Volume 41 Number 4

WHAM evidence summary: Use of yoghurt for managing malodorous wounds

Robin Watts and Terena Solomon 

Keywords Wound odour, malodorous wound, yoghurt

For referencing Watts R and Solomons T. WHAM evidence summary: Use of yoghurt for managing malodorous wounds. WCET® Journal 2021;41(4):22-24

DOI https://doi.org/10.33235/wcet.41.4.22-24

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Author(s)

References

中文

Clinical question

What is the best available evidence in the effectiveness of treating yoghurt for managing malodorous wounds?

Summary

Malodour can occur in chronic wounds (e.g., tumours, pressure injuries and venous ulcers). The combination of anaerobic bacterial colonisation, biofilm and necrotic tissue produces the odour. Unless the odour and exudate from malodorous wound(s) are significantly reduced they might have both physical and psychological impacts on the individual with a wound, including embarrassment, depression and social isolation1. Despite a detailed literature search, no evidence has been found that supports the use of yoghurt for reducing malodour in chronic wounds. Research on the effectiveness of probiotics may provide evidence in this field in the future.2

Clinical practice recommendations

All recommendations should be applied with consideration to the wound, the person, the health professional and the clinical context.

There is insufficient evidence on the effectiveness of yoghurt products to make a graded recommendation on their use in reducing odour in chronic wounds.

Sources of evidence: search and appraisal

This summary was developed using methods published by the Joanna Briggs Institute (JBI)3-7. The summary is based on a systematic literature search in English combining search terms that describe malodorous wounds and yoghurt (yoghurt OR live bacillus acidophilus) AND (wound odour OR malignant fungating wound* OR malodorous wound*). Searches were conducted in Embase, Medline, the Cochrane Library, CINAHL, Scopus, Epistimonikos and Google Scholar for dates up to August 2021. Studies were assigned a level of evidence (see Table One) based on JBI’s hierarchy3-7. Recommendations are made based on the body of evidence and are graded according to the system reported by JBI3-7.

 

Table 1. Levels of evidence

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Background

Over time, numerous solutions have been employed in treating the problem of wound odour, some with success8. However, research into comparative effectiveness of different strategies to manage wound odour is lacking. One author refers to ‘trial and error’ being the process of assessing the most effective or ineffective treatments.9 It is only recently that controlled trials have been implemented to provide some certainty of effectiveness10. The results of these studies have now been combined in several systematic reviews11-13.

With commercial development of various treatments, wound malodour can be managed promptly. However, in low resource contexts, wound odour management strategies such as specialised dressings and pharmaceutical products can be beyond the financial reach of the health service or the individual.

Consequently, cheaper alternative methods of treatment have been sought. While some have evidence supporting their use, others have proved unsuccessful in attaining significant clinical benefit, and some are yet to be formally studied. Yoghurt falls into the latter category.

Evidence

Although several journal articles in the 1980s and 1990s mentioned plain live yoghurt in treating wound malodour and exudate, their reports do not provide a research plan nor any data. Among those who considered the use of yoghurt in this period were Benbow, Welch, Schulte, and Haughton and Young with their personal speculations as to how the yoghurt might work14-17 to reduce wound odour.

Haughton and Young declared that yoghurt should not be used due to the possibility of infection from Lactobacillus, leading to this treatment being ceased in many clinical settings despite there being no evidence supporting the claim15. The laboratory development of a unique probiotics-based milk peptide plus hydrogel may challenge this idea. Recent work promoting wound healing via the use of probiotic bacteria or their extracts involves lysates of Lactobacillus, and to date has shown initial promising results2.

Considerations for use

Consider using alternative low cost treatments to manage malodorous wounds, including green tea18, medical-grade honey19, sugar paste15, or rice bran sheets20.

Conflicts of interest

The author declares no conflicts of interest in accordance with International Committee of Medical Journal Editors (ICMJE) standards.

About WHAM evidence summaries

WHAM evidence summaries are consistent with methodology published in:

Munn Z, Lockwood C, Moola S. The development and use of evidence summaries for point of care information systems: A streamlined rapid review approach, Worldviews Evid Based Nurs. 2015;12(3):131-8.

Methods are outlined in detail in resources published by the Joanna Briggs Institute as cited in this evidence summary. WHAM evidence summaries undergo peer-review by an international multidisciplinary Expert Reference Group. WHAM evidence summaries provide a summary of the best available evidence on specific topics and make suggestions that can be used to inform clinical practice. Evidence contained within this summary should be evaluated by appropriately trained professionals with expertise in wound prevention and management, and the evidence should be considered in the context of the individual, the professional, the clinical setting and other relevant clinical information.

