Malodorous Wounds Research Articles

Understanding and caring for patients with smelly wounds

Some wounds, particularly chronic, infected and neoplastic wounds, in addition to causing pain, damage the person's self-image, particularly when they are malodorous. For the patient himself, for their relatives and for the professionals responsible for their care, these malodorous wounds penalise the relationship and even the care. They are a source of isolation and can have severe effects on the patient. However, solutions do exist.

WHAM evidence summary: Use of yoghurt for managing malodorous wounds

WHAM evidence summary: Use of yoghurt for managing malodorous wounds

When is a surgical multidisciplinary approach required in the management of head and neck non-melanoma skin cancer and in advanced head and neck pathologies involving skin?

SUMMARYNon-melanoma Skin cancer, including cutaneous squamous cell carcinoma and basal cell carcinoma, is the most common form of malignancy in the Caucasian population, and the skin of the head and neck is the site most involved. They should not be underestimated; in particular, high-risk lesions and advanced skin cancers require accurate diagnostic work up, aggressive surgical treatment and should be managed by the head and neck surgeon, the dermatologist and the plastic surgeon. Cutaneous head-neck malignancies are often overlooked or not routinely treated with a multidisciplinary surgical approach. Similarly, for primary head and neck cancers with involvement of surrounding skin, the involvement of the dermatologist and the plastic surgeon could better define an adequate diagnosis and treatment planning. The management of these patients presents both therapeutic and ethical problems, because the poor prognosis is burdened by facial disfigurement, open malodorous wounds and intractable pain. Therefore, in patients with advanced disease that is not candidate to radical surgery, palliative surgery with flap reconstruction could take place and could be proposed to improve quality of life.

Topical odour management in burn patients

Preventing microbial colonization or infections that cause offensive smells may lead to odor reduction. As both anaerobic and aerobic bacteria cause the release of malodor from wounds, the most direct way of avoiding or eliminating wound odor is to prevent or eradicate the responsible infection through the debridement of necrotic tissues. However, some burn patients with malodorous wounds are unable to undergo debridement due to systemic conditions, especially in the acute stage. Moreover, the optimal drug doses and dressings to ensure the efficacy and cost-effectiveness of odorous burn wound management is unclear. The purpose of this commentary is to outline the odor management options available for burn patients, focusing on topical strategies. Numerous potential therapies for treating odorous wounds after burn injuries are suggested.

Activated Carbon Containing PEG‐Based Hydrogels as Novel Candidate Dressings for the Treatment of Malodorous Wounds

AbstractMalodorous wounds have a detrimental effect on the patient's well‐being. A dressing combining the properties of hydrogels and activated carbon (AC) would be beneficial for the treatment of these wounds, controlling wound exudate while adsorbing malodor‐causing compounds. The present work involves the use of acrylate‐endcapped, urethane‐based precursors (AUPs) and methacrylated alginate (AlgMOD). AUPs are synthesized with a varying poly(ethylene glycol) backbone molar mass (2–20 kg mol−1) to tune mechanical and swelling properties, whereas methacrylated alginate, known for its hemostatic properties, enables chemical cross‐linking. Blends of AUP and AlgMOD with AC are processed into hydrogel sheets and electrospun membranes. The results indicate tunable mechanical (Young's moduli 0.03–0.63 MPa) and swelling properties (2.2–34.9 gwater ) along with high gel fractions (>85%). The sheets are compared with commercial odor‐adsorbing dressings (Carbonet and Carboflex), enabling benchmarking. AUP sheets (8 and 10 kg mol−1) containing 0.5% w/w AC show strong adsorption (>90% after 24 h) of crystal violet. The obtained (core–shell AlgMOD/AUP) fibers are visualized using scanning and transmission electron microscopy. Indirect cell tests reveal the developed materials to be biocompatible. In conclusion, a hydrogel‐based odor‐adsorbing wound dressing is successfully synthesized and holds promise for malodorous wound healing.

