Patient Guide

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Food Safety Guidelines

Bacteria, mold, and other organisms commonly found in food are of particular concern to people undergoing chemotherapy, radiation, or a bone marrow or stem cell transplant. These treatments put you at increased risk for infection. By following safe food practices, patients and caregivers can reduce the risk of foodborne illness.

Sources of foodborne illness, or food poisoning, may be the person handling the food, the environment (such as a contaminated work surface), or the food itself. The keys to food safety are to:

If you have any questions regarding food safety and diet guidelines, talk to your dietitian. In addition to these food safety measures, see:

Keep Your Hands and Kitchen Surfaces Clean

Wash your hands frequently with soap and warm, running water using a rubbing motion (friction) for 15 seconds.

  • Wash before and after every step in food preparation, particularly before and after handling raw meat, seafood, and poultry.
  • Wash hands before eating.
  • Wash after using the rest room, handling garbage, or touching pets.
  • Dry hands with a paper towel or cloth hand towel that is changed daily.

Tools for Food Safety

  • Hand soap
  • Clean towels (cloth or paper)
  • Food and refrigerator thermometers
  • Dilute bleach solution for washing countertops, cutting boards, and other items (1/3 cup unscented household bleach with 3-1/3 cups water)

Kitchen Cleanliness

  • Replace dishcloths and dishtowels daily; Launder in the hot cycle of your washing machine.
  • Sanitize sponges daily by soaking for five minutes in a dilute bleach solution; heating in a microwave oven on high for one minute; or running them through the dishwasher.
  • Use liquid dish soap and very warm water when hand-washing dishes, pans, and utensils. You may air-dry dishes instead of towel-drying them.
  • Wash counters, utensils, and can openers with soap and hot water immediately after use. After washing, they can be sanitized using a dilute bleach solution.
  • Keep the refrigerator clean. Clean spills immediately. Wash shelves and doors weekly using a dilute bleach solution.
  • Keep food storage areas clean.
  • Rotate food stock so older items are used first. Check expiration dates. Do not use foods past the expiration dates.
  • Throw away (without tasting) any bulging, leaking, or cracked cans, or those deeply dented in the seam area.
  • Keep appliances free of food particles (including the microwave oven, toaster, can opener, blender, and mixer blades). Blender blades and the bottom ring should be removed from the blender after each use and washed in hot, soapy water.
  • Do not store any food supplies under the sink. Do not store chemicals and cleaning solutions over or near food supplies.

Avoid Cross Contamination

Cross contamination is a big cause of food-borne illness. Follow these tips to avoid it.

  • Use a clean knife for cutting different foods (for example, use different knives for cutting meat, produce, and bread).
  • Use plastic or glass surfaces for cutting raw meat and poultry. However, wooden cutting boards are considered safe if they are used exclusively for raw meat and poultry. Use a different board for cutting other foods, such as produce and bread.
  • Wash cutting boards with hot, soapy water after each use. Then rinse and air-dry or pat dry with fresh paper towels. Nonporous acrylic, plastic, or glass boards and solid wood boards can be washed in a dishwasher. (Laminated boards washed in the dishwasher may crack or split.)
  • Sanitize both wooden and plastic cutting boards with a dilute bleach solution at least once weekly. Sanitize every time the board is used for raw meat, fish, or poultry. Flood the surface with the bleach solution and allow it to stand for at least 2 minutes, then rinse and air-dry or pat dry with fresh paper towels. Alternatively, use a commercial sanitizing agent (such as Clorox Disinfectant Wipes) and follow the directions on the product.
  • Replace worn cutting boards, including boards with cracks or grooves.
  • During food preparation, do not taste the food with the same utensil used for stirring. Use a clean utensil each time you taste food while preparing.
  • In the refrigerator, store raw meat separately from ready-to-eat foods.
  • When grilling, always use a clean plate for the cooked meat.

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Shop Wisely

To reduce your risk of infection, keep foods at safe temperatures, check expiration dates, choose produce and containers in good condition, and avoid certain food items.

  • Shop for shelf-stable items first. (Shelf-stable refers to food products that can be stored at room temperature before opening; the container may require refrigeration after opening.)
  • Select frozen and refrigerated foods last, especially during the summer months.
  • Never leave perishable foods in the car. Refrigerate or freeze them promptly.
  • Check “sell by” and “use by” dates on dairy products, eggs, cereals, canned foods, and other goods. Select only the freshest products.
  • Check packaging dates and “use by” dates on fresh meats, poultry, and seafood. Do not purchase if they are outdated.
  • Do not taste free, unpackaged food samples.
  • Do not use damaged, swollen, rusted, or deeply dented cans. Check that packaged and boxed foods are properly sealed.
  • Select fruits and vegetables that are not moldy, bruised, or damaged. Fresh fruits and vegetables should look fresh. Wilted salad greens may indicate that the product is old and not properly handled.
  • Place meat, poultry, and fish in plastic bags. Ask to have these items placed in separate bags from the fresh produce and ready-to-eat foods when at the checkout stand.

