Health Consequences from Exposure to Urine: Is it possible to develop an illness from cleaning up urine?
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, the heavy rainfall facilitates the spread of the micro-organisms as the water saturates the ground. If Leptospira or other sewage related organisms are present they can be carried by the surface water. Micro-organisms 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, they might experience fever, chills, myalgia, nausea, diarrhea, cough, and 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 micro-organisms. 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.
—Jim Holland
Carpet Cleaning and Pre-existing Conditions: Our company primarily does carpet cleaning. Occasionally we handle very small water losses. Sometimes, while on a carpet cleaning job, I’ve discovered...
Carpet Cleaning and Mold: Carpet Cleaning and Pre-existing Conditions
Q.) Our company primarily does carpet cleaning. Occasionally we handle very small water losses. Sometimes, while on a carpet cleaning job, I've discovered that the property had a previous water loss that was not professionally dried, or that may have been contaminated with sewage or mold. We would normally turn these jobs down, but what do we do when we find out about them after we have begun work? Is there anything in any of the Standards that addresses this problem?
A.) Every company should develop procedures for dealing appropriately with a contaminated building. These procedures should be developed by company management and perhaps in consultation with the company’s attorney. Apparently, your company has already developed at least an informal policy of turning down mold or contaminated water losses.
Unfortunately, property owners do not always disclose actual or potential contamination prior to starting work. In many cases, the customer may be unaware of the presence of the contamination. Your attorney may be able to add language to your work authorization that gives you some protection in this situation.
Technicians can also contribute to minimizing these kinds of problems by taking appropriate steps on each job site to determine if there are indicators that the structure may be contaminated. For instance, before each carpet cleaning job starts, the customer should be asked about any unusual odors, stains or moisture problems. The answers to these questions will help to determine whether or not there are possible conditions that might complicate the cleaning process. A secondary benefit to asking these questions is that you can offer to solve these problems in the cleaning process either as part of the process or at an additional charge.
Any information received from the customer should be documented on the work order or in the customer file. Even a response that there are no unusual conditions should be noted. If it is later discovered that contaminants were present when you cleaned the carpet, this note will show that you made appropriate attempts to determine whether contaminants were present, but were not provided with accurate information by the client. Your records will help demonstrate that you behaved as a reasonable and prudent person would.
Prior to the carpet cleaning, you probably perform a visual inspection for urine and other stains, general condition and type, traffic areas, filtration soiling, as well as other relevant factors. The conditions you find during this inspection affect your decisions about the cleaning procedures that you will use. While performing this routine pre-cleaning inspection, technicians should also be looking for indicators of possible contamination, including obvious odors, water staining (rings), wet areas and any other conditions that point to the possibility of a present or past moisture problem. If such conditions are found, further inquiry of your client might be appropriate. Adding these activities to the inspection that you are already performing should take little, if any, additional time.
For your routine carpet cleaning work, I recommend that your technicians be familiar with and follow the Institute of Inspection, Cleaning and Restoration Certification (IICRC) S100 Standard and Reference Guide for Professional On-location Cleaning of Installed Textile Floor Covering Materials. Since you occasionally perform water damage restoration services, technicians should also be familiar with and follow the IICRC S500 Standard and Reference Guide for Professional Water Damage Restoration. These documents cover the procedures that should be used as part of your routine work practices. If improperly done, both carpet cleaning and routine water damage restoration services can result in microbial amplification (bacteria and mold), possibly creating a contaminated environment. The standards described in the preceding paragraph will help you understand the procedures necessary to prevent this from happening. The S500 is broken into sections covering sanitary and unsanitary water losses. The section that would apply to your routine business is the sanitary water damage section. Workers at your company should also have a familiarity with the section of the S500 standard that deals with unsanitary water losses so that they can recognized those situations where your company’s policy might be to decline the job.
Since improperly performed carpet cleaning can result in mold growth, technicians need to be familiar with industry documents addressing the mold issue. One of the first guidelines dealing with mold was the New York City Department of Health Guidelines on Assessment and Remediation of Fungi in Indoor Environments. More recently the Environmental Protection Agency published a document titled Mold Remediation in Schools and Commercial Buildings, and OSHA has released A Brief Guide to Mold in the Workplace as a safety and health information bulletin. All three of these documents were prepared as general guidance documents to assist decision makers dealing with these issues. They indicate that workers must be properly trained before they are permitted to perform even small isolated areas of mold clean up. The OSHA bulletin has clarified the question of when OSHA can issue citations for mold by stating “Citations can only be based on standards, regulations, and the General Duty Clause,” which requires that employers provide work environments free of recognized hazards or those likely to result in death or serious harm.
Finally, the IICRC has recently completed its final review of the S520 Standard and Reference Guide for Professional Mold Remediation. The S520 has been developed by a diverse group of industry experts as a standard of care for mold remediation. It should be in print by the time this column reaches publication. Even though your company doesn’t perform mold remediation, it is still highly recommended that workers be familiar with those parts of the document that deal with mold awareness as well as safety and health considerations.
You might want to pay particular attention to the Inspection and Preliminary Determination; Limitations, Complexities, Complications and Conflicts; and the Administrative Procedures and Insurance sections of the S520 Standard and the Reference Guide.
To acquire copies of the guidance documents and standards mentioned in this article, you can go to the following websites:
NYC Guidelines on Assessment and Remediation of Fungi in Indoor Environments:
http://www.ci.nyc.ny.us/html/doh/html/epi/moldrpt1.html
EPA Mold Remediation in Schools and Commercial Buildings: http://www.epa.gov/iaq/molds/index.html
OSHA Safety and Health Information Bulletin A Brief Guide to Mold in the Workplace:
http://www.osha.gov/dts/shib/shib101003.html
IICRC S100, S500 and S520: www.iicrc.org
—Jim Holland
Carpet Cleaning and Mold: Is carpet cleaning an appropriate method for removing mold from carpets?
