# Protective measures and daily life during neutropenia: hand hygiene, visitors, pets, plants, school and swimming

Source: https://onco.cc/protocols/neutropenic-precautions-and-daily-life/  
OnCo record `neutropenic-precautions-and-daily-life` (Protocol). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Clean hands, for everyone, matter most. A 2024 guideline for children with cancer says many old restrictions can go: children can keep pets, go to school even when their white count is low, keep plants and swim, unless they have a PICC line. Still avoid building sites and digging in soil, bath toys that hold water, cleaning pet litter or cages, and ill visitors. Transplant units are stricter.

## Summary

For children with cancer on curative treatment as outpatients (not after stem cell transplant), the Dutch Children's Oncology Group guideline (2024, GRADE, endorsed by the Children's Oncology Group in March 2025) makes hand hygiene for patients, carers and staff a strong good practice statement; recommends school or kindergarten attendance irrespective of neutropenia unless a classmate has a serious contagious disease such as varicella (strong, very low); suggests keeping domestic pets (weak, very low) but not letting children clean litter boxes or cages (weak, expert); suggests swimming irrespective of neutropenia (weak, very low) but not with a non-tunnelled line such as a PICC (strong, expert); recommends against reservoir bath toys (strong, very low) and public warm bubble baths (weak); suggests against chlorhexidine bathing or wipes (weak, very low); allows indoor plants (strong, expert); and, following ASCO/IDSA, recommends avoiding prolonged contact with environments high in fungal spores such as construction, demolition, gardening or digging (strong). It advises against crowded places and public transport with neutropenia during viral seasons (weak, expert).

For HCT recipients the CDC/IDSA/ASBMT guideline (2009) is stricter: no plants or flowers in hospital rooms (DIII), avoid gardening, soil and plants while immunosuppressed (CIII), avoid construction areas, screen visitors and keep symptomatic visitors away (BIII), vaccinate VZV-susceptible contacts (AIII), and do not ask patients to part with pets but avoid reptiles, chicks, exotic and young or ill animals, with someone else changing cat litter.

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: neutropenic precautions; reverse barrier nursing; protective isolation; safe living during chemotherapy; social restrictions for children with cancer; pets during chemotherapy; gardening during chemotherapy; school during chemotherapy
- Tags: protocol; neutropenic-precautions; paediatric; safe-living

## Connected records

- protocols: [Antifungal prophylaxis for people at high risk of invasive fungal infection](https://onco.cc/protocols/antifungal-prophylaxis-in-haematology/), [Central line maintenance bundle: preventing bloodstream infection after insertion](https://onco.cc/protocols/central-line-maintenance-bundle/), [Food safety during cancer treatment and the evidence against neutropenic diets](https://onco.cc/protocols/food-safety-and-neutropenic-diet/), [Hand hygiene in cancer care: staff, patients, families and visitors](https://onco.cc/protocols/hand-hygiene-in-cancer-care/)
- cancers: [Childhood cancers (all types)](https://onco.cc/cancers/childhood-cancers/)
- fronts: [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- technologies: [Allogeneic stem cell transplantation](https://onco.cc/technologies/allogeneic-hsct/), [Peripherally inserted central catheters (PICC lines)](https://onco.cc/technologies/picc-lines/)
- companies: [Children's Oncology Group (COG)](https://onco.cc/companies/childrens-oncology-group/)
- institutions: [American Society of Clinical Oncology (ASCO)](https://onco.cc/institutions/asco/)
- terms: [Febrile neutropenia](https://onco.cc/terms/febrile-neutropenia/), [Neutropenia](https://onco.cc/terms/neutropenia/), [Thrombocytopenia](https://onco.cc/terms/thrombocytopenia/)

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