Q: Is it possible to develop an illness from cleaning up urine?

A: The simple answer is yes. However, there are a number of factors that ultimately determine whether or not there is a chance of developing an illness. The question does not state whether the urine is human or from animals (not to imply that humans are not animals). Before I answer the question, let’s discuss urine in general.

Urine is a fluid that is produced by the kidneys, consisting of water and dissolved substances. It is stored in the bladder until discharged from the body. Urination is the process that allows the body to eliminate certain waste products as a result of the metabolic process. Also it is the primary method for excreting toxins, chemicals and drugs from the body.

When urine leaves the kidneys it is virtually sterile. In the case of healthy adults, the urine is generally safe and is unlikely to cause an infection. If the individual has a kidney or urinary tract infection, the urine is likely to contain bacteria that possibly could cause an infection. Healthy urine from humans can contain up to 1,000 bacteria of various types per milliliter. Unhealthy urine will contain more than 100,000 bacteria per milliliter. (1 ounce = 29.57 milliliters) According to one source, urinary infections can be caused by bacteria, fungi, protozoa or viruses. The most significant bacterial infections include Escherichia coli, Pseudomonas aeruginosa, Proteus vulgaris, Klebsiella pneumoniae, Staphylococcus aureus, Streptococcus pyogenes, and Streptococcus faecalis. The World Bank published a study in 1980 that indicated that there is also the possibility to pass Salmonella, Leptospira and Yersinia bacteria in human urine.

There is also the possibility of developing an infection or disease from animal urine. Leptospirosis and Hantavirus are examples of zoonotic diseases that can develop from contact with contaminated animal urine. A zoonotic disease is one that is caused by an infectious agent and can be transmitted between or shared by animals and humans. Recently there has been considerable concern about Leptospirosis infection following exposure to flood waters contaminated by animal urine.

When there is extensive flooding, a heavy rainfall can facilitate the spread of the microorganisms as the water saturates the ground. If Leptospira or other sewage-related organisms are present, they can be carried by the surface water. Microorganisms can enter the body through a cut, an abrasion, the mucous membranes or by ingestion. The result can lead to an infection. Symptoms range from a mild flu-like illness to an acute life-threatening condition known as Weil’s syndrome. If a restorer were to develop Leptospirosis, he might experience fever, chills, myalgia, nausea, diarrhea, cough, while the most common symptom is reddening of the eye surface. Some infected persons might not develop any symptoms. In severe cases an infected person might experience jaundice, liver failure, kidney damage or respiratory distress. There is no vaccine available to prevent Leptospirosis in the United States.

According to the Centers for Disease Control and Prevention (CDC), the infection can be treated with antibiotics. However, the most effective response is proactive and preventative. The use of appropriate personal protective equipment (PPE) is the best defense against the development of any disease from working in contaminated or potentially contaminated environments. Since the route of exposure for any microorganism can include ingestion, inhalation or dermal exposure, the restorer should wear PPE that protects against all routes of exposure. OSHA requires that employers provide their employees with the necessary PPE to reduce the risk of exposure to chemical, physical or biological hazards (29 CFR 1910.132). The IICRC S500 Standard and Reference Guide for Professional Water Damage Restoration states that:

Employers shall provide dermal and respiratory protection for employees entering a containment area where microbial contamination is present and remediation is being performed. The selection of PPE depends on the anticipated exposure, types of microbial contamination, activities to be completed and potential hazards of chemicals that may be used in the restoration process. Restorers should consult an IEP or other specialized expert, if there is a question regarding PPE selection. (7.3.2)

Notice that the S500 says that Category 2 water (which includes urine) “has the potential to cause discomfort or sickness”

Category 2 - Category 2 water contains significant contamination and has the potential to cause discomfort or sickness if contacted or consumed by humans. Category 2 water can contain potentially unsafe levels of microorganisms or nutrients for microorganisms, as well as other organic or inorganic matter (chemical or biological). Examples of category 2 water can include, but are not limited to: discharge from dishwashers or washing machines; overflows from washing machines; overflows from toilet bowls on the room side of the trap with some urine but no feces; seepage due to hydrostatic pressure; broken aquariums and punctured water beds.

The cleanliness of Category 2 water can deteriorate for many reasons, including but not limited to: contact with building materials, systems, and contents; mixing with soils and other contaminants. Some factors that influence the potential organic and inorganic load in a structure include the age and history of the structure, previous water losses, general housekeeping, and the type of use of the structure and, elapsed time or elevated temperature.

One reason for Category 2 water to degrade into Category 3 water is that human urine contains nitrogen, phosphorous and potassium at a much higher ratio than in commercial fertilizers. Even though healthy urine may not have sufficient bacteria present to be considered contaminated, it can and does have the ability to enhance the growth of other microorganisms.

Without sampling, urine contaminated environments need to be restored as though the urine has the potential to cause disease. It is not dissimilar to the cleanup of blood-contaminated environments. While the blood might not have blood-borne pathogens present, the prudent approach to the cleanup is to consider all blood as contaminated.