Copyright © 2021 Wound Healing and Management Unit, Curtin Health Innovations Research Institute, Curtin University

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WHAM证据总结:使用酸奶处理恶臭伤口

Robin Watts and Terena Solomon 

DOI: https://doi.org/10.33235/wcet.41.4.22-24

Author(s)

References

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临床问题

在使用酸奶治疗恶臭伤口的有效性方面的现有最佳证据是什么?

总结

慢性伤口(例如,肿瘤、压力性损伤和静脉性溃疡)中可能出现恶臭。厌氧性细菌定植、生物膜和坏死组织结合会产生异味。除非恶臭伤口的异味和渗出液显著减少,否则可能会对伤口患者产生生理和心理影响,包括尴尬、抑郁和社会孤立1。尽管进行了详细的文献检索,但未发现支持使用酸奶来减少慢性伤口恶臭的证据。对益生菌有效性的研究可能会在未来为该领域提供证据。2

临床实践建议

采用所有建议时,应考虑伤口、患者、专业医护人员和临床环境。

目前没有足够的证据可证明酸奶产品的有效性,因此无法对其在减少慢性伤口气味方面的用途提出分级建议。

证据来源:检索和评价

本总结是采用乔安娜·布里格斯研究所(JBI)公布的方法得出的3-7。本总结以系统性的英语文献检索为基础,并结合描述恶臭伤口和酸奶(酸奶或活性嗜酸乳杆菌)和(伤口异味或恶性蕈状伤口*或恶臭伤口*)的检索术语。在Embase、Medline、考克兰图书馆、CINAHL、Scopus、Epistimonikos和Google Scholar等数据库中进行了检索,日期截至2021年8月。根据JBI的等级划分,对研究进行了证据水平(见表1)的划分3-7。建议是根据大量证据所提出的,并根据JBI报告的系统进行评分3-7

 

表1.证据水平

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背景

随着时间的推移,已采用许多解决方案来治疗伤口异味问题,其中一些方案已取得成功8。然而,目前还缺乏比较不同处理伤口异味策略有效性的研究。一位作者提到“反复试验”是评估最有效或无效治疗的过程。9直到最近,才进行了对照试验,以提供一定的有效性。这些研究的结果现已合并在几项系统性综述中11-13

随着各种治疗方法的商业化发展,现已可以迅速控制伤口异味。然而,在资源匮乏的情况下,伤口异味管理策略(如专用敷料和药品)可能超出医疗服务机构或个人的经济能力范围。

因此,人们一直在寻找更便宜的替代治疗方法。虽然有一些替代治疗方法有证据支持其用途,但其他替代治疗方法已被证明无法成功获得显著临床益处,还有一些替代治疗方法尚未正式研究。酸奶属于后一类。

证据

虽然20世纪80年代和90年代的几篇期刊文章提到了纯活酸奶治疗伤口异味和渗出液,但其报告中未提供研究计划或任何数据。在这一时期考虑使用酸奶的人包括Benbow、Welch、Schulte、Haughton和Young,他们对酸奶如何减少伤口异味14-17进行了个人推测。

Haughton和Young声明,由于乳酸菌有可能造成感染,所以不应该使用酸奶,导致在许多临床环境中停止使用这一治疗方法,尽管没有证据支持这种说法15。实验室开发的一种独特的以益生菌为基础的牛乳肽加水凝胶可能会挑战这一想法。最近通过使用益生菌或其提取物促进伤口愈合的工作涉及乳酸菌的裂解物,迄今为止已初步显示出良好成果2

使用注意事项

考虑使用替代低成本治疗方法来处理恶臭伤口,包括绿茶18、医用级蜂蜜19、糖膏15或米糠片20

利益冲突

根据国际医学期刊编辑委员会(ICMJE)的标准,作者声明没有利益冲突。

关于WHAM证据总结

WHAM证据总结与以下出版物中发表的方法一致:

Munn Z,Lockwood C,Moola S。医护信息系统(一种简化的快速审查方法)证据总结的开发和使用,Worldviews Evid Based Nurs。2015;12(3):131-8.