A study to assess the chemical composition and antibacterial properties of honey

The present study was to assess the chemical composition and antibacterial properties of honey. From ancient times, honey was increasingly used as a remedy for wound healing. Globally, several studies have been conducted and proved that there are a numerous ways that honey can heal the wound. To accept that honey has medical property in wound healing there is limited evidence. Hence the researcher was interested to determine the chemical composition and anti-bacterial properties of honey. It was assumed that honey has antimicrobial, anti-oxidant, anti-inflammatory properties as per the literature review. Also is acidic with high osmolality. Honey also has an antioxidant property that protects the cells from free radicals. Clinically topical application of honey possess antimicrobial properties, promote autolytic debridement, deodorize malodorous wounds, stimulate growth of wound tissues to fasten healing, stimulate anti-inflammatory activity and promote moist wound healing. Thus the use of honey can be effective and economical approach to managing large wounds. An experimental approach is carried out to fulfil the objective in a controlled setting. Whole honey has been sent to the laboratory for compound isolation through column chromatography. Three compounds have been isolated namely compounds (1-3). The isolated compound along with whole honey and standard antibiotics were send to the clinical laboratory for antibacterial study with selected pathogens. The results showed compound-2 had a good antibacterial effect against pathogens like E. coli, Klebsiella, Staphylococcus albus, Staphylococcus aureus while comparing with compound 1 and compound 2. Against Pseudomonas the compound has no effective antibacterial effect. Hence it is concluded that honey can be a potential treatment for diabetic foot ulcer caused by pathogens.

Early identification of wound infection: understanding wound odour.

Malodorous wounds can be distressing for patients and their families, negatively impacting on quality-of-life outcomes. For health professionals malodorous wounds can also cause distress manifesting in feelings of disgust when faced with a wound emitting an unpleasant or repulsive odour. There has been investigation into the management of controlling odour particularly in relation to fungating wounds. However, there is limited research that explores techniques for early identification and recognition of wound odours that may be indicative of infection. Electronic nose technology has received some attention, but to date has not been integrated into either diagnostics of infection in wounds or education of health professionals to prepare them for the realities of clinical practice.

Exploring psychology and nursing students perceptions of disgust

Objective : Practitioners can often experience feelings of disgust when exposed to malodorous wounds. This study reports on an investigation to measure a group of psychology and nursing students (n = 158) perceptions of disgust using the Disgust Scale-Revised questionnaire. Methods : Data were collected via anonymous on line survey of 158 psychology and nursing students at two Universities in the UK between June and July 2015. Results : Statistical analysis of the data revealed that the majority of the sample were female (97.3%) with nursing students being more resilient to disgust. Disgust scores diminished with increasing age. Psychology students are more sensitive to actual and perceived vulnerability to disease. Levels of perceived vulnerability fall with increasing age. Discussion and conclusions : Nursing students undertake 50% of their pre-registration programme in clinical practice where they may have been exposed to potentially disgust provoking situations that may sensitize them to such situations. It is unclear whether their disgust diminishes because they become more tolerant, or accustomed to such situations or to other factors. Previous and repeated exposure to situations provoking disgust may however, explain why nursing student responses differ to their psychology counterparts. Nursing students are disgusted less easily than psychology students; although all individuals become slightly more tolerant to certain issues over time. Psychology students are significantly more sensitive to actual and perceived vulnerability to disease than nursing students. Perceived vulnerability falls with increasing age. In order to fully examine the impact of gender on disgust more research is required with a purposive sample.

Exploring nurses' and patients' feelings of disgust associated with malodorous wounds: a rapid review.

To identify primary empirical research related specifically to feelings of disgust associated with malodorous chronic cutaneous wounds. A rapid review of the literature using the key words disgust; wounds; malodour and psychosocial. A total of 163 papers were retrieved with seven being included for the final review. Themes emanating from the review were malodour, health-care professionals coping with malodour and disgust. Malodour is a concern to patients, which can sometimes go unreported by nursing staff; although the reasons for this remain unclear. The coping mechanisms developed by nurses in response to 'disgusting' wounds requires further exploration in order for a fuller understanding of these mechanisms to be achieved. This review has identified that both health-care professionals and patients can become distressed at wound odours, yet there is little evidence that is available to guide people as to how to manage these feelings. Hard-to-heal or chronic cutaneous wounds, such as leg ulcers and diabetic foot ulcers, are an increasing global health-care issue. While some research has been undertaken to explore the psychological impact of living with a fungating carcinoma; much less has been written about the management and mitigation of feelings of disgust for patients and families living with a malodorous wound or how health-care professionals can effectively provide psychosocial care.

