A nurse is providing discharge teaching to a client who has an impaired immune system due to chemotherapy. Which of the following information should the nurse include in the teaching?

Chemotherapy often leads to neutropenia, a significant reduction in neutrophils (white blood cells that fight infection). When a client is immunocompromised, they are at high risk for "opportunistic infections" from bacteria that would not normally harm a healthy person. Discharge teaching focuses on neutropenic precautions, which involve strict hygiene and the elimination of sources of stagnant water or bacteria in the environment. Rationale: A. "Change the water in your drinking glass every 4 hours" is the correct instruction. Stagnant water can quickly become a breeding ground for bacteria. To minimize the risk of ingestion, the client should use fresh water frequently and avoid drinking water that has been sitting out at room temperature for longer than 4 hours. B. Washing a toothbrush in the dishwasher once a month is insufficient. Immunocompromised clients should be taught to wash their toothbrush daily in a dishwasher or to soak it in a bleach solution. Many protocols even recommend replacing the toothbrush weekly or after any sign of illness to prevent oral infections like candidiasis (thrush). C. Clients who are immunocompromised should avoid cleaning litter boxes entirely. Cat feces can carry Toxoplasma gondii, a parasite that causes toxoplasmosis, which can be fatal for those with a weakened immune system. If no one else is available to perform the task, the client must wear gloves and a mask, but the primary recommendation is to delegate this chore. D. While personal hygiene is vital, the standard recommendation is to wash the perineal area (and the rest of the body) at least once daily with a mild, moisturizing soap. Using harsh antimicrobial soap twice daily can lead to skin drying and cracking. In an immunocompromised client, any break in skin integrity (even a small crack from dryness) serves as a portal of entry for bacteria.