What is Wound Malodour?
Assessment, Treatment and ImpactWound malodour refers to an unpleasant smell produced by a wound and is reported by 76% of patients. Recent surveys of clinicians and patients found that both regard malodour as the second most distressing symptom after pain. Living with malodorous wounds often leads to feelings of embarrassment, depression, self-isolation and resistance to treatment. [1]
Despite the significant impact of wound malodour on patients and their carers, there are few validated assessment and treatment options available to clinicians. This often results in inadequate care and poorer patient outcomes. [2] By identifying and treating the cause of malodour, clinicians can improve a patient’s quality of life.
What are the causes of wound malodour?
Wound malodour can have a range of causes, including bacteria, devitalised tissue and high levels of exudate. [3]
When devitalised tissue breaks down, bacteria play a key role in the liquefaction and putrefaction processes, which produce volatile malodorous compounds such as cadaverine and putrescine. [4]
Some bacteria can be identified by their odour. For example, aerobic bacteria, such as pseudomonas aeruginosa, are described as grape-like or fishy, while anaerobic bacteria are often rotten-smelling. [5]
It is important to note that while some wounds may have a single cause for the odour, it is common for malodorous wounds to have a combination of causes. [6] Wound malodour may also occur naturally as part of the wound healing process and is not always indicative of an issue with the wound. [7]
Table 1: Common odour-causing bacteria
| Aerobic bacteria |
|---|
|
|
|
|
| Anaerobic bacteria |
|---|
|
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How is wound malodour assessed?
Assessment is an essential part of wound management. However, assessing wound malodour is both challenging and subjective because clinicians and patients often have different perceptions of odour. [8] These variations mean there is no standardised unit of measure for odour, which makes its classification more difficult.
Several scales have been developed to help clinicians describe and monitor the severity of wound malodour. These include the Baker and Haig Scale and the Teler Odour and Impact of Odour Scales. It is important to be aware that most scales do not consider the psychosocial impact of living with a malodorous wound.
In addition to classifying the strength of the odour, assessment should also focus on identifying the root cause[s], as well as examining the broader impact on patients and their carers.
How is wound malodour treated?
There are very few validated treatments for wound malodour, often resulting in a trial-and-error approach, which can lead to variations in care and poorer patient outcomes. [9] Consequently, management should prioritise treating the reversible causes of malodour. Some wounds may have multiple causes for the malodour, which should be treated individually to either reduce or completely eliminate the odour.
In cases where the underlying cause is not treatable, management should focus on making life for the patient more comfortable. This should include odour-neutralising strategies, including the use of charcoal dressings, improving ventilation and aromatherapy.
How can patients with wound malodour be supported?
The impact of wound malodour on patients and their carers is sometimes underestimated. [10] Every person is affected differently by wound malodour depending on their wound, perceptions and lifestyle.
Information should be provided to patients on why their wound is malodorous and how their treatment and dressings will help to eliminate and/or reduce the odour. This may help patients feel more in control of their situation and less daunted by the experience of living with a malodorous wound.
Patients should also be given the time to express their concerns and feelings around wound malodour. Where necessary, patients could be referred for additional mental health support.
Table 2: Impact of wound malodour on patients
| Psychological |
|---|
| Embarrassment |
| Negative body image |
| Physical |
| Nausea |
| Sleep disturbances |
| Social |
| Self-isolation |
| Financial implications |
| Impact on care |
| Lack of confidence in clinicians |
| Resistance to treatment |
| Impact on family, friends and carers |
| Disengagement from patient care |
| Perceived lack of hygiene |
References:
- Mahoney K (2025) Understanding wound malodour: patient and clinician perspectives. J Community Nurs 39(2): 34–8
- Pramod, S (2025) Impact of Wound Malodour on Patients: How to Assess and Manage. J Community Nurs 39(1): 18-25
- Ibid
- Fletcher, J (2008) Malodorous Wounds: Assessment and Management. Wounds UK 3: 14-17
- Pramod, S (2025) Impact of Wound Malodour on Patients: How to Assess and Manage. J Community Nurs 39(1): 18-25
- Gethin, G, Vellinga, A, McIntosh, C, et al (2023b) Systematic Review of Topical Interventions for the Management of Odour in Patients with Chronic or Malignant Fungating Wounds. J Tissue Viability 32(1): 151-157
- Pramod, S (2025) Impact of Wound Malodour on Patients: How to Assess and Manage. J Community Nurs 39(1): 18-25
- Ibid
- Ousey, K. Roberts, D, Gefen, A (2017) Early Identification of Wound Infection: Understanding Wound Odour. Journal of Wound Care 26(10): 577-582
- Pramod, S (2025) Impact of Wound Malodour on Patients: How to Assess and Manage. J Community Nurs 39(1): 18-25
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.