Why malodor occurs
- Critical colonisation/local infection can delay healing, cause complications and significantly affect daily living for patients, with increased pain and anxiety, exudate with the potential for leakage and odor (Wounds UK Best Practice Statement, 2013).
- This is caused by the development of non-viable or devitalisedthat results when a wound becomes infected, which provides an opportunity for anaerobic and aerobic bacteria to grow (Wounds UK Best Practice Statement, 2013).
- As bacteria grow and metabolize in the colonized or infected wound, waste byproducts and volatile fatty acids are produced. The molecular structure of these substances can register with human olfactory receptors as having an unpleasant or offensive smell (Bale et al, 2004).
Exudate’s role in odor
In healing wounds, exudate supports healing and a moist wound environment. The main role of exudate is in facilitating the diffusion of vital healing factors (eg growth and immune factors) and the migration of cells across the wound bed (Thomas, 1997). It also promotes cell proliferation, provides nutrients for cell metabolism, and aids autolysis of necrotic or damaged tissue.
However, in wounds that are not healing as expected (i.e. chronic wounds), exudate appears to impede healing by:
- Slowing or preventing cell proliferation
- Interfering with growth-factor availability
- Containing elevated levels of inflammatory mediators and activated matrix metalloproteinases (Yeager et al, 2006; Trengove et al, 1999; Vowden and Vowden, 2004).
The increased proteolytic activity of chronic wound exudate is implicated in perpetuating wounds, damaging the wound bed, degrading the extracellular matrix, and causing periwound skin problems (Chen and Rogers, 2007; Gibson et al, 2009). As a result, exudate can provide a favourable environment in which bacteria can multiply and, therefore, result in malodor (Romanelli et al, 2010).
Effect on quality of life
There are a number of ways that wound malodour can inhibit quality of life, including:
- Malodor carries a social stigma that can cause patients to feel embarrassed or shameful. For example, patients might feel inhibited in being intimate with a loved one, which can compound negative feelings associated with wound malodor.
- The general psychological effect of wounds can include depression, anxiety, poor body image and diminished self-esteem (Fleck, 2006), and associated odor can also act as a constant physical reminder of the wound, which can lead to feelings of disgust, self-loathing and low self-esteem (International Consensus, 2012).
- Further negative effects of malodour can include isolation from friends and family, disruption of sleep patterns, loss of appetite (because presence of odor affects ability to taste), and general distress to patients and carers (Fleck, 2006).
- Patients may also take action themselves to eliminate the smell, including using room deodorizers (e.g. candles, potpourri), frequently bathing or showering, or even cleansing wounds themselves, which can impede wound healing (Fleck, 2006).
Controlling wound odor is therefore imperative to patient quality of life and should be a key goal of wound management for clinicians.
Many kinds of wounds can present with odor. Some examples:
Venous leg ulcer
1. Ask the patient/carer whether he or she detects odor. Acknowledge this self-report, and enquire as to the nature of theodour, whether it has affected daily activities and, if so, how they have changed their activities.
|a) Are you aware of the odor?|
|b) Are you concerned that other people will notice it?|
|c) Are you upset by the reaction of others?|
|d) Do you get embarrassed?|
|e) Does it affect your work environment?|
2. Assess the wound type per local assessment protocol and documentation:
|a) Exudating wound?|
|b) Venous leg ulcer?|
|c) Necrotic wound?|
|d) Pressure ulcer?|
|e) Diabetic/neuropathic ulcer?|
f) Fungating/cancerous/malignant wound?
3. Assess the odor type, which may be sweet, pungent, foul, strong, faecal or musty (Fleck, 2006).
|a) Sweet? Sweet odor can indicate Pseudomonas infection, particularly in the presence of thin, foamy, green exudate|
|b) Pungent odor? Pungent odor can indicate Clostridium infection, particularly where there is necrosis, and may result in gangrene, which could be life-threatening|
Keep in mind that some wound dressing materials (e.g. hydrocolloids) can also produce odor due to the reaction between the active ingredient and the wound.
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