When you start chemotherapy, your doctor will likely advise you to be extra vigilant about washing your hands and avoiding people who are sick. That’s because cancer itself can increase your risk for infections, especially when you’re also undergoing cancer treatments like chemo.

Infection-fighting white blood cells are produced in the bone marrow — the blood-making “factory” responsible for producing the cells in your blood. Bone marrow resides inside the large bones in your body, such as your hip and thigh bones. Cancer can spread to the space in your bones, displacing your bone marrow’s healthy cells. As cancer grows in this place, the remaining bone marrow cells may not be able to produce enough white blood cells to fight infections.

Chemotherapy and other cancer treatments also kill the fastest-growing cells throughout your body, including the bone marrow responsible for making your white blood cells. With fewer white blood cells, your body has a harder time fighting off bacteria and viruses.

“Chemotherapy wipes out a person’s immune system so they can’t fight off infections that they may encounter,” says Jessica Geiger, MD, an oncologist at Cleveland Clinic Cancer Center who specializes in head and neck cancer.

Just how long you’ll need to be cautious depends on the type of cancer and your treatment, says Dr. Geiger. Talk to your oncologist to understand when you’re at risk of infection.

Here are nine ways to avoid infections during chemotherapy.

Tips to Reduce Infection Risk During Chemotherapy

1. Wash Your Hands Frequently

“Handwashing is single-handedly the most effective way to reduce infection,” says Geiger, and it’s essential for you and everyone around you to do so regularly when you’re undergoing chemotherapy. Wash your hands every time you prepare food, both before and after; when you eat; and after you use the restroom.

To get your hands clean, wet them and add soap liberally. Scrub for at least 20 seconds, including the backs of your hands, between your fingers, and under your nails. Rinse with water, and air-dry or pat dry with a clean towel.

If soap and water aren’t available, use a hand sanitizer that contains at least 60 percent alcohol, advises the Centers for Disease Control and Prevention. Use enough to completely cover your hands, and rub over all surfaces.

2. Avoid People Who Are Sick

Another top recommendation if you’re undergoing chemotherapy is to avoid people who are sick, Geiger says. That means staying away from places that are likely to be crowded, such as the subway, airplanes, or the childcare center — especially during cold and flu season. “Sometimes it’s unavoidable, but if it’s elective, I recommend pushing it until later,” says Geiger.

Request that family and friends reschedule a visit if they have any symptoms of illness, including a cold. And ask healthy visitors to cover their mouths with their elbows if they sneeze or cough.

3. Check Your Vaccinations

Some vaccines contain live viruses, which can be problematic if you’re on chemotherapy. These include the nasal mist flu vaccine, MMR vaccine, and varicella vaccine, says the American Cancer Society. Most other vaccines contain dead viruses, which are easier for the body to handle.

Oncologists generally recommend that people ensure they’re up to date on their vaccinations, including the seasonal flu shot. If you think you may need a vaccination, be sure to talk to your oncologist.

“I generally recommend that my patients get vaccinated prior to treatment or wait until treatment is over to be on the safe side,” says Geiger.

4. Stay Away From Hot Tubs, Lakes, and Ponds

Hot tubs, freshwater lakes, and ponds are generally off-limits when you’re undergoing chemotherapy, although the risks vary depending on the type of cancer and treatment.

“These are considered high-risk areas for bacteria to thrive, especially warm areas like hot tubs or freshwater ponds,” says Geiger.

Although saltwater pools and the ocean are generally safer, Geiger says it’s best to avoid them as well if you’re on active treatment and your blood counts are low.

5. Don’t Eat Raw or Undercooked Meat

Raw meat, fish, and eggs can contain potentially dangerous levels of illness-causing bacteria, so keep them separate from other foods and cook them to the proper temperature. Store leftovers within two hours of preparation in a refrigerator set to under 40°F. “There’s just no sense in taking unnecessary risks,” says Geiger.

Also talk to your oncologist about fresh fruits and veggies, which can cause foodborne illness; your doctor may recommend avoiding most uncooked produce. Otherwise, wash vegetables and fruits thoroughly under running water before eating.

6. Skip the Mani-Pedi

Accidental tears or cuts on your skin can allow bacteria to enter your bloodstream, which can lead to a potentially dangerous infection, according to the National Cancer Institute. Low platelet counts during chemotherapy also increase the risk for bleeding complications.

“Even minor cuts can be a major complication,” says Geiger. “It could be catastrophic in someone who doesn’t have an immune system due to chemotherapy.”

It’s best to skip manicures and pedicures while you’re on chemotherapy — even if you bring your own tools. Also avoid shaving, or use an electric shaver if you tend to nick yourself.

7. Brush Your Teeth Twice a Day

You’ve heard that you should brush twice a day and floss, but a regular oral hygiene routine is especially important when you’re undergoing chemo. “There’s a lot of natural bacteria in your mouth and GI tract,” says Geiger. Because chemotherapy suppresses your immune system, this bacteria can then increase your risk of infection, according to the Dana-Farber Cancer Institute.

However, your doctor might actually tell you to avoid brushing and flossing if you’re at risk of bleeding gums. Instead, she may recommend a special mouthwash (often water and baking soda) that doesn’t contain alcohol.

8. Practice Impeccable Personal Hygiene

“I don’t think we have to get out the scrub brush and scrub from head to toe or use wet wipes,” says Geiger. But since we do have natural bacteria on our skin, it’s a good idea to shower every day using mild soap and to wipe your genital area meticulously after using the bathroom, she says.

9. Avoid Sharing Glasses or Towels

While Geiger says it’s fine to sleep in the same bed as your partner, it is a good idea to use separate towels, silverware, and glasses to avoid spreading germs.

Tips to Bolster Your Immune System During Chemo

There is no one secret to boosting your immune system during chemo, says Geiger, but you should try to live a generally healthy lifestyle. That includes eating plenty of fruits, vegetables, whole grains, and lean proteins and skipping sweets and processed foods. Geiger says a multivitamin a day is not a bad idea. Still, talk to your oncologist before taking any vitamin or supplement, as some can interfere with your prescribed treatment.

Light to moderate exercise — think yoga, stretching, and walking — may also boost your energy levels, Geiger adds. Talk to your oncologist about the best ways to stay active.

9 Ways to Avoid Infections During Chemo