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In-House Disposal of Leptospirosis Urine
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Technician Assistant Manager at DoveLewis, Marisa Perring, explains the protocol used in-house at DoveLewis for the safe disposal of Leptospirosis urine.Sidebar Bookmark Button
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Marisa Perring
Enrolled: 03/2014
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Is that what you use for all your urine collection bags?
Hi Cindy! Only for Lepto. Using IV fluid bags has a decreased exposure to risk and is also an affordable alternative for disposal.
How do you handle/store the IV fluid bags before they are used for urine collection in these patients? Is this less than ideal since there is such a potential for infections with urinary catheterization? Do you have protocols in place to reduce potential infection when removing and placing an empty bag? What are your typical protocols for urinary catheter care?
What do you use to plug the bag once it's removed from the patient?
Stephanie,
Great questions! To start the IV fluid bags are stored in a drawer, and only used in Lepto suspect cases. For other instances we have sterile urine collection bags. In regards to the risk of infection from these bags being connected to the system, if you look at the video: https://www.atdove.org/video/isolation-urine, you can see the urine collection bag is connected via fresh tubing and 3-way stopcocks. The amount of line the bacteria would have to climb, along with the two 3-way stopcocks it would have to pass, makes it a very unlikely scenario. Removing a full bag is done with full PPE, so gloves, mask, and goggles, and the tip of the line is kept from touching sources of contamination until it is placed into another empty bag. We then cap off the bag with a male adapter. The urine is then rendered inert using Bleach, and discarded. As far as our Urinary catheter care, for immobile patients we have them on an 8 hour schedule of cleaning with dilute chlorhexadine to help remove any build-up that may be present and keep the area clean. Let me know if you have any other questions!
Thank you Chris, I appreciate your answer. Is it necessary to wipe the port on the bag with chlorhex or alcohol before connecting the line (since the bag has been stored in a drawer)?
Hey Stephanie,
Wiping the port on the bag won't hurt anything, however does not really seem necessary as the urine is flowing into the bag not from it. However being more sterile in your technique is definitely not a bad thing.
Why do you wear the goggles and mask? Is it more for the bleach fumes or do you where them as part of your Lepto protocol?
Hi Erica! We wear all the protective gear for both reasons! Because of the zoonotic risk of Lepto, it is imperative that you wear all protective gear when handling anything from a potential suspect. And yes, since bleach is harmful to us as well, keeping our eyes, mouth and skin protected is protocol here as well.
Are there any cases in which you WOULDN'T place a urinary catheter in a Lepto/Lepto suspect patient, and if so, how would you properly dispose of urine?
Hi Louisa:
We place urinary catheters in all of our hospital patients with acute disease in which leptospirosis is suspected. The urinary catheter mandate is a protocol in our hospital to manage zoonotic disease that works well for us. However I understand there are some instances of chronic liver or kidney disease where leptospirosis is on the differential list but a bit lower that might not have a urinary catheter placed while in hospital. In these cases, these patients should be managed by having them urinate/eliminate in a dedicated area with a hard surface that can be immediately cleaned/sprayed with 10% bleach solution. Personal protective equipment including gloves, gown, goggles or facemask are still recommended during patient and bedding care that might expose staff to urine. ACVIM has a published a great consensus statement that gives recommendations for preventing zoonosis related to lepto- here is the link http://onlinelibrary.wiley.com/doi/10.1111/j.1939-1676.2010.0654.x/full
Is there a risk to mixing this bleach with urine (ammonia)?
Hi Caitlin,
I was able to check in with a few of our CVT's here at DoveLewis, and have posted their response below.
"There isn't really a risk. It can make some people feel light-headed (the bleach itself) but it's not toxic and life-threatening like mixing household ammonia and bleach. Ammonia in urine is in a different form called urea. The body breakdowns ammonia into urea through the liver, bloodstream, and kidneys because increased levels of ammonia in the body can be toxic. Urea is easier and safer way for the body to transport excess nitrogen out of the body.
There's ammonia that is produced or biosynthesized in the body and then there's household ammonia or ammonia solution that most people use in cleaning supplies. Same name, both can have toxic effects, but in mammals we break it down and excrete in urine in a less toxic form. Urine is also mostly water, very small percentage of it is urea. Our protocol also limits the amount of urine we are disposing of. We are not disposing of a large amount of urine at one time, usually somewhere around 800mls leaving room to add the bleach to the urine bag.
At DoveLewis, we choose to use bleach because it is likely the most effective in a wet environment like urine, where the organisms will live the longest. However, leptospires are actually susceptible to many different cleaning products. This is why we use vindicator on hard surfaces that have come in contact with our lepto patients. We confidently know that if we adhere to appropriate contact times this method is perfectly adequate. Other hospitals place povidone-iodine into the collection bag prior to hooking it up to the patient which will kill the organisms as the bag fills.
If other hospitals have concerns because of the irritating factors of bleach, other solutions could be considered. Thankfully, leptospires are fairly fragile organisms and usually are not too difficult to eradicate with appropriate containment and contact time."
Please let me know if I can answer any further questions, and thanks for asking! :)
How do you cap off the bags once disconnected from the collection line?
Hi Mary,
Thanks for watching! We use male adapters to cap off the fluid bags, and transport the capped bags directly to the morgue where we then process the urine as demonstrated in the video.