SAN DIEGO--The staff at the H. Lee Moffitt Cancer Center in Tampa has initiated new practices that allow immunocompromised patients to eat fresh fruits and vegetables without worrying about bacterial infection, said Linda Rice, RN, OCN, RN III, staff nurse at Moffitt’s Medical Oncology/Hematology unit.
Ms. Rice explained the program and procedures in her podium presentation, "Fresh Fruit for Neutropenics: A Diet With ‘A Peel’," at the 26th Annual Conference of the Oncology Nursing Society (abstract 40).
Multiple Nutritional Challenges
"Oncology patients encounter multiple nutritional challenges," she said. "Therefore, our patients often have difficulty meeting their increased nutritional needs. They have appetite changes, which can include anorexia, nausea, and vomiting, as well as a change in taste, and, of course, neutropenia is often present."
In the past, food that might be a major source of bacterial introduction, such as fresh fruit and raw vegetables, was eliminated from the diet. The risk, Ms. Rice said, was that enterococcus, E coli, pseudomonas, and aspergillus could reside in the food and infect already immunocompromised patients.
"We reviewed our previous practice because the patients continued to tell us they wanted fresh fruit and vegetables, and we wanted to give them a more diverse selection of food, considering their known difficulty meeting nutritional requirements," Ms. Rice said.
A literature review was done, and other oncology centers were contacted for information on their practices. The staff then compiled the information and presented it to the Infectious Disease Department and the bone marrow transplant (BMT) physicians.
The issue of how to wash the fruit and vegetables raised concerns about using products that would leave a bad taste on the food. Thus, a decision was made to use plain water to wash the raw vegetables and fruit. The key, however, is to use running water, not a tub or bath, so that any bacteria will be rinsed away.
To ensure accountability, the Center now uses immunosuppressed diet production worksheets that food service workers sign to verify that special preparation methods are used as outlined, including wearing gloves. All food is fresh and tagged to identify its age. Salads are made fresh daily, no foods are used more than 3 days after they were prepared, and all items are wrapped individually.
The program, which was initiated 2 years ago, has some exceptions. "Mushrooms, being a fungus, are not allowed," Ms. Rice said. "Neither are garnishes."
Ms. Rice said that a complete list of diet guidelines are available for patients and their caregivers (see below). There has been no increase in infection rates reported after the introduction of the new immunosuppressed diet, either from the Bone Marrow Transplant Program or the Infectious Disease Department, and, she said, it has opened up nutritional opportunities for patients.
"With our diet expansion, we have enabled our immunocompromised patients to increase their nutritional intake and better meet their nutritional needs," Ms. Rice said, "while providing a more appealing diet in comparison to our previous neutropenic dietary restrictions. We’ve achieved our greatest goal, patient satisfaction."