How to assess wound odour more effectively using grading tools?

Assessing wound odour is challenging for healthcare professionals to navigate sensitively and effectively. [1] This is because wound odour can have a considerable impact on both a patient’s physical and mental wellbeing.

Patients report that even temporary bouts of wound malodour cause discomfort and embarrassment. [2]

Using a grading scale to assess wound odour can ensure as part of a broader wound assessment can be beneficial.

Why is it difficult to assess wound odour?

One of the fundamental challenges of assessing malodour is recognising that it can be subjective. This is because the sense of smell varies from person to person.[5] This means that even if they are using the same scale, different healthcare professionals may not classify wound odour in the same way.

It is also important to be conscious that wound odour is often a normal part of the wound healing process and is not always indicative of any issues with the patient or a more serious underlying problem such as infection.[6]

Although a bacterial infection may be responsible for wound odour, it is also true that some wounds have a distinctive smell.[7] It is critical to accurately differentiate between a normal, albeit unpleasant, odour and one that points to a problem.

As such, all assessments of wound odour should take a patient wellbeing-first approach. This means that even if wound malodour is not necessarily indicative of infection, the emotional impact of the odour on the patient should still be addressed as a matter of priority.

How does the Baker and Haig scale grade odour?

The Baker and Haig Scale was developed to mitigate some of the difficulties healthcare professionals face when they assess wound odour. Namely, that simply acknowledging that a wound is odorous does not convey the severity or help with creating an effective management plan to tackle the issue. 

What are the limitations of the Baker and Haig Scale?

The Baker and Haig scale cannot be used as a conclusive diagnostic tool. The scale does not identify the root cause of the wound odour, nor does it prescribe any solutions to help manage it.

The Baker and Haig scale descriptions are somewhat broad. As smell is largely subjective, the patient’s clinicians and caregivers may find it difficult to come to a unanimous verdict on the severity of the odour.

One of the most significant limitations of the Baker and Haig scale is that it does not measure the effect of wound odour on the patient’s wellbeing.

How does the Teler Impact of Odour Scale grade wound odour?

The Teler Impact of Odour Scale was devised as a more patient-focused tool for assessing wound odour than the Baker and Haig Scale. It can help clinicians to identify areas of concern, or components, for the patient [8]. These components can be documented at each dressing change to establish if treatment for malodour is effective.

Components of the scale can be changed to reflect the situation for the individual, which can give a more accurate representation for each patient.  For example, this can include whether the odour is affecting the patient’s work environment, their relationships and intimacy, and the quality of their sleep.

What are the limitations of the Teler Impact of Odour Scale?

Although the Teler Impact of Odour Scale is more patient-focused than the Baker and Haig Scale, it also cannot be used as a definitive diagnostic resource. Additionally, it does not help with determining the source of the malodour, nor does it contain any care recommendations.

References:

1. David, Mellar P., Samala, Renato V. et al. Comprehensive Wound Management: Win the Race. Cleveland Clinical Journal of Medicine 2015; 82(8): 535
2. Akhmetova, Alma. A Comprehensive Review of Topical Odor-Controlling Treatment Options for Chronic Wounds. J Wound Ostomy Continence Nurs 2016; 46 (6): 598
3. Berke, Christine, Black, Joyce,. Top Ten Tips: Managing Wound Odour. Wounds International 2020; 11(4): 8
4. Fletcher, Jacqui. Malodorous Wounds: Assessment and Management. Wound Essentials 2008; 3: 15
5. Ibid: 14
6. Ibid: 14
7. Berke, Christine, Black, Joyce. Top Ten Tips: Managing Wound Odour. Wounds International 2020; 11(4): 8
8. Ibid: 8
9. Browne, N., Grocott, P., Cowley, S., Cameron, J., Dealey, C., Keogh, A., Lovatt, A., Vowden, K., & Vowden, P. (2004). Woundcare Research for Appropriate Products (WRAP): validation of the TELER method involving users. International Journal of Nursing Studies, 41(5), 559–571. https://doi.org/10.1016/j.ijnurstu.2003.12.009

Disclaimer:

Please note that while every effort is made to ensure the accuracy of the content presented, it is purely for educational purposes only and is not a substitute for professional medical advice.