An Evaluative Survey Regarding the Use of Odor as a Diagnostic for Infection: Does the Concept Stink?

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.

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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.

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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