Written by: Janis Harrison, RN, BSN, WOCN
Have you ever had a patient that smelled as if a bottle of cologne spilled all over their clothes rights before they came to see you? Did you also notice a peculiar stench beneath the perfumed deodorizer?
A friend of mine was staying in LTC for rehab where her husband would visit her daily. He was always dressed in clean clothes and was well-groomed. After a week of visits, this gentleman noticed that the stench was becoming unbearable. So much so that the nursing staff was heard talking about the smell outside of his wife’s room. The staff became concerned that there was a dead animal in the room somewhere, yet they could not find the odor.
It just so happened I was visiting my friend, and her husband was there at the same time. I asked if he noticed the odor. He replied that he did but thought maybe it was something on his boots. He had washed them several times and even put some talc inside.
He is a diabetic with no protective sensation in his feet. I suggested looking at his feet where we found fresh blood on his sock. As he removed his sock, I looked inside his boot and saw a nail was poking through the bottom. The nail caused several puncture wounds and a wet, black necrotic tissue with redness going up and around the foot toward his ankle. I immediately took him to the Emergency Room.
Some odors are undeniable.
If you've been in wound care long enough, you can almost pick out the sweet almond-like smell of Pseudomonas.
Klebsiella also has a unique odor, as do other anaerobic bacteria (bacteria that don't need oxygen to survive or multiply).
It is the anaerobic bacteria that tend to colonize and cause infections in the wounds. This must be addressed by debridement of the eschar and slough in the wound. If it is a fungating cancerous wound, it is important to control odor as well.
Odor Controlling Wound Dressings
Dressings with antimicrobial components such as silver, iodine, and honey all help to decrease the bioburden of the wound. If the wound worsens and becomes infected, then it may be time to treat the wound systemically, locally, or both.
CarboFlex is indicated for shallow wounds or as a secondary dressing over a wound filler for deeper wounds. Used to manage malodorous wounds. These dressings must be secured on all four edges to force the odor through the charcoal area.
Actisorb Silver 220 is an activated charcoal dressing with silver, enclosed in a non-adherent nylon sleeve traps odor while providing an effective barrier to bacterial penetration, which may help reduce infection.
Exuderm Odor Shield is a hydrocolloid dressing designed to absorb exudate. The dressing includes cyclodextrins which are designed to help reduce odor, and it tapered edges to prevent roll-up.
Cadexomer iodine is an antimicrobial agent containing slow-release iodine. It has been shown to decrease bacteria. With the decrease in bacteria, there will be a decrease in odor. Ointment and impregnated bandage forms are available through Halo Wound Solutions.
Manuka HD Superlite releases honey into the wound bed and absorbs exudate and necrotic tissue into the dressing. Eschar and debris tissue are taken up by the mesh fiber in the dressing resulting in a clean and viable wound bed. The result is a clean and viable wound bed that creates an optimal wound healing environment and reduces or eliminates wound odor.
Sodium impregnated gauze can help decrease bacteria the wound which can help with odor management. Mesalt stimulates the cleansing of heavily discharging wounds in the inflammatory phase by absorbing exudate, bacteria, and necrotic material, which helps with odor management.
Topical Antibiotics to Manage Odor
Metronidazole (Flagyl) is an antibiotic that fights bacteria. It can be compounded into a topical powder and is also available as a gel. This product is given systematically and is known to cause some nausea as a side effect. It can be sprinkled into the wound bed and covered with a foam or gauze dressing.
You can also apply with a petroleum-based dressing.
The gel format is now available commercially, typically covered with a hydrogel or wet gauze, and changed daily. It has been reported to reduce odor in 3-7 days.
If the wound worsens and becomes infected, then it may be time to treat the wound systemically, locally, or both.
Chloromycetin is an antibiotic that can be used when wound healing is not the goal. Gauze is moistened with this solution then placed over the wound to control odor. Be sure to protect the good intact surrounding skin as this may cause irritation and further breakdown.
Additional Options to Reduce Wound Odor
Dakins’ solution is a possible wet-to-moist solution to use with gauze as a means of decreasing the bacterial count. You can obtain Dakins’ over the counter but this is only suggested when you’ve been evaluated by your physician and he/she has directed you to do so.
Another idea is to apply yogurt or buttermilk directly to the wound for 15 minutes. Then, cleanse the wound with the clinician’s choice of wound cleansers and apply an absorbent dressing.
Sugar paste is reported as a being an odor-reducing dressing. Apply a sugar paste mixture to gauze and cover the wound. Sugar paste dressings help to reduce the bioburden in the wound and help autolytically debride the necrotic tissue in the wound. Nursing Times, VOL: 96, ISSUE: 36, PAGE NO: 15 contains a great article on this method. https://www.nursingtimes.net/clinical-archive/tissue-viability/using-sugar-paste-to-heal-postoperative-wounds-07-09-2000/
Some ideas taken from palliative care writings on ways to hide the odor include: Aromatics -- scented candles, air freshener sprays, peppermint, essential oils, coffee beans or grounds, and cider vinegar in a shallow pan are all used to hide odors. Adsorbents (a substance that absorbs another)-- charcoal (such as a basket of charcoal briquettes) or cat litter can be placed in a patient's room. Baking soda can be placed under the bed to help absorb odor.
Ideally, a wound dressing is the better choice masking wound odor and then followed up by a room deodorizer that can better meet the overall objective. It is important to take the patient's goals of palliative care or wound healing into consideration as you attempt to control the odors of the wound.
The odors of a wound can cause a decline in the patients’ care and self-esteem. Patients often stop eating and become depressed due to odors.
Take care when treating a wound that is emitting strong odors that the patient does not sense displeasure in your work. This can lead to future avoidance behaviors regarding their return visits.
Jan Harrison is the owner of Harrison WOC Services, L.L.C. in Thurston, Nebraska. A graduate of Morningside College in Sioux City, IA. She works as an independent contractor of Wound, Ostomy, Continence, and Foot and Nail Care services for medical entities throughout Northeast Nebraska. Janis has over 30 years of experience as a nurse and 12 years as a CWOCN and CFCN.
Find more about Jan Harrison and her work at www.harrisonwoc.com