Products to Avoid

  • Avoid unpasteurized juice (unless prepared at home with washed produce).
  • Choose shelf-stable salsa rather than salsas found in the refrigerator section of the grocery store.
  • Avoid unpasteurized milk, yogurt, or cheese, and other unpasteurized milk products, including Mexican-style cheese made from unpasteurized milk (such as queso fresco).
  • Do not use foods with any mold present.
  • Avoid unrefrigerated, cream- and custard-filled pastry products, such as fresh bakery cream pies, éclairs, cream-filled doughnuts, and pastries. Commercial, shelf-stable items such as Danish pastries, Hostess fruit pies, Twinkies and Ding Dongs are allowed. Follow the “use by” date, and store them according to the manufacturer’s guidelines after opening.
  • Avoid foods from “reach-in” or “scoop” bulk food containers. Avoid food from any type of bulk food container if it will not be cooked prior to consumption.
  • Choose eggs that are refrigerated in the store. Do not use cracked eggs. 
  • If a recipe calls for raw eggs in foods that will not be cooked, use pasteurized eggs, liquid pasteurized egg products (such as EggBeaters), or powdered egg whites.

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Handle Foods Safely

Easy ways to keep yourself healthy include handling your food safely. Following these tips will help.

  • Wash the tops of canned foods before opening. Clean the can opener after each use.
  • Throw away eggs with cracked shells.
  • Throw away foods older than their “use by” or expiration dates.
  • Throw away entire food packages or containers with any mold present, including yogurt, cheese, cottage cheese, fruits (especially berries), vegetables, jelly, bread, cereal, and pastry products.
  • Do not feed honey or foods made with honey to children younger than one year of age.

Handle Fruits and Vegetables Safely

All fresh produce (whether organic, natural, or general produce) may carry dangerous bacteria or other organisms that can cause foodborne illness. Bacterial contamination can occur in the fields from the use of natural fertilizers (such as animal manure) or from human contact during produce harvesting or transporting and in the grocery store. The terms “organic” and “natural” refer to growing without the use of chemical fertilizers or pesticides, and they have no relationship to the cleanliness of the produce. The following guidelines will help you handle all raw produce, including organic, organically grown, “natural,” and general produce safely:

  • Refrigerate fruits and vegetables promptly.
  • Do not purchase produce that has been cut at the grocery store (such as melon or cabbage halves). This is particularly true for produce that will not be cooked before eating.
  • Do not eat any type of raw vegetable sprouts (including alfalfa sprouts, clover sprouts, mung bean sprouts, and others) due to high risk of Salmonella and E. coli contamination. Cooked mung bean sprouts are acceptable.
  • Throw away fruits and vegetables that are slimy or show mold.

Wash Produce Carefully

  • Rinse produce thoroughly under clean, running water just before use, including produce that is to be peeled (such as bananas, melons, and oranges) or cooked. Do not wash fruits and vegetables with soaps, detergents, or chlorine bleach solutions. Produce can absorb these cleaning agents.
  • Do not use commercial produce rinses (such as Fit Fruit and Vegetable Spray). They have not been shown to be more effective for removing bacteria than washing under running water.
  • Use a clean vegetable scrubber to scrub produce that has a thick, rough skin or rind (such as cantaloupe or potatoes) or has visible dirt on the surface.
  • Rinse leaves of leafy vegetables (such as lettuce, spinach, and cabbage) individually under running water.
  • Rinse under running water packaged salads, slaw mixes, and other prepared produce, even when marked pre-washed. Using a colander can make this easier. 
  • Check for “use by” dates.

Can Food Safely

  • When preparing home-canned foods, review the processing procedure. Be sure the procedure is appropriate for the acidity of the food, size of the bottle, and elevation above sea level. 
  • Before eating home-canned food, look for mold and leaks. Check seals. 
  • If you suspect a home-canned food may not have been properly processed (for example, if the lid bulges or if the food has any bad odor or unusual characteristics after opening), THROW IT AWAY. 
  • Use home canned foods within one year of canning as chemical changes may occur. 

Keep Foods at Safe Temperatures

Safe food handling includes keeping food at the right temperatures to keep bacteria from growing. This includes the time it takes to get food from the grocery store to your home.

Refrigeration and Thawing

  • Keep the refrigerator temperature between 34°F and 40°F.
  • Keep the freezer temperature no higher than 2°F.
  • Marinate foods in the refrigerator.
  • Never thaw foods on the counter.
  • Thaw meat, fish, or poultry in the refrigerator away from raw fruits and vegetables and other prepared foods. Place on a dish to catch drips.
  • Cook defrosted meat right away; do not refreeze. If you are in a hurry you can thaw meat in the microwave, but the meat must be cooked immediately after thawing.

