Is the wound smelly

1
Is the wound smelly?

• Produced by Candice Rice, Natalie Campanaro,
  Gabrielle Trewin, Kable Fransen, Martin Spink and
  Jason Burton

2
What is malodour?

• Malodour is caused by the presence of anaerobic
  bacteria, which produce malodorous fatty acids.
• The most effective way of dealing with
  malodourous wounds is to prevent or eradicate the
  infection responsible for odour
• How was this traditionally achieved?
• Systemic antibiotics or antimicrobial agents
• Topical antiseptics
• Deodorizes

3
Consequences of Malodour?

• Malodour can have a devastating effect on the
  patient's and the carers' quality of life
• The subjective reporting of smell by the patient
  and carers should guide treatment

4
Advances in odour management

• Effective wound cleansing and control of exudate
• Use of topical or systemic metronidazole
• Or
• Use of odour-absorbing activated charcoal
  dressings

5
Types of odour absorbing dressings

• Activated charcoal
• Hydrogel
• Honey

6
Activated charcoal dressings

• Charcoal reduces the concentration of offensive
  odour to low levels.
• The material used is charcoal cloth which is
  incorporated into pads containing surgical gauze
  and a layer of a water repellent fabric as well
  as an antibacterial agent

7
Charcoal Dressings

• Activated charcoal cloth increases the effective
  surface area of the cloth fibres aiding in their
  ability to remove unpleasant smells.
• The molecules that are responsible for the
  production of the odour are attracted to the
  surface of the carbon and are held there
  (adsorbed) by electrical forces.

8
Activated Charcoal other uses

• Acute Poisoning
• Flatulence

9
Indications for use

• Discharging, infected and malodorous wounds
• Acute and chronic wounds.
• Primary dressing
• Secondary dressing over wound fillers

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Examples..

• Venous leg ulcers
• Fungating carcinomas
• Fistulae
• Infected surgical wounds

11
Contraindications

• Dry Wounds
• Known sensitivity to specific dressing or
  dressings containing charcoal.
• Monitor for irritation and/or maceration of skin
  and hypergranulation tissue

12
Examples of dressings

• Actisorb Plus
• Carbonet
• Carboflex
• Lyofoam C
• Release
• Hollister

13
Actisorb Plus (Silver)
By Johnson Johnson
Silver acts an antimicrobial agent Reduces the
bacterial colonisation of wound and thus
inhibits infection
14
Carbonet
By Smith and Nephew
Multilayer dressing combining both fluid and
odour absorbing properties.
15
Hydrogels

• Transparent gel
• Active ingredient Metronidazole (8)
• Has two actions
• 1. Provides a moist environment
• Promotes autolytic debridement
• 2. Active against odour producing bacteria

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Example..
17
Honey

• Deodorising action due to honeys antibacterial
  action and its rich source of glucose
• Anti-inflammatory action reduces oedema and
  exudate
• Reduce odour producing microbial population

18
Maggots

• larval therapy can eliminate wound infection and
  odour from extensive necrotic wounds.

19
Method of use

• Absorbent dressing
• Debride wound if required
• Clean wound with sterile saline or antiseptic
  solutions
• Charcoal dressings cannot be cut
• Choose appropriate dressing size (ensure 3cm
  overlap)
• Shallow wounds apply directly to skin
• Deep wounds - lay over a wound filler as a
  secondary dressing
• Secure with tape or other appropriate adhesive
• Note The absorbent wound contact layer will take
  up exudate and form a soft gel.

20
Method of use

• Gels and honey
• Should be applied liberally to wound surface and
  covered with secondary dressing or film depending
  on volume of exudate

21
Frequency of dressing changes

• Change the dressing when
• clinically indicated or
• if there is exudate strikethrough on the top
  layer or
• the odour is no longer being absorbed
• With non-infected malodourous wounds should be
  changed every 3 days.
• With infected malodourous wounds should be
  changed every day.

22
Advice to Patients

• Changing the dressing as required
• Taking prescribed medications as directed
• Drinking plenty of fluids
• Following a healthy diet, as recommended,
  including eating plenty of fruits and vegetables