Learning About Preventing Foodborne Illnesses After a Bone Marrow Transplant

Foodborne illness, or food poisoning, is illness from eating food that is contaminated. The food may have harmful bacteria, parasites, or viruses. Or it may have poisons (toxins). Food poisoning mainly happens when food isn't cooked, handled, or stored safely.

Foodborne illness causes symptoms that may start within minutes of eating or show up weeks later. Symptoms can include nausea, vomiting, diarrhea, and fever. Because these symptoms can feel like the flu, many people may not realize they are sick from harmful substances in food.

Anyone can get a foodborne illness. But some people are at greater risk for more serious illness or even death from one. People who have weakened immune systems face a high risk of serious illness. This includes people who have had a transplant, such a bone marrow transplant.

It's important to protect yourself as much as possible after a bone marrow transplant. One way to do that is to take extra care when preparing food.

• Scrub your hands with soap and clean water for at least 20 seconds. Dry them with a clean towel before, during, and after meal prep.
• Consider using paper towels to clean surfaces. If you use cloth towels, wash them often using the hot-water cycle.
• Wash and sanitize your cutting boards, utensils, dishes, and food containers with hot, soapy water.
• Wash and gently rub fruits and vegetables under clean, running water. Do this even if you plan to peel them. Use a clean vegetable brush to scrub firm vegetables such as melons and cucumbers. Remove and throw away the outer leaves of a head of lettuce or cabbage.
• Dry all fruits and vegetables with paper towels or an unused towel to reduce any bacteria that may still be present.
• Do not rinse raw meat. Water can splatter and spread bacteria.
• Always clean the lids of canned foods before you open them.

• Use separate cutting boards, plates, and utensils for raw and cooked foods.
• Separate raw meat, poultry, seafood, and eggs from other foods in your grocery cart.
• Thaw frozen meat in a drip-free container in your refrigerator away from other raw or unprepared food.
• Never place cooked food on a plate that has previously held raw meat, poultry, seafood, or eggs unless you’ve already cleaned that plate with hot, soapy water.

• Poultry: 165°F
• Pork, egg dishes, and ground beef: 160°F
• Steak, fish, and roasts: 145°F

Keep your refrigerator temperature at 40°F or below.

• Refrigerate perishable foods within 2 hours.
• Thaw frozen food safely in your refrigerator, in cold water, or in the microwave. Never thaw foods on the counter.

Certain foods and drinks can increase the risk of foodborne illness after a bone marrow transplant. So it’s important to be careful what you eat and how you eat it. Talk to your transplant team or a dietitian for recommendations specific to you. Your care team will tell you how long you need to follow these precautions.

You can eat:

• Food that is not past its sell-by date.
• Fully cooked eggs from shells without cracks.
• Homemade chicken and tuna salad.
• Homemade smoothies and milkshakes made using pasteurized dairy and juice products.
• Meat, fish, and poultry cooked to the right internal temperature, confirmed with a thermometer before eating it.
• Tap water, bottled water, or well water that has been pre-tested for bacteria.
• Packaged meats and hotdogs that are cooked until steaming hot.
• Pasteurized dairy products (including milk and cheese) and juice.
• Pasteurized honey.
• Pasteurized ice cream from cartons (never soft serve).
• Single-serving snack foods (not large, sharable bags).
• Thoroughly washed and peeled fruits and vegetables.
• Cooked sprouts (including alfalfa and bean) and mushrooms.

There are foods you should not eat after having a bone marrow transplant. These foods and drinks have added infection risks.

You should never eat:

• All food with raw, undercooked, or damaged eggs, including raw cookie dough, soft-boiled eggs, and Caesar salad dressing.
• Deli counter meats, cold lunch meats, and uncooked or undercooked hot dogs.
• Fountain drinks, soft-serve ice cream, and all milkshakes that are not made at home with safe ingredients.
• Ice from restaurants or unknown water sources.
• Pre-made salads (egg, ham, chicken, tuna, pasta, and potato salads) from grocery stores or delis.
• Raw sprouts (including alfalfa and bean) and mushrooms.
• Raw or undercooked meat, fish, and poultry, including ceviche, sashimi, smoked or pickled seafood, and sushi.
• Unpasteurized cheeses and cheeses made with mold.
• Unpasteurized milk and juice.
• Unwashed and blemished fruits and vegetables.

Ask your doctor when you can start eating at restaurants. Extra care is always required. Choose freshly cooked foods from trusted restaurants.

Things to do every time you dine out:

• Wash your hands before eating.
• Ask how your food will be prepared and if it contains raw eggs, meat, or fish. If you order meat, ask for it to be cooked well done.
• Order water or any other drink with no ice.
• Ask that your meal be served without any fresh garnishes on your plate or in your drink, including lemon slices or parsley.
• Place your fork, knife, and spoon on your plate at all times. Never place any of them directly onto the table throughout your meal.
• Wash your hands again after eating.
• Store any leftovers in small containers and refrigerate them within 2 hours of dining.

Things to avoid doing every time you eat out:

• Do not eat food that has been sitting under warming lights (a common practice in fast food restaurants).
• Do not eat food that is not served hot.
• Never have a drink with ice.
• Never reheat leftovers more than once.
• Never share food or drinks with other people. Do not bite from the same sandwich, use the same utensil, or drink from the same cup or water bottle.
• Skip all buffets, salad bars, and smorgasbords.
• Throw away any leftovers that have been left out for more than 2 hours.
• Throw away all refrigerated leftovers that are more than 3 days old.