Leftovers

  • Cool hot foods uncovered in shallow containers in the refrigerator. Cover storage containers after cooling. Make sure that covers seal tightly.
  • Throw away all prepared food after 72 hours, or three days.
  • Date foods placed in the refrigerator to keep track of their age.
  • Never leave perishable food out of the refrigerator for more than two hours. Throw away food left out longer than two hours.
  • Freeze foods that will not be used within two to three days.
  • NEVER TASTE FOOD THAT LOOKS OR SMELLS STRANGE!

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Cook Foods Adequately

  • Cook meat until it is no longer pink and the juices run clear. These are signs that the meat may be cooked to a high-enough temperature. However, the only way to be sure that the meat has been cooked to the proper temperature is to use a food thermometer. (See table below.)
  • Thoroughly heat until steaming (165°F) all hot dogs and ready-to-eat luncheon meats, cold cuts, and deli-style meats before eating.
  • Do not eat raw or lightly cooked eggs or soft-boiled eggs.
  • Do not eat uncooked foods containing raw or undercooked eggs, such as raw cookie dough, cake batter, or salad dressings containing raw or coddled eggs. 
  • Pasteurized eggs and liquid pasteurized egg products (such as EggBeaters) may be used in recipes calling for raw eggs in foods that will not be cooked.
  • Hold food at safe temperatures: Hot food should stay above 140°F.

Proper Thermometer Use

  • Insert the meat thermometer into the middle of the thickest part of the food to test for doneness. The entire part of the stem, from the dimple to the tip, must be inserted into the food. For thin foods, insert the thermometer sideways. (Also, follow the manufacturer’s instructions.)
  • Test a thermometer’s accuracy by putting it into boiling water. It should read 212°F.
  • A refrigerator thermometer should be placed on a shelf toward the back of the refrigerator. It should read 40°F or less.

Recommended Minimum Cooking Temperatures for Meats and Poultry

Product Cooking Temperature

 

Eggs, Egg Dishes and Casseroles Eggs, Egg Dishes and Casseroles

Eggs                                                        Cook until yolk and white are firm
Casseroles, foods containing eggs, custards and egg sauces 160°F

 

Veal, Beef, Pork, Lamb, Rabbit, Goat, Game Veal, Beef, Pork, Lamb, Rabbit, Goat, Game

Whole pieces meat, hot dogs 160°F
Ground veal, beef, lamb, pork, rabbit, goat, game 160°F

 

Poultry (Chicken, Turkey, Duck, Goose) Poultry (Chicken, Turkey, Duck, Goose)

Chicken and turkey: whole bird and dark meat (thigh, wing) 180°F
Breast, roast 170°F
Ground chicken, turkey 165°F
Stuffing (always cook in separate container outside of bird) 165°F

 

Ham Ham

Fresh (raw) 160°F
Pre-cooked (to reheat) 160°F

 

Seafood Seafood

Fin fish (such as salmon, cod, halibut, snapper, sole, bass, trout) Cook until opaque and flakes easily with a fork
Shrimp, lobster, crab Should turn red and flesh should become pearly opaque
Scallops Should turn milk white or opaque and firm
Clams, mussels, oysters Cook until shells open (may be high-risk food for people with low white count or immunosuppressed)

 

Leftovers

Leftovers 165°F
Hot dogs, luncheon meat Steaming hot


Microwave Cooking

  • Microwave cooking can leave cold spots in food where bacteria can survive.  Rotate the dish a quarter turn once or twice during cooking if there is no turntable in the appliance.
  • When heating leftovers, use a lid or vented plastic wrap to cover them.  Stir several times during reheating.  When the food is heated thoroughly (to a minimum of 165°F), cover and let sit for two minutes before serving.

Dine Out Safely

  • Eat early to avoid crowds.
  • Ask that food be prepared fresh in fast-food establishments. (For example, a hamburger should be fresh off the grill, not one that has been sitting under heat lamps.)
  • Ask if fruit juices are pasteurized.
  • Avoid raw fruits and vegetables when dining out.  Eat these items when prepared at home, where you can wash them thoroughly and prepare them safely.
  • Ask for single-serving condiment packages.  Do not use public self-serve condiment containers, including salsa.
  • Avoid salad bars, delicatessens, buffets and smorgasbords, potlucks and sidewalk vendors. 
  • Be sure that utensils are set on a napkin or clean tablecloth or placement, rather than directly on the table.
  • Check the general condition of the restaurant. Are the plates, glasses and utensils clean? Are the restrooms clean and stocked with soap and paper towels? How clean the restaurant looks may tell the amount of care taken while preparing the food.
  • If you want to keep your leftovers, ask the server to bring you a box into which you can transfer the food yourself, rather than having your food transferred into a box in the restaurant kitchen. Be sure to take home and refrigerate the leftovers immediately.

For information on diet during treatment, see: