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Cynthia Fleck, MBA, BSN, RN, ET/WOCN, CWS, DNC, DAPWCA, FCCWS and
Michael Miller, DO, FACOS, FAPWCA, CWS
BACKGROUND:
Wound malodor is a subject vital to patients, caregivers and clinicians
but is sometimes underrated, not fully appreciated nor appropriately
addressed. Although exudating, odoriferous wounds are a complex
clinical quandary,1 precise information concerning incidence and
prevalence is unknown.Wound odor is a not only a palliative problem
but often a function of critical colonization and/or infection.2
Research has shown that wounds most commonly associated with odor
include exudating wounds, chronic pressure ulcers, venous leg ulcers,
diabetic/neuropathic ulcers, fungating,3 cancerous or malignant
lesions and wounds with necrotic tissue.4,5
Wound odor is largely thought to be due to tissue degradation and/or
tissue death or necrosis or nonsporing anaerobic bacteria that colonize
cutaneous lesions releasing compounds such as putrescine, cadaverine,
unstable sulphur compounds, and short chain fatty acids, as metabolic
end products,6 an autolysis. However, aerobic bacteria such as Pseudomonas
and Klebsiella species also can generate unpleasant odors.7 Odors
that point to of infection may be sweet, pungent, foul, strong, fecal
or musty.A sweet odor may indicate a pseudomonas infection, especially
if it is accompanied by thin, foamy green drainage.A strong pungent
odor along with tissue necrosis or separation of the skin into paper
thin black-purple layers may indicate Clostridium and life-threatening
moist gangrene. Putrescine and cadaverine are frequently described
as pungent-smelling.They tend to be constant and persistently evident.8
They are known to elicit the gag reflex and can cause vomiting. Certain
dressings, such as hydrocolloids (one of the most frequently used
advanced products) tend to also produce odor due to their occlusive
nature and the chemical reaction that takes place between the dressing
and wound exudate.
Foul odor is usually caused by Gram-negative
bacilli. Pseudomonas species have another specific odor that is
characteristically described as “ripe” or “fruity”,
and anaerobic bacteria cause a pungent or rotten odor. Foul odor
is usually associated with the presence of anaerobes;9 the combination
of anaerobic and aerobic bacteria is believed to be the most common
cause of smelly wounds.10 Critically colonized wounds also may
exhibit new and sudden odor with increased exudate production.11
PROBLEM:
Not everyone interprets wound malodor in the same way, making clinical
diagnosis of
odor problematic.
OBJECTIVE:
Collect data from multidisciplinary wound care professionals regarding
their opinions on
wound odor and infection.
 
METHODOLOGY:
A survey is being conducted to ascertain wound management practitioners’ opinions
on
wound odor.
CONCLUSION:
Information regarding clinicians’ attitudes about odor will
provide a backdrop for
education and further investigation into the phenomenon of wound
odor and its
etiology and treatment.
To complete the survey, please click here.
1 Grocott P.The palliative management of fungating malignant wounds.
Journal of Wound Care. 1995;4(5):240-242.
2 Fleck CA. Fighting odor in wounds.Advances in Skin and Wound Care,
2006;19(5):242-244.
3 Grocott P, Browne N, Crowley S. Quality of Life: Assessing the
Impact and Benefits of Care to Patients With Fungating Wounds WOUNDS
2005;17(1):8-15.
4 Thomas S, Fisher B, Fram PJ,Waring MJ. Odor absorbing dressings.
Journal of Wound Care. 1998;7(5):246-250.
5 Benbow M. Malodorous wounds: how to improve quality of life. Nurse
Prescriber. 1999;Feb:43-46.
6 Moody M. Metrotop: a topical antimicrobial agent for malodorous
wounds. Br J Nurs. 1998;7:286–289.
7 Hampson JP.The use of metronidazole in the treatment of malodorous
wounds. Journal of Wound Care. 1996;5(9):421-425.
8 Van Toller S. Invisible wounds: the effects of skin ulcer malodors.
Journal of Wound Care. 1994;3(2):103-106.
9 Sapico FL, Ginunas VJ,Thornhill-Joynes M, Canawati HN, Capen DA,
Klein NE. Quantitative microbiology of pressure sores in different
stages of healing. Diagn Microbiol Infect Dis. 1986;5:31-38.
10 Lindholm, Pressure ulcers and infection: Understanding clinical
features. Ostomy/Wound Management, May 2003;49(5A): 4 – 7.
11 Kingsley A. A proactive approach to wound infection. Nursing Standard |
