are being mowed or past a construction site where dust and dirt are blown.

Others around you should wear a mask if they have:

• An active cough or sneezing
• A recent respiratory infection, cold, or flu
• Allergies that cause a runny nose or cough

Gastrointestinal Hygiene

Gastrointestinal hygiene includes safe food handling, preparation, and intake. Foodborne illness can be reduced significantly by following these guidelines.  

• Wash hands with soap and water before touching any food or eating.
• Start with a clean cooking area
• Prepare raw meat or poultry on a separate dish away from other food. Cook meat thoroughly.    
• Wash all produce under warm water before cooking or eating (even thick-skinned fruit).
• Keep cold food cold and warm food warm.
• Cook food thoroughly (no medium or rare meat, no runny eggs, no raw fish).
• See the “Eating Safely at Home After Stem Cell Transplant” booklet for more information.

High-Risk Activities

Activities or situations that can put you at high risk of infection include:

• Crowds of people  
• Professional sporting events, grocery stores, shopping malls, gyms, large gatherings, parties, or events
• Sick people
• Infants and young children
• Construction areas  
• Damp or moldy areas (basements, garages)  
• Animals
• Farm animals, exotic animals, stray animals

Personal Hygiene

• Toiletry items: Always use your own clean towel, washcloth, soap, toothbrush, and toothpaste. Do NOT share these or other toiletries with family or friends.  
• Bathing: Take a bath or shower every day. Wash and dry your head, face, underarms completely. If daily showers are not possible, wash at a sink or use a basin. Avoid very hot water and use only small amounts of very mild soap.
• Hygiene products: Throw away any personal hygiene products from before your transplant (including hairbrush, comb, toothbrush, makeup, deodorant, etc.), and buy new products.
• Make-up/Creams/Lotions: Replace makeup, creams, lotions, etc. with new products. Use the same brand you used before transplant but buy new products.
  • Do not share these items with anyone.  
  • Apply eye makeup with special care because your lashes and tears may not yet be effective in protecting your eyes.
  • Watch for any skin changes after using these products and notify your care team of any rashes or changes.
• Skin Checks: Check your skin daily for rashes or changes. Use a mirror or have someone check your shoulders and back. New skin rashes or skin changes may indicate infection or graft-versus-host-disease. Report any new findings or worsening conditions to your care team immediately. Your care team can provide treatment if necessary.
• Shaving: Nicks and cuts caused by shaving can become sites of infection or bleeding. Shave with an electric razor until your platelet count is higher than 20,000, and your neutrophil count and ANC is over 500. If irritations occur, clean the area with soap and water and apply a small bandage or piece of gauze.
• Contact Lenses: Talk with your care team before wearing contact lenses again. When you begin wearing them again, your eyes may be dry and irritated. New lens fittings may be necessary, or you may need a new prescription. Tell your care team right away if you have any pain in or on the eye.

Skin Care

It is common to have sensitive skin after your transplant. Following a skin care routine and understanding how your treatment may affect your skin can help protect your skin.

Sun Protection

Avoid sun exposure. After you’ve had chemotherapy or radiation therapy, your skin becomes sensitive to sunlight. Common post-transplant medications, such as Bactrim and Voriconazole, also increase your skin’s sensitivity to the sun. Exposure can cause skin reactions, serious burns, and can increase your risk of skin cancer. Whenever possible, stay in the shade and follow these sun protection guidelines:

• Avoid being outside or in direct sunlight when the sun’s rays are strongest, from 10 a.m. to 4 p.m., without protective clothing and/or sunscreen.
• Cover as much skin as possible with light-colored clothing and a hat with a wide (about 4 inches) brim. Several organizations sell sun-protective clothing designed to block ultraviolet rays.  
• Use sunscreen with a sun protection factor (SPF) of at least 30 and apply it every morning.  
  • Apply to all exposed areas, paying special attention to your face, ears, back of neck, hands, and feet.  
  • Use a mineral-based sunscreen. Look for this description on the label.  
  • Reapply sunscreen every two to three hours or if you’ve sweat heavily.  
• When using high SPF sunscreen, you may want to supplement your diet with vitamin D3/cholecalciferol. Speak with your care team about taking a vitamin D supplement.
• Use a lip balm with sunblock, to protect your lips.
• Wear sunglasses with UVA/UVB protection.
• Do not use tanning booths.
• Be aware of sun exposure from a sun roof or other open window.  

Dry Skin

Dry skin is common after transplant. These tips can help:  

• Use moisturizer. Different types of moisturizer have varying levels of soothing ingredients. Ointments are the most hydrating, then creams, then lotions.  
  • Use ointments or creams if you have severely dry skin.
  • Choose products with limited additives and no fragrance. This helps reduce irritation or chance of skin allergy.
• To help break down dry skin buildup, use products containing urea (10-40%), lactic acid (5-15%), or ammonium lactate.  

Make-up/Creams/Lotions  

Replace makeup, creams, lotions, etc. with new products. Use the same brand you used before transplant but buy new products.

• Do not share these items with anyone.  
• Apply eye makeup with special care because your lashes and tears may not yet be effective in protecting your eyes.  
• Watch for any skin changes after using these products and notify your care team of any rashes or changes.

Recognizing Signs of Skin Cancer

Patients who have had stem cell transplantation are at increased risk for skin cancer. Follow these guidelines to recognize and prevent skin cancer:

• Check your skin daily for rashes or changes
• Check your skin monthly for new, changing, bleeding, and non-healing spots. Lesions that are growing, bleeding, ulcerated, symptomatic, or non-healing should be evaluated.
• Use a mirror or have someone check your shoulders and back.  
• Use the ABCDE rule for identifying potentially concerning changes in moles
  • Asymmetry: One half of the spot does not match the other half.
  • Border: The edges of the spot are irregular or blurred.
  • Color: The spot is various shades of the same color or multiple colors.
  • Diameter: The spot is larger than ¼ inch (6mm), or the size of a pencil eraser.
  • Evolution: The spot looks different from other spots and is changing in size, color, and shape.  

Recognizing Signs of Skin GVHD

One of the most common complications after an allogeneic transplant is graft-versus-host disease (GVHD). GVHD happens when your donor’s stem cells see your body’s cells as something foreign and attack them. It may occur early (acute) or late (chronic) after the transplant.

Acute GVHD usually occurs within the first 100 days after your transplant, and chronic GVHD (cGVHD) may occur later. Both conditions can affect the skin, as well as other systems of the body.  

The symptoms of GVHD may be mild or severe.  

The skin is the most common site of acute GVHD. Skin GVHD usually starts as a rash. It can be pink, red, or purple in color and can be flat, raised, or both. The rash may be itchy or painful or you may not feel it at all and, in some areas, may start peeling. If you notice any changes in your skin, tell your care team so they can closely monitor these changes.

Chronic GHVD of the skin can look like acute GVHD. Skin can also become swollen, irritated and/or tight. Your skin may become dry or bumpy. The pigment in your skin can change and either lose color or become darker in color.

Management and treatment of these symptoms is controlled with medication. The treatment process for GVHD can be long and recovery can be slow.

Find more information on GVHD and signs, symptoms, and other systems this condition affects.

Mouth Care

Maintaining a good dental care routine will help prevent infection as you recover from your transplant. One of the most important things to remember is to be gentle when brushing or flossing. Your platelet count may still be low as you recover from your transplant, which may cause your gums to bleed a little in the beginning. Follow these guidelines and in the comprehensive guide to help you maintain a healthy mouth. Tell your care team if you develop any soreness or pain in your mouth.

Going to the Dentist

If you have dental problems at any time during your recovery, consult your care team about seeing your dentist. Try to schedule your appointment at a time when the dentist has few patients (for example, early in the morning) to avoid contact with people who may have infections or may be sick.

You should make a dental appointment for a routine dental examination generally six to 12 months after your transplant. At your visit, you should have bite wing x-rays taken. This is especially important if the pre-transplant dental evaluation showed that you needed elective procedures that were not performed prior to the transplant, or if you have dry mouth. After this initial visit, see your dentist regularly (i.e., every six months).  

Tell your dentist about your medical condition and that you have received a stem cell/bone marrow transplant. They can contact your oncologist and/or primary care physician as necessary.

Dry Mouth

If you have cGVHD, your mouth may become very dry. This makes you more likely to develop cavities or a mouth infection called thrush. Often, the dryness will lessen over time. The following steps may help provide oral comfort.

