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Special Procedures for the Immune-Compromised

Foodborne illness is never pleasant, but it can be especially devastating for anyone with a weakened immune system. Special precautions should be taken to protect anyone who is susceptible to foodborne illness.

Disease-causing microorganisms can be anywhere, even on food that looks good, smells good, and tastes delicious! Following three basic rules can make a real difference in preventing foodborne illness. These simple rules are:

  • Keep food clean.
  • Keep food hot.
  • Keep food cold.

Many people may contribute to the risk of foodborne illness without knowing it by improperly handling foods. Many of the techniques learned over the years may actually be unsafe. Common unsafe food-handling practices include:

  • Thawing food on the kitchen counter.
  • Letting food cool on the counter before refrigerating.
  • Keeping food at room temperature for longer than 2 hours (1 hour on very hot days).
  • Not washing hands adequately before handling food, or between handling different kinds of food.

For general directions on handling food safely, refer to Keep Food Safe It's In Your Hands! Fact Sheet from Delaware Cooperative Extension. Special considerations for immune compromised individuals are described below.

Keep Food Clean

Poor personal hygiene is the cause of many foodborne outbreaks.  Microorganisms are found everywhere on our bodies and can be transferred easily to the foods we prepare. Good hand washing is essential to break the chain of transmission. Using a double hand washing method significantly reduces disease-causing organisms on hands.

The steps include:

  1. Remove jewelry and watch. Wet hands under hot, flowing water.
  2. Apply soap to develop a good lather. Although the Centers for Disease Control warns about unnecessary use of antimicrobial soaps, use of these soaps for the immune-compromised may decrease their risk of foodborne illness.
  3. Scrub for 20 seconds. Use a fingernail brush to eliminate dirt on fingertips and under nails. Be sure to wash backs of hands, thumbs, and lower part of arms.
  4. Rinse hands and brush under hot, flowing water.
  5. As an added precaution, wash hands (without nail brush) and rinse again.
  6. Dry hands and arms with disposable paper towel.

Repeat the above hand-washing procedure after handling different foods (especially raw meat, poultry, or fish), touching animals, using the restroom, or handling garbage.

Under normal circumstances, hot soapy water is sufficient to clean utensils, counters, equipment, and dishcloths. However, when preparing food for individuals with a weakened immune system, using a sanitizing agent adds a safety factor. Items to be sanitized should first be washed with hot soapy water to remove food particles and then rinsed with plain water. To sanitize work surfaces, equipment, and dishcloths, ordinary chlorine bleach works well. Dilute 1 teaspoon of unscented bleach in a quart of cold water. This solution can be used for work surfaces, equipment, and as a soaking solution for dishcloths.

Before eating, wash fresh fruits and vegetables with large amounts of plain cold tap water. Scrub with a brush; do not use soap. Peeling fruits and vegetables and throwing away the outer leaves of leafy vegetables, such as lettuce and cabbage, are other ways to protect against microbial foodborne illness.

Keep Food Hot

Cooking foods thoroughly is one of the best defenses against foodborne illness. Foods for the immune-compromised should be well done. Cooking and reheating foods to an internal temperature of 165° F should destroy all disease-causing microbes.

Take special care when preparing meat and eggs. The immune-compromised individual should avoid raw eggs (even tasting batters that contain raw eggs such as cookie dough), meat, fish (sushi), shellfish, and un-pasteurized (raw) milk or milk products.

Care should also be taken when cooking the above items in the microwave. Because of uneven heating, not all areas of a food may be sufficiently heated to destroy harmful organisms. If microwaving follow directions carefully and as an added precaution cover foods so a moist atmosphere is developed.

Keep Food Cold

Refrigerators should be maintained at 40° F, and preferably colder. Date packages of all leftovers before placing in the refrigerator and store foods no longer than the recommended length of time. Expiration dates should be followed even if the food looks and smells good.

Cooling foods to room temperature before refrigerating is a common food-handling mistake. Some people say that placing hot food in the refrigerator will cause it to sour. This is untrue. In fact, keeping food at room temperature invites disaster. Under ideal temperature conditions (which is room temperature for most bacteria), bacteria divide every 20 minutes.

To cool foods rapidly, place pot containing food in cold ice water. Stirring occasionally further speeds cooling. Dividing large pieces of food or placing food in small, shallow containers are other ways to quickly cool foods. The internal temperature of food should reach 45° F within four hours.

For anyone, the health and economic consequences of eating tainted food is much greater than the investment in the food. This is especially true for the immune-compromised.

Final word--If in doubt, throw it out.



Author: Sue Snider, Ph.D.

Professor/Food Safety and Nutrition Specialist


UD Cooperative Extension

This institution is an equal opportunity provider.

In accordance with Federal law and U.S. Department of Agriculture policy, Cooperative Extension is prohibited from discriminating on the basis of race, color, national origin, sex, age, or disability.