The answer to this question is — It depends. If water in the carpet, especially carpet installed over pad, has resulted in actual mold growth, it is less likely that the carpet can be successfully cleaned. This is because mold growth usually results in staining and deterioration of the carpet fibers, backing and binding materials. When mold growth occurs because of standing water that permeates the carpet and the pad, it may simultaneously result in bacterial amplification, loss of structural integrity, discoloration, and odor problems that cannot be corrected by surface cleaning. In these cases, the specialty restoration that might be successful in cleaning and restoring the carpet may exceed the carpet's value.
If carpet has been affected by settled spores with no indications of dampness or record of water damage, there is a much greater chance that carpet cleaning can be effective in removing the mold. When cleaning carpets by dry vacuuming with portable cleaners, the equipment must be a true HEPA type (see last month's Q&A column). If the equipment exhausts directly to the outside, such as when a truck mount unit is used, spores will be exhausted to the outside where people passing by may be exposed. The Canadian Mortgage and Housing Corporation (CMHC) recommends removing mold spores from carpeting by vacuuming with HEPA equipment at a rate of up to 90 seconds per square yard. The greater the number of spores that are present and the more they have been worked into the carpet, the harder it may be to remove them by cleaning. Dry methods of cleaning may not be effective in removing the water insoluble binders that hold spores to the carpet surface. Bonnet cleaning or shampooing may be effective at detaching soils from fiber surfaces, but not allow for their immediate removal. The delay in removal can allow for re-entrainment of spores into the air space. Hot water injection-extraction provides for a more immediate and thorough removal of spores.
According to studies conducted by Air Quality Sciences in Atlanta Georgia, hot water extraction cleaning is the most effective method for removing mold contamination. The study was performed by predetermining the level of fungal contamination present. Carpet was pre-cleaned by HEPA vacuuming, followed by detailed cleaning using hot water extraction methods. The reduction in fungal levels was reported to be better than 96%. After cleaning, the carpet was divided and half was maintained in a chamber simulating a dry environment. The other half was kept at an elevated relative humidity (85-95%). Both sections of the carpet were retested after two weeks. Fungal levels in the cleaned dry portion of carpet remained low, but the carpet in the damp chamber returned to the contaminated levels that had been present prior to cleaning. This study shows that hot water extraction cleaning that is dried quickly is an effective way of removing settled spores, if it is kept in a dry condition. However, appropriate cleaning and drying will not prevent re-amplification if the carpet is left in a high humidity area. To prevent re-amplification, carpets cleaned with wet processes should be completely dry within six to twelve hours.
It is also important that furnishings and items like plastic carpet mat protectors stay off the carpets until they are thoroughly dry to prevent trapping moisture and resultant mold and bacteria amplification.
There are several ways to promote rapid drying. First, if the carpet will tolerate it, use hot water. It not only cleans more effectively, but it also results in a higher rate of evaporation. Second, increase the amount of extraction by using more dry extraction strokes of the wand to remove as much water as possible. Third, use the drying principles developed by the water damage restoration industry to accelerate the drying of carpet. These include increasing the air movement across the carpet surface to move moisture into the air and then controlling humidity by dehumidification.
Air movers (which most carpet cleaners already own) are a great way to speed drying by increasing the speed of air movement across the carpet. The property owner may also have ceiling fans or other types of fans that with their permission can be used. It is important that the property owner understand the necessity for rapid drying so they don't turn the equipment off too soon. Of course the use of air movers assumes they are not being used in areas with mold growth or other contamination. Air movement can cause additional problems by spreading mold spores from areas of growth to other parts of the building.
Reducing the humidity can be accomplished by using outdoor air when the outdoor humidity is low. The outdoor air should be at least 15 grains lower than the inside air. Be aware that cold surfaces may result in problems with condensation. The decision to use outdoor air for drying, requires the cleaner to have a thermo-hygrometer and a psychrometric chart and know how to use them.
Outdoor air can be brought into the building using a variety of approaches, such as kitchen, bathroom and whole house fans can be used for setting up air circulation. However, care should be taken that the exhaust fans move air to the outside and not into an attic space or other internal part of the building where condensation might occur. On a windy day simply opening windows on both the upwind and downwind sides of the structure helps move the moisture-laden air to the outside.
If outdoor conditions are inappropriate for drying, mechanical dehumidification may be necessary. In order to be effective, this equipment will generally need to be left on-site and picked up the next day. The home air-conditioning system may also provide some dehumidification. However, inappropriately sized systems may just cool down the structure, cycle off and not remove much moisture. This cooling down and cycling off condition may actually slow down the drying.
Increasing the heat in the structure, may also speed carpet drying. As air temperature increases its ability to hold moisture goes up, so its relative humidity goes down. Warmer temperatures also directly encourage evaporation by adding the energy necessary for water molecules to evaporate. Turning up the thermostat is one obvious way to increase temperatures. The carpet will dry more rapidly by releasing its moisture into the air. The warm moist air can then be exhausted to the outside. The cycle of warming up the air, and then opening windows to exchange the warm moist air with cooler outside air can be repeated every hour or so until the carpet is dry. However this can become rather labor intensive and economically impractical.
Many of these approaches require significant additional set up and/or handling time and may create considerably more expense for the cleaner, but result in less chance of mold re-amplifying from remaining moisture after cleaning.
—Jim Holland