• Stay hydrated. Always keep drinking water nearby.
• Use sugar-free gum to stimulate the production of saliva. Sugar-free hard candies are also ok if you are careful. These candies develop sharp edges and may cut the inside of your mouth and gums.
• Consider using over the counter dry mouth rinses, sprays and gels.
• Ask your doctor for a prescription for saliva-stimulating medications (pilocarpine and cevimeline). You can request a prescription for this from your care team.  
• Apply petroleum jelly (such as Vaseline) to dry lips.
• Use prescription fluoride toothpaste, gel and/or rinse every night. You can request a prescription for this from your care team.
• Visit your dentist every 6 months so any cavities can be treated immediately.

Mouth Infections

One of the most common infections in the mouth after transplantation is yeast infection, also known as thrush. This appears as white and sometimes red patches in the mouth, which cause soreness.  

Another common infection is caused by the herpes simplex virus, the cause of cold sores around the lips. These can occur inside your mouth and resemble canker sores.  

These conditions are treatable. If you see red or white patches in your mouth or develop any mouth sores, contact your care team, who will diagnose your condition and prescribe a treatment.

Graft-Versus-Host Disease (GVHD) and Allogeneic Transplant

One of the most common complications after an allogeneic transplant is graft-versus-host disease (GVHD). GVHD is caused when your immune system recognizes your donor's immune system as something foreign. It may occur early (acute) or late (chronic) after the transplant.

Usually, acute GVHD occurs within the first 100 days after your transplant. Acute GVHD can affect the skin, gastrointestinal tract, and liver. Chronic GVHD (cGVHD) may occur later. It affects the same systems as acute GVHD, but may also affect the eyes, mouth, lungs, joints, and vagina. The symptoms of GVHD may be mild or severe.

Management and treatment of these symptoms is controlled with medication. The treatment process for GVHD is long and recovery is slow.

If you experience any of the following symptoms, call a member of your care team:  

• Rash
• Skin changes, including hypersensitivity, pigmentation, or thickening or crusty lesions
• Loss of joint mobility
• Difficulty swallowing, nausea, vomiting, or diarrhea
• Shortness of breath
• Excessive dryness, pain, sores, or burning mouth
• Burning in the eyes, blurring, photophobia (sensitivity to light), or “gritty feeling”
• Frequent, watery stools that may be painful, diarrhea (with or without cramping)
• Yellowing of the skin or eyes
• Significant vaginal dryness, pain, or narrowing of the vaginal canal

Pneumonia (and other lung problems)

Because of your risk of developing pneumonia (or other lung infections) after transplant, you will start to take preventive medicine early in your treatment and continue to take this medication for at least one year after transplant. Despite taking medication, you may still develop pneumonia. Smoking or vaping of marijuana or tobacco products can also cause a life-threatening fungal infection. It is therefore extremely important to be completely honest and straightforward with your care team about any smoking.

If you experience any of the following symptoms, call a member of your transplant team:

• Fever
• Shortness of breath during your normal activities
• Coughing

Follow these guidelines for 100 days after your stem cell infusion (Day 0) unless noted or directed otherwise by your care team. Speak with your care team about any specific questions you have.

Visitors

• Limit the number of visitors to your home to reduce your risk for infection.
• Avoid close contact with anyone who is not feeling well or who has a respiratory illness.  
• Visitors should be healthy.  
• Visitors should wash their hands immediately upon entering your home.  
• Be sure that no other member of their household is sick.  
• Speak with your care team for guidelines specifically for you.  
• Your care team will advise you when it is safe to have regular visitors into your home.

Home Cleaning

Guidelines for cleaning your home after transplant are below. You should not do this cleaning yourself, since it may expose you to germs or fungus. Your caregiver should help with the cleaning tasks or help find someone who can provide support.  

If you stay at a short-term housing location contracted with Dana-Farber, housekeeping staff should not enter your room for daily cleaning. Make arrangements with the facility to discard/pick up linens and to borrow a vacuum cleaner for periodic cleaning. It is a good idea to have Lysol wipes available for spot cleaning counters and other surfaces as needed.  

Daily cleaning

• Clean the shower stall, bathtub, toilet, and sink each day for the first month after your transplant to prevent the growth of bacteria (mold and mildew), fungi, and viruses.
• If you are using a shared bathroom, your caregiver should clean the fixtures, sink, toilet, and doorknobs after every use.

