A Practical Approach to Managing Wound Odor

Background

Foul-smelling, non-healing wounds are common among hospice and palliative care patients with advanced illnesses — including those with pressure ulcers, vascular disease, or tumors. Odor can deeply affect patients’ self-esteem, social interactions, and emotional well-being, often making them feel isolated¹. This issue provides a concise overview of effective, evidence-based strategies for reducing and masking wound odors.

Understanding the Cause

Wound odor typically results from anaerobic and gram-negative bacteria producing malodorous by-products. Even without deep infections, these bacteria can cause significant odors.

Addressing the Cause of Odor

1. Cleanse the Wound²

• Remove necrotic tissue using mechanical debridement (e.g., wiping with moistened gauze).
• Use wound cleansers with hypochlorous acid to reduce bacteria and fungi.
• For strong odors, use 0.125–0.25% sodium hypochlorite solution.
• Preservative-free, room temperature normal saline is similar in efficacy and safety as a non-irritating agent

2. Control Infection

• Metronidazole: used off-label to reduce odors by working as an anti- inflammatory as well as an anti-infective agent against anaerobic bacteria³. It is available in the following preparations. Commercially available topical gel (0.75% and 1%) Applied once or twice daily Costs can range from $120-$150 Crushed oral tablets – sprinkled into wound and covered with dressing Significantly more cost effective than gel ($0.45 per tablet) Applied once or twice daily Compounded metronidazole 5% topical powder Alternative to crushed tablets Injection solution soaked in gauze or dressings Systemic Metronidazole Reserved for deeper or systemic, more severe infections
• Topical Silver Sulfadiazine: Reduces odor in superficial wounds⁴⁵ (~$20).
• Cadexomer Iodine: Offers slow-release antimicrobial action and absorbs exudate—ideal for odorous, draining wounds.
• Natural Options: Medical-grade honey: Bactericidal and may reduce both odor and pain⁵.

Hiding the Odor

Aromatics

• Use essential oils, peppermint, coffee grounds, or cider vinegar to neutralize odors in rooms. Oils are applied to the outside of the wound dressing.
• Avoid strong perfumes that may irritate patients.
• Immediate disposal of saturated dressings will also assist in odor control.⁶

Adsorbents

• Activated charcoal (briquettes or dressings) effectively absorbs odor.
• Baking soda between dressings can help.
• Cat litter can also serve as a low-cost alternative for room odor control.

Support & Education

Odorous wounds can cause embarrassment, shame, and isolation.

• Encourage psychological and spiritual support for patients and families.
• Educate caregivers on wound cleaning, odor management, and emotional sensitivity.
• Healthcare professionals should remain composed—avoid showing distress in front of patients.

Final Note

Wound odor is more than a clinical challenge — it’s an emotional one. It can quietly erode a patient’s confidence, strain family visits, and weigh on caregivers who feel they’re never doing enough. Addressing it well isn’t just about choosing the right cleanser or dressing; it’s about preserving dignity in the small, everyday moments of care.

For hospice teams, those moments define the quality of the experience — for patients, for families, and for staff. Every gentle approach, every small improvement in comfort, is an act of respect that carries further than we often see.

About Wise

Wise Hospice Options partners with hospices nationwide to strengthen medication management and financial oversight across every facet of care. Our unified platform supports mobile prescribing, cost transparency, and integrated reporting — giving clinical and administrative teams the data and confidence to act quickly, safely, and in full compliance.

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