Assessment and treatment of fungating, malodorous wounds.

Assessment and treatment of fungating, malodorous wounds.

Smell and taste in palliative care: a systematic analysis of literature

Little is known on the role of the senses smell and taste in end-of-life care. The presented systematic literature analysis investigates the significance of smell and taste in palliative care. The online databases PubMed, CINAHL, MEDLINE, Deutsche Nationalbibliothek and British National Library were searched for English and German literature published between 1970 and April 2013 containing any kind of original data on the impact of smell and taste in patients in a palliative care situation. All retrieved publications were screened for relevance and full text was obtained for all articles identified as relevant. We integrated 13 papers for further analysis (explorative surveys 5, clinical trials 3, case studies 2, qualitative study 1, brief report 1, clinical report 1). Prevalence of smell and taste alterations in palliative care ranges between 60 and 86%. Existing literature reflects the significance of smells and tastes in palliative care setting in two main streams--smell and taste alterations as symptoms and malodorous wounds. Prevalence of smell and taste alterations in palliative care is high. However, in palliative care literature concepts for the assessment and fostering of subjective significance of smell and taste and the individual impact of significant smells and tastes are predominantly neglected. Available instruments should be characterized, validated and adapted for the use for palliative care patients.

Hydrogel Dressings Are Obsolete

I find it impossible to understand that none of the guidelines includes as the basis for hygienic wound care soap baths or showers, which should precede any other measures. Water, even sterile saline solution would not have yielded any evidence. These would counteract any surgical hand scrubbing and any recommendation of hygiene committees for healthcare staff to wash their hands after any contact with patients. What do colleagues do in case of filthy and grossly malodorous wounds, in case the hair on the head is glued together by blood, in case of ingrown stockings, or in case of maggot or insect infestation? The point of any lavage is to reduce any massive contamination of body cavities and skin by bacteria, fungi, or insects to a minimum. Because of the environment it is impossible to make wounds completely sterile. By eliminating protein, fat, and detritus, the breeding ground for any pathogens is removed. Further therapies should be undertaken only after this initial step. It is then of no crucial relevance how the wound is dressed, unless the patient has allergies. Sterile dressings and daily changes of dressings, wherever possible, are what is needed. For this reason we do not allow hydrogel dressings in our clinic for homeless people. Some 24 hours later, specimens almost always show massive growth of mostly Staphylococcus aureus. In patients with venous-lymphatic stasis, compression therapy is essential.

A clinical evaluation of the effcacy and safety of singlet oxygen in cleansing and disinfecting stagnating wounds

This cohort study evaluated the clinical efficacy of singlet oxygen, ActiMaris (AM) a hypertonic (3%) ionised (pH 9.8) sea water solution. It was assumed that when used for wound cleansing, disinfection and the reduction of inflammation, AM would be safe and effective. Between May 2008 and May 2009, ambulant patients presenting at one of four wound healing centres were included in the study. Patients had critically colonised and/or infected, malodorous wounds, covered with slough/fibrin or wounds showing inflammation of the periwound skin. Wounds were assessed in terms of percentage changes in fibrin, slough and granulation tissue, they were assessed clinically and high resolution digital photographs were scored by a physician who was blinded to treatment allocation. Results were compared at baseline (week 0) and following 42 days of AM treatment (week 6). Seventy-three patients were included in the analysis. Dressing changes were at 2-day intervals on average, and the median treatment period was 46.04 days (range: 3-197). At 42 days, 33% (n=24) of included wounds had healed, 57% (n=42) had improved and 10% (n=7) remained stagnant. Cleansing and wound disinfection with AM was effective. In 31 patients (42%) wounds had showed clinical signs and symptoms of critical colonisation and/or infection at day 0, whereas at day 42 the infection was completely eradicated. Inflammation was reduced in 60% (n=44) of cases and patients did not report pain or discomfort when using AM. The use of singlet oxygen was shown to be safe and the results of this study indicate AM to be useful for wound cleansing, disinfection, reducing inflammation and promoting wound healing. The centres were supplied with the study product by the sponsor. The authors have no financial interest in writing this article.

Treatment of venous leg ulcers to improve quality of life.