Tip! Keep disinfectant wipes in the bathroom to make daily cleaning easy for your caregiver.

Weekly cleaning  

• Vacuum all rooms.
• Dust all rooms.
• Do a thorough cleaning of bathroom(s) and kitchen.

Laundry

• Use the warm water cycle.  
• Wash all new clothes before you wear them.
• Always use the same detergent. This will help reduce skin rashes, a common problem during and after transplant.
• If there is a baby in the house using cloth diapers, wash diapers separately from all other laundry. You should not handle dirty diapers.  
• If using a laundromat or central laundry area, wipe the drum with disinfectant wipes (Lysol or other) and make sure there is no visible mildew prior to using.

Plants

• Remove plants (live and fake) from the rooms you will be using.  
• Do not handle or re-pot any plants in the house.  
• Silk or dried flower arrangements should not have dried mosses as a base.  
• Dust silk or dried flower arrangements regularly.  

Cleaning Reminders

• You should not be doing the cleaning.
• You should not be in a room when it is being cleaned.  
• Wait at least 30 minutes before entering a room that has just been cleaned to allow dust and strong smells to settle.  
• Focus on the rooms you will be using.  
• Do not go into areas that are likely to be damp (like the cellar, attic, and/or garage) and have increased mold (fungus or bacteria).
• If your basement is well-ventilated and has been “finished,” you may spend time in it.  
• Avoid contact with all chemicals, including paints, aerosols, cleaning fluids, paint thinners, strippers, solvents, etc.; they can cause nausea and trouble breathing.

Pet Care

While pets can be a great source of comfort and companionship during recovery from transplant, they can also put you at risk of infection due to your reduced immunity.  

General Pet Care Guidelines

• Wash your hands thoroughly after handling or petting your pet.
• Do not pick up pet feces or litter boxes. Someone else should do this for you.
• Do not allow animals on your bed.
• Keep pets up-to-date on all vaccinations.
• Stay away from animals with diarrhea, rashes, mange, hair loss, or fungal infections.  
• Call your care team if you are scratched or bitten by any pet or animal.
• Follow the guidelines outlined by your care team.

Pet-related exposures

If your pet gets sick and develops diarrhea, have it seen by a veterinarian. Ask the veterinarian to examine your pet’s fecal sample for cryptosporidium, salmonella, and campylobacter. These can cause bacterial disease which can be harmful to immune-compromised patients. Contact your care team if any of these sample results are positive.

Cats

Cat ownership can bring risks to stem cell transplant patients, due to the potential for exposure to toxoplasmosis (if the cat goes outdoors), cat-scratch fever, and intestinal infections. Unless cats are always kept indoors, it is preferable to board or temporarily rehome them for one year after a stem cell transplant.  

• To reduce the risk of toxoplasmosis (a common infection in cats that can transfer to humans), always keep cats indoors and do not feed cats raw or undercooked meat.  
• To reduce the risk of Bartonella infection, maintain flea control.  
• Testing cats for toxoplasmosis or Bartonella infection is not recommended.

Litter boxes:

• Litter boxes should be cleaned daily by your caregiver or other member of your household.  
• Do not change the cat litter yourself.  
• Keep litter boxes in rooms that you do not use.

Scratches and bites:  

• Avoid activities that may result in cat scratches or bites.  
• If you are scratched or bitten:
  • Wash the area right away.  
  • Do not allow cats to lick your cut or wound.
  • Contact your care team immediately.

Dogs

• Avoid contact with dog urine or feces. Someone else should pick up your dog’s feces.
• Dogs should not sleep in your bed.  
• Avoid close contact, especially near your face.  
• Do not allow dogs to lick your face or wounds.  
• Groom your dog regularly.  
• Wash your hands thoroughly after handling your dog.  
• Avoid activities that may result in scratches or bites. If you are scratched or bitten:
  • Wash the area right away.  
  • Do not allow cats to lick your cut or wound.
  • Contact your care team immediately.

Birds: We recommend that you do not have birds as pets after a stem cell transplant. This increases your exposure to bacteria and fungi (from the droppings in their cages, etc.) and puts you at high risk of infection.

