Wednesday, 01 July 2015
rendezvous - Beta 0.3
Pissin’ in the Wind (or wound) Sept09

 Pissin’ in the Wind (or wound)

If you teach wilderness medicine someone will ask about the use of urine as a wound irrigating solution, to cool hot people and for who knows what else.  While it can be asked in a manner that gives us the image of someone urinating on a patient I bet – no, I fervently hope - people would actually urinate into another container first.

 

We know water works quite well to clean wounds.  Urine has been used in times of war and natural disaster as an antiseptic, I can't find any science saying it is effective.  Urine is used in some cultures for medicinal purposes, but western medicine generally shuns it as a treatment.   

 

If it’s warm, wet and not yours, don’t touch it.

We teach body substance isolation on day one in our courses.  Urine on skin without obvious blood is not considered an exposure by CDC, but urinating on a patient, especially into a wound, would violate such a simple yet important rule.

 

Is urine sterile?

Urine should be sterile as it leaves a healthy kidney.  Sterility when it leaves the end of the urethra, or in the presence of a UTI, is another matter.  

 

Any doctor or nurse worth their pay would consider a wound that is contaminated with a patient's own urine to be a dirty wound.  They wouldn’t say "Hey, no big deal if the patient got pee on their wound.  Urine is sterile." 

 

Why do you want to use urine to cool a hot person?   

Urine is at least 98°F (37°C), often a few degrees warmer.  Why would you put hot liquid on a heat stroke victim?  Plus, you don't have enough urine to make a good flush; we make 1-2 liters a day and you're in a heat stress environment already, and likely a bit dehydrated.

 

Why do you want to use urine to irrigate a wound?

Why would you use something that could be non-sterile in a wound?  You don't have enough urine to make a good flush.  You’re breaking body substance isolation precautions.  The urea in urine is an irritant and may have worked to prevent wound infections during war and disaster by killing tissue on the wound edges (dark thick urine was thought to be better than light urine). Why the urgency?  Why not wait for clean water?

 

Why would you use it to prevent nematocysts from discharging?

This myth gained a boost in popularity a few years ago after an episode of the television comedy Friends where one of the “friends” recommends urine to treat the jellyfish sting of another (www.youtube.com).   As well, it made a WMI Instructor unpopular when he said aloud in a theatre “no way” to the scene in the cartoon movie "Surf's Up" when the old time "soul" surfer penguin urinated on the kid penguin who had stepped on a sea urchin.  Urine to prevent nematocysts from discharging is a discredited therapy, and in some cases – dilute urine for example -  can increase the discharge rate.

 

What about urine to cure athlete’s feet?

I can’t find any medical science supporting this, only a lot of internet chatter.  I choose to believe the former.  It takes an anti-fungal to treat the fungal infection of athlete’s foot.  Many myths are based on misused fact, and here it is explained that urea, present in urine and as an inactive ingredient in some athlete’s foot treatments, allows the anti-fungal to penetrate deeper into the skin.  Maybe this works in the anti-fungal creams, but urine has much less urea and much less contact time.  It’s likely just an excuse to justify the bad habit of peeing in the shower.

 

Bottom line: Urine on a patient is not the standard of care.  Medical professionals would not support this action.  Many of us consider it ineffective, unprofessional and creepy.  As my colleague Ray Cramer said “I hope this puts a stop to the stream of urine questions.”

 

Take care

 

Tod

 

 

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