Controversial Patient Odors in Nursing

Body odor is a somewhat controversial topic. More specifically, there is the persistent belief that certain groups of patients are more odorous than others. This piece will highlight several groups of patients who, rightly or wrongly, have been deemed more odorous than usual. Nurses General Nursing Article


In fact, the mere mention of body odor can trigger a knee-jerk reaction in some persons. Moreover, any nurse who has worked on the floor or in a home care setting can attest to the reality that not all patients, clients, or their families come to the table smelling cleanly. In other words, body odor often comes with the territory during the delivery of direct patient care.

Some unpleasant stenches are certainly to be expected in the nursing profession. For example, every health care worker is cognizant that fecal matter has an unpleasant odor. Urine-stained linens, briefs and pads sometimes reek strongly of ammonia. Smelly phlegm in the intranasal area is usually associated with sinus infections, while pneumonia caused by bacterial agents such as Pseudomonas aureginosa result in sputum with a notable smell that characteristically blends sweetness with foulness. Furthermore, depending on the causative agent or microbe, infected wounds can generate lingering odor that is capable of knocking the strongest clinician to his or her knees.

In spite of the usual and customary smells commonly associated with the provision of hands-on nursing care, several types of patients are believed to be more odorous than normal. It should be highlighted that, fairly or unfairly, some nurses have expressed a visceral dislike of a few of these patient populations, which may or may not affect their perceptions of the supposed body odors. After all, a person's perception is his or her reality, and perceptions can definitely be clouded by a strong loathing of the patient in that hospital bed. Without further ado, the following types of patients and their purported aromas will be elucidated.

Patients With Renal Failure

Patients who have been afflicted with severe chronic kidney disease or end stage renal failure are often the subject of various complaints from health care staff. Many outpatient dialysis nurses gripe nonstop about the inappropriate behaviors of some of their clients while conveniently failing to mention any of the well-mannered, compliant patients they have. It is negativity bias at its finest: belligerent patients who arrive at the dialysis center late while cursing at the staff will make a more profound impression than those who are polite.

On the other hand, patients with renal failure can sometimes possess the characteristic smell of ammonia due to nitrogenous waste byproducts that leave their bodies through their skin. When the kidneys are no longer functional, they can no longer expel nitrogenous waste effectively through the genitourinary system. These waste products exit the body via the patient's skin, resulting in the unmistakable smell of ammonia.

Patients With Obesity

Unfortunately, the overweight and obese are one of the last groups of people who can experience legal discrimination in most American states. Obesity is a poorly understood phenomenon, as evidenced by legions of physicians and nurses who exclaim with disgust that their rotund patients simply need to put the fork down. Simply put, a sizable number of health care workers harbor overt or hidden biases against obese patients. Countless health care personnel also claim that their obese patients smell badly. A recent Google search of the term "obese odor" generated 464,000 hits, and a search of the phrase "obese stench" yielded a whopping 885,000 results.

Here is the deal: adipose (fat) tissue is odorless. However, since many people are disgusted by the obese, perhaps they perceive that their heavier counterparts smell worse than others. When a person with a normal body weight smells badly, poor personal hygiene or other issues are often blamed. Yet, if a heavyset person has an odor, it is almost instantly blamed on obesity. Is the double standard becoming apparent?

Homeless Patients

Homelessness and health are interconnected. Homeless patients tend to be in poorer health than their counterparts who possess stable housing. Additionally, since the vast majority of homeless patients lack health insurance coverage, they sometimes utilize hospital emergency rooms to receive care. A number of health care workers express disdain toward homeless patient populations, making statements such as, "They need to pull themselves up by the bootstraps and find jobs like the rest of us."

A growing patient population exists; they are known as the 'invisible homeless' or the 'hidden homeless.' These patients live in shelters, weekly rate motels, campers, RVs, or tents in the wilderness. They are often part of the working poor, so they never have enough money to conjure up the security deposit and first month's rent required by landlords to rent a permanent dwelling. These homeless people are usually cleanly and without body odor because they have access to shower facilities at a shelter, motel, friend's house, health club, or campground.

Likewise, the visible homeless (read: the unsheltered individuals who 'sleep rough' in parks, alleys, cars and other places unintended for human shelter) may smell offensively. Regularly unable to bathe or shower, they can sometimes possess the smell of destitution, which is the smell of pungent sweat, filth and/or urine (Kozol, 1988).

Specializes in Public Health, TB.
Ruby Vee said:
Once they land in LTC, the norm is bathing once a week. If they smell bad, perhaps it's not their own fault.

Yup, we just finished a clinical rotation at an ECF, that does take some folks rehabbing from hip surgery. Once a week showers.

A bazillion years ago as an aide, and then an LPN, it was 2, sometimes, 3 times a week for shower or tub bath.

Specializes in Public Health, TB.

There is also the smell of liver failure (fetor hepaticus).

When I worked at an inpatient hospice and the patients were on high doses of morphine, I swear I could smell it on their breathe and skin. I was told that was the "smell of cancer", but I think it was the morphine. Especially when I had a chance to smell tincture of opium.

Specializes in Med/Surge, Psych, LTC, Home Health.
Ruby Vee said:
I want to know where you work! My mother (in Wisconsin) and mother-in-law (in Massachusetts) get weekly showers unless we wish to pay extra for a second shower every week. Or unless they make a really big mess.

