Cath Lab Digest

P atients with chronic wounds - for example, pressure ulcers, leg ulcers, gangrenous wounds, and fungating malignant wounds - are at risk of developing body malodor.¹ Although exuding, malodorous wounds are a difficult clinical problem,² exact data on the incidence and/or prevalence of such wounds are not known. Problems associated with malodor include social isolation, loss of appetite, inhibition of intimacy, and distress for patients and their caregivers.^3-6

In chronic wounds, odor is due to tissue degradation or anaerobic bacteria generating odor by emitting compounds such as putrescine, cadaverine, volatile sulphur compounds, and short chain fatty acids, although aerobic bacteria such as Pseudomonas and Klebsiella species also can produce offensive odors.⁷ Putrescine and cadaverine often are described as acrid-smelling; they are persistent and constantly detectable⁸ and can cause a vomit or gag reflex.

Through a mechanical process of adaptation, the body protects an individual from being saturated by weak stimuli (smells) by desensitizing sensory cells.⁹ This may occur in the case of a patient with a malodorous wound but not necessarily for the nurse caring for the patient. Failure to adapt can result in increased sensitivity from repeated exposures to the malodor; this can become a stressor and can eventually elicit health symptoms such as nausea.¹⁰ This is commonly reported by patients with fungating breast carcinomas. For many, awareness of a particular smell usually occurs quickly, but for chronic unpleasant odors, this may not be the case.

Preventing or treating microbial colonization or the infection that is causing the offensive smell may achieve odor reduction. This can be accomplished using systemic or topical antibiotics. However, the optimal dose to ensure efficacy is not clear. Other odor-control mechanisms include cleansing the wound, implementing general hygiene measures, and using odor- controlling dressings. These products are designed to act like filters and adsorb odor-causing molecules. The first successful use of charcoal cloth incorporated into gauze and water repellent fabric in the treatment of fungating breast cancer, gangrene, and postoperative colostomy management to reduce the odor was reported in 1976.¹¹ The efficiency of such dressings seems to depend on the presentation of activated charcoal.^12-15

Study Dressing

The dressing under evaluation, Carboflex® (ConvaTec, a Bristol-Myers Squibb Company, Princeton, NJ), is a multicomponent wound dressing designed specifically for controlling malodor and wound exudate. The product consists of a skin friendly wound contact layer of nonwoven fibers (Kaltostat® and Aquacel®, both from ConvaTec, a Bristol-Myers Squibb Company, Princeton, NJ) capable of absorbing exudate and maintaining a moist wound environment. Between the wound contact layer and charcoal cloth is a one-way, perforated, water-resistant film. The film protects the charcoal cloth by delaying the passage of fluid through to the cloth; thereby, enhancing the ability of the charcoal to control odor. Above the charcoal cloth is an additional absorbent padding layer of mixed fibers that provides greater security against the problem of fluid strikethrough. An outer, perforated layer delays the passage of fluid through the dressing and completes the structure of the dressing. The aim of this study was to evaluate the effectiveness and performance of the odor-control dressing in the treatment of exuding, malodorous, acute and chronic wounds.