Venous leg ulcers are difficult to heal, often recur and are associated with pain, decreased mobility and quality of life. These factors, combined with malodorous wounds, can lead to social isolation. Venous ulcers indicate a lifelong treatment plan including compression therapy, leg exercises and leg elevation. Studies have shown that many people do not concord with treatment for numerous reasons including discomfort, difficulty in applying compression hosiery, uncomfortable footwear, poor cosmetic appearance of compression bandaging or lack of proper healthcare advice.

Wound odour: principles of management and the use of CliniSorb

The management of malodour in fungating wounds and chronic ulcers presents a number of challenges. This article examines the sense of smell and the development of fungating malignant wounds. It describes the psychological and physical aspects of managing malodorous wounds and how they impact on quality of life for the patient. It concludes with a focus on CliniSorb® – an activated charcoal dressing from CliniMed – and how the dressing impacts on the psychological and physical needs of a patient with a malodorous wound.

Use of an ionic sheet hydrogel dressing on fungating wounds: two case studies

Two patients with terminal cancer presented with painful, highly exuding and intensely malodorous wounds. In both cases, use of an ionic hydrogel controlled the malodour, absorbed the exudate and reduced pain, improving quality of life.

Consensus Panel Recommendations for Chronic and Acute Wound Dressings

To seek a consensus on recommendations that would help health professionals choose appropriate wound dressings in daily practice, since a systematic review found only limited evidence to support reported indications for modern wound dressings. A steering committee selected a panel of 27 experts with no declared conflicts of interest from lists of nursing staff and physicians (specialists or general practitioners) with long-standing experience of wound care. The lists were put forward by 15 French learned societies. The panelists received a recent systematic review of the literature, a classification of indications established by a working group, and definitions for the dressings. The steering committee designed questionnaires on chronic wounds and on acute wounds including burns for each of the 2 panels. The consensus method was derived from the nominal group technique adapted by RAND/UCLA. Panelists rated the relevance of each possible dressing-indication combination on the basis of the published evidence and their own experience. After the first round of rating, they met to discuss results and propose recommendations before taking part in a second round of rating. The working group peer reviewed the final recommendations. A strong consensus was reached for use of the following combinations: for chronic wounds, (1) debridement stage, hydrogels; (2) granulation stage, foam and low-adherence dressings; and (3) epithelialization stage, hydrocolloid and low-adherence dressings; and for the epithelialization stage of acute wounds, low-adherence dressings. For specific situations, the following dressings were favored: for fragile skin, low-adherence dressings; for hemorrhagic wounds, alginates; and for malodorous wounds, activated charcoal.

Psychological and physical care of malodorous fungating wounds

To be given a diagnosis of cancer is devastating, but to develop a malodorous fungating tumour can only serve as a constant reminder of the power this disease has over a person's life. It can have a profound effect on quality of life, and the patient often experiences depression, shame, embarrassment and alteration of body image, sometimes leading to social isolation. A literature review looking at the management of these wounds demonstrated limited clinical research on which to base evidence of the best care and although much is written about the psychological effects, there is little to show that these needs are being met. The aim of this article is to explore if nurses are equipped to care for the psychological problems of these patients and briefly considers the psychological issues the nurses caring for these patients may have.

Efficacy of commercial dressings in managing malodorous wounds

This paper investigates a novel in vitro method of ascertaining quantitative comparative data on a selection of commercial available odour absorbent wound dressing. The aim of this study is to determine and evaluate quantitative desirable data on the efficiency of odour absorbency along with other comparable physical characteristics of commercial odour absorbent dressings. This study is a part of an ongoing research programme into the design and development of novel odour absorbent dressings for managing malodorous wounds. The study also includes the development of a controlled in vitro test method that simulates a more realistic situation. A selection of commercially available activated charcoal dressings were analysed and tested, and comparative evaluation was carried out and discussed.

Overview of current practice and future trends in the evaluation of dressings for malodorous wounds

Wound malodour can affect patients both socially and psychologically. The putrid odour is often misinterpreted as poor hygiene. It can induce constant nausea, resulting in lack of appetite, weight loss and lethargy, which all affect healing. In addition, practitioners have to manage the wound without reacting to the malodour to avoid offending or alarming the patient.