Reptiles: Avoid contact with reptiles (e.g., snakes, lizards, iguanas, and turtles) to reduce the risk of salmonellosis.  

Tropical fish: Wear gloves when cleaning tropical fish aquariums to reduce the risk of infection with Mycobacterium marinum. Someone else should clean these aquariums.

Exotic pets: Avoid contact with exotic pets (e.g., monkeys or other primates).

Ferrets: Avoid ferrets because they can contract and transmit influenza.

Barns and barnyard animals: Avoid direct contact with livestock. Do not enter barns, corrals, pens, coops, and other areas where animals are kept. These areas are contaminated with manure and nearly impossible to keep completely clean.  

Discuss any concerns or specific pet care questions with your care team.

Follow these guidelines for 100 days after your stem cell infusion (Day 0) unless noted or directed otherwise by your care team. Speak with your care team about any specific questions you have.

Outdoor Activities

We encourage you to go outside, take walks, and exercise. Below are some safety guidelines.  

Swimming

• Swimming in a private pool or the ocean is permitted.
  • Wear water or beach shoes to protect yourself from cuts  
  • Avoid swimming pools used by children or people with open wounds.
  • Do not swim if your central line is still in place.  
• Do not swim in a lake or pond for at least 100 days after your stem cell infusion. Check with your care team before doing so.
• Do not use a Jacuzzi or hot tub for at least 100 days after your stem cell infusion. Check with your care team before doing so.
• Do not swim if you have an external central line (PICC or Hickman).  

Yard work

• Avoid yard work that may expose you to bacteria or fungus until your care team advises that it is safe. In general, you should avoid the following activities for at least one year after your transplant:
  • Mowing the lawn
  • Raking leaves
  • Chopping wood
  • Gardening
• Once you have been told it is ok to resume some of these activities, wear gardening gloves.

Sun exposure

Avoid sun exposure. After you’ve had chemotherapy or radiation therapy, your skin becomes sensitive to sunlight. Exposure can cause skin reactions, serious burns, and can increase your risk of skin cancer. Whenever possible, stay in the shade and follow these sun protection guidelines:

• Avoid being outside or in direct sunlight when the sun’s rays are strongest, from 10 a.m. to 4 p.m., without protective clothing and/or sunscreen.
• Cover as much skin as possible with light-colored clothing and a hat with a wide (about 4 inches) brim. Several organizations sell sun-protective clothing designed to block ultraviolet rays.  
• Use sunscreen with a sun protection factor (SPF) of at least 30 and apply it every morning.  
  • Apply to all exposed areas, paying special attention to your face, ears, back of neck, hands, and feet.  
  • Use a mineral-based sunscreen. Look for this description on the label.  
  • Reapply sunscreen every two to three hours or if you’ve sweat heavily.  
• When using high SPF sunscreen, you may want to supplement your diet with vitamin D3/cholecalciferol. Speak with your care team about taking a vitamin D supplement.
• Use a lip balm with sunblock, to protect your lips.
• Wear sunglasses with UVA/UVB protection.
• Do not use tanning booths.
• Be aware of sun exposure from a sun roof or other open window.

Shopping and/or Going to Public Places

Do not go shopping (indoor or outdoor) or enter public buildings unless absolutely necessary. Your care team will tell you when it is safe to do so. If you need to go to public places or places where you may be exposed to crowds, take the following precautions.

• Wash your hands often and thoroughly.
• Avoid touching handrails and doorknobs.  
• Wear gloves if touching things touched by many people (e.g. elevator buttons).  
• Avoid crowds.  
• Wear a facemask if you cannot avoid contact with people.
• Avoid contact with people, especially those who are sick or have a cold.
• Reference the “Eating Safely at Home After Transplant” booklet for guidelines on dining outside of your home once your care team has said it is ok to do so.

Dining Out

Your transplant physician will tell you when it is safe for you to dine out at a restaurant.  

Travel

Ask your care team when you can travel on public modes of transportation, such as buses, trains, planes, etc. Traveling in a car is allowed but be very careful when using ridesharing services such as Uber or Lyft. Wear a mask and gloves while in someone else’s car and wash your hands thoroughly after riding in someone else’s car.

Return to Work

Discuss with your care team when you may be able to return to work. This will depend on the nature of your job and how you are feeling.