本证据总结中引用的乔安娜·布里格斯研究所发表的资源中详细概述了方法。WHAM证据总结经过国际多学科专家参考小组的同行评审。WHAM证据总结提供了关于特定主题的最佳可用证据的总结,并提出了可用于指导临床实践的建议。本总结中包含的证据应由经过适当培训的具有伤口预防和管理专业知识的专业人士进行评价,并应根据个人、专业人士、临床环境以及其他相关临床信息考虑证据。

版权所有©2021科廷大学科廷健康创新研究所伤口愈合和管理组织

 

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Author(s)

Robin Watts*
AM, PhD, MHSc, BA, Dip NEd, FRCNA
Emeritus Professor, Curtin University, School of Nursing, Midwifery and Paramedicine, Wound Healing and Management (WHAM) unit

Terena Solomon
BA, Grad Dip Lib Sc ALIA
Curtin University

* Corresponding author    

References

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  2. Mohammedsaeed W, Cruickshank S, McBain AJ, O’Neill CA. Lactobacillus rhamnosus GG lysate increases re-epithelialization of keratinocyte scratch assays by promoting migration. Scientific reports, 2015;5:16147.
  3. Munn Z, Lockwood C, S. M. The development and use of evidence summaries for point of care information systems: A streamlined rapid review approach. Worldviews Evid Based Nurs, 2015;12(3):131-8.
  4. Aromataris E, Munn Z, editors. JBI 2021. Manual for Evidence Synthesis. https://synthesismanual.jbi.global: Joanna Briggs Institute.
  5. Joanna Briggs Institute Levels of Evidence and Grades of Recommendation Working Party. New JBI Grades of Recommendation. 2013. https://jbi.global/sites/default/files/2019-05/JBI-grades-of-recommendation_2014.pdf: Joanna Briggs Institute.
  6. Joanna Briggs Institute Levels of Evidence and Grades of Recommendation Working Party. Supporting Document for the Joanna Briggs Institute Levels of Evidence and Grades of Recommendation. 2014. https://jbi.global/sites/default/files/2019-05/JBI%20Levels%20of%20Evidence%20Supporting%20Documents-v2.pdf: Joanna Briggs Institute.
  7. Joanna Briggs Institute Levels of Evidence and Grades of Recommendation Working Party. JBI Levels of Evidence. 2013. https://jbi.global/sites/default/files/2019-05/JBI-Levels-of-evidence_2014_0.pdf: Joanna Briggs Institute.
  8. Akhmetova A, Saliev T, Allan IU, Illsley MJ, Nurgozhin T, Mikhalovsky S. A comprehensive review of topical odor-controlling treatment options for chronic wounds. J Wound Ostomy Cont Nurs, 2016;43(6):598-609.
  9. Gethin G, Grocott P, Probst S, Clarke E. Current practice in the management of wound odour: An international survey. Int J Nurs Stud, 2014;51(6):865-74.
  10. Villela-Castro DL, Santos VL, Woo K. Polyhexanide versus metronidazole for odor management in malignant (fungating) wounds: a double-blinded, randomized, clinical trial. J Wound Ostomy Cont  Nurs, 2018;45(5).
  11. da Costa Santos CM, de Mattos Pimenta CA, Nobre MRC. A systematic review of topical treatments to control the odor of malignant fungating wounds. Journal of Pain and Symptom Management, 2010;39(6):1065-76.
  12. Winardi A, Irwan AM. Topical treatment for controlling malignant wound odour. EWMA Journal, 2019;20(2):7-15.
  13. Caldeira Brant JM, Teodora da Silva LH. Efetividade do metronidazol tópico e/ou sistêmico no controle do mau odor de tumores malignos fétidos: revisão sistemática. Revista da Faculdade de Odontologia de Porto Alegre, 2021;62(1):121-8.
  14. Benbow M. Malodorous wounds: how to improve quality of life. Community Nurse, 1999;5(1):43-6.
  15. Haughton W, Young T. Common problems in wound care: malodorous wounds. Br J Nurs, 1995;4(16):959-63.
  16. Schulte MJ. Yogurt helps to control wound odor. Onc Nurs Forum, 1993;20(8):1262.
  17. Welch LB. Buttermilk & yogurt: odor control of open lesions. Crit Care Update, 1982;9(11):39-44.
  18. Lian SB, Xu Y, Goh SL, Aw FC. Comparing the effectiveness of green tea versus topical metronidazole powder in malodorous control of fungating malignant wounds in a controlled randomised study. Proceedings of Singapore Healthcare, 2014;23(1):3-12.
  19. Samala RV, Davis MP. Comprehensive wound malodor management: Win the RACE. Cleve Clin J Med, 2015;82(8):535-43.
  20. Hayashida K, Ogino R, Yamakawa S, Shirakami E. Antiodor effects of rice bran sheets in patients with malodorous wounds. J Palliat Med, 2020;23(6):750-1.

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