Word has it that some surveyors are citing facilities if they find a rare event called “Purple Urine Bag Syndrome” (PUBS), if the facility does not know what caused the discoloration of the urine. One case was an F880 citation for “failed to identify purple bag syndrome”. The surveyor noted she “inquired how long” the resident had PUBS and the infection preventionist states she was not familiar with this syndrome but knew it was not normal to have purple urine.  The catheter bag and tubing indeed appeared to be a purple color however, the urine in the bag was yellow when emptied.

PUBS was first reported in 1978 and is rare. There is no scientific evidence to explain it and it can happen with any type or brand of catheters and urinary bags.  This phenomenon occurs predominantly in women who are chronically catheterized and usually constipated according to the NIH. Highly alkaline urinary bacteria can produce sulphatase/phosphatase that interacts with the urinary bag. The etiology is thought to be due to indigo (blue) and indirubin (red) from bacteria or to their reaction to the synthetic materials of the catheter and urinary bag that becomes purple. The exact cause of the purple color change is unclear. Constipation (commonly found with spinal cord injuries) prolongs the transit time that tryptophan is in the bowel, so others believe it is a change do to delayed metabolization of tryptophan by the liver. And so, bowel stasis, a complicated breakdown of tryptophan and the presence of a UTI could result in PUBS.

PUBS is generally a benign process but can be upsetting to staff, residents, and families. Facility staff should report changes in the appearance of indwelling urinary drainage devices to the attending physician as this syndrome may signal underlying recurrent UTIs, that may be related to improper care of the urinary catheters and/or improper sanitation. While this syndrome may seem harmless, an underlying urinary tract infection could lead to a serious condition and PUBS could be a warning sign.  Medical management of PUBS is to change the indwelling catheter and drainage bag and treat any underlying bacterial infection. (As of this writing, the CDC has nothing related to PUBS on their website).