I've worked in 4 different LTC facilities here in Kentucky, and they all also had the policy

of bathing residents twice weekly.

Specializes in retired LTC.

Pseudomonas a. wounds, incl UTIs, esp if the pt is diabetic. Nasty odor but the blue-green color is a pretty one.

Every time I see the color turquoise for anything, I think Pseudomonas. Kinda changes your mind ....

Didn't this bug get its name changed some time back?

The only smells I find to be a true challenge to work through are: decaying/rotting flesh (stays in your olfactory/gustatory system for days like formaldehyde but smells/tastes distinctly worse) and C.diff.

Malodorous scents are part and parcel with nursing work. All patients get stinky or emit a smell (at some point) and I don't know many nurses who don't accept this reality and assist them with hygiene, as required/appropriate. However, the OP's references to "Patients With Obesity" and discrimination not only seems a bit like sensationalism, but it neglects to address the fact that skin folds present an issue. Obese patients usually require extra attention to these areas and cleansing more routinely because sweat, etc gets trapped in these areas and... I don't see how that correlation = discrimination. To me, this is a "whatever" and an obese patient gets that extra hygiene care because it is required to prevent other complications (ex. intertrigo, fungus, sores, and YES unpleasant odors resulting from moisture/bacteria/infection).

I certainly agree that obesity discrimination is a real thing, but I have (thankfully) never witnessed/experienced it in the workplace. Nor have I ever seen a lack of compassionate care delivered simply because someone was overweight. Care is care regardless of the patient's size, skin color, ethnicity, beliefs, religion, etc...

Homelessness related hygiene issues break my heart because of the extreme barriers they experience to basic human rights of access to shelter, water, sanitation, to name a few. When I have cared for homeless patients in the past, barriers to hygiene were often sadly linked with a mental health issue. For ex., a homeless holocaust survivor would have flashbacks with any reference to bathing, or showers and would violently resist bathing to the point of developing sores all over his body. Seeing people neglected in any way breaks my heart.

Slender people do not have a pannus that droops halfway to the floor, so yes I think morbidly obese people smell sometimes to the point of needing a mask on when doing a skin assessment.

I have been a nurse in LTC before, and unfortunately the elderly can have an odor. And as far as showering, it usually is two-three times a week unless otherwise specified. But we don't actually need to shower as often as we think. It is unhealthy to shower daily, and the DON who said that about drying out the skin was correct. And nobody is discriminating against the obese - they do often come with an odor, and hygiene is more difficult for them. It's just a fact.

Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
DeeAngel said:
Slender people do not have a pannus that droops halfway to the floor, so yes I think morbidly obese people smell sometimes to the point of needing a mask on when doing a skin assessment.

I stand by my assertion that when a slender person smells offensively, the odor is typically attributed to issues such as poor personal hygiene or problems external to the individual.

However, when an obese person smells badly, it is almost always attributed to the sweeping generalization that "fat people just smell a certain way." Nonetheless, I have encountered a fair share of both normal-weight people and overweight/obese persons with body odor.

Can You Smell Obesity? |

To many, fat stigma makes obesity smell foul - LA Times

Specializes in Psych.

Skip that shower – a daily wash is doing you more harm than good - BT

There are multiple studies reporting that Americans overbathe, and it opens the skin up to dryness, cracks, and reception for bacteria. Odour is largely a cultural phenomenon. A 'bird bath' - cleaning the pits and crotch and hair as it gets oily is perfectly healthy according to many studies.

On the other hand, I have kidney disease and would want to know if toxins are building up and making it unpleasant for people to be around me. But showering is a very temporary measure.I cannot even use regular antiperspirant because of the aluminum in it, but I found a deodorant that seems to work quite well.

In general, I protest the stigma, and advocate for personal bathing choice as long as infection control is taken into consideration. Speaking of which, if we want to begin controlling cross-contamination, assisting pts with a good nail cleaning and perhaps trim might be a good start in terms of real transmittable threat of germs.

Specializes in Psych.
TheCommuter said:
I stand by my assertion that when a slender person smells offensively, the odor is typically attributed to issues such as poor personal hygiene or problems external to the individual.

However, when an obese person smells badly, it is almost always attributed to the sweeping generalization that "fat people just smell a certain way." Nonetheless, I have encountered a fair share of both normal-weight people and overweight/obese persons with body odor.

We have to be careful about our assumptions of why people are slender, too. Slenderness can have just as pathological causes as obesity, not 'poor personal hygiene.' I've said it elsewhere, but I'll repeat: I'm slender, and have kidney failure. The uremic pruitis makes me scratch unbearably and has been mistaken for a drug symptom. Maybe the ammonia makes me stink. I don't know. Good stuff to ponder.

Specializes in progressive care, cardiac step-down.

I think the "fat people smell" that you refer to is the yeasty odor that is found in the skin folds. It is a different smell than what is found in the underarm and peri areas (hot spots). An obese person and a person with a healthy BMI can be equally stinky in the hot spots, but a person without folds, even with questionable hygiene, will not have the issues with moisture and bacteria that an obese person can have. Morbidly obese patients with limited mobility are not always able to clean and dry thoroughly, and I think that's where the stereotype comes from. That said, I agree that there is a lot of discrimination and poor treatment of obese patients, and I work at an accredited bariatric surgery center.

The one smell I cannot stand is feces of someone on Iron supplements. LOL. I don't know why it grosses me out so much.