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 Case mgmt., rehab, (CRRN), LTC & psych.
TruvyNurse said:
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.

The fecal matter of patients who regularly take iron supplements also has an interesting appearance, if you know what I mean...

Now that we are on the subject of poop, the smell of C. difficile is unforgettable.

TheCommuter said:
The fecal matter of patients who regularly take iron supplements also has an interesting appearance, if you know what I mean...

Now that we are on the subject of poop, the smell of C. difficile is unforgettable.

I agree with BOTH...oh C.Diff...

Specializes in Gastrointestinal Nursing.

Gi bleed is an odor that is unmistakable and is very hard to remove from the nose once it's in there!

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.

It depends how obese they are. If they are morbidly obese, they do sweat more and have trouble reaching certain areas to get clean. Many years ago, I had a patient who was over 500 lbs. She had to sleep sitting up in a recliner so she could breath. We had to have 5 people assist during a bed bath to move her. One afternoon, I kid you not, we found a half sandwich in her pendulous abd. She had no idea it was there. We didn't tell her either. Didn't want to embarrass her. If patients are only getting a bath 1x a week and there is a sandwich where it shouldn't be, it is gross. I just can't do patient care anymore. One of the reasons (and there are many) is the disgusting smells. I never got used to it. I never let the patients know I was about to hurl my lunch (or dinner), I'd pretend like it was no big deal.

One time, many years ago, I was working on an oncology unit. A woman had breast cancer and the smell of necrotic tissue did it for me. I went and threw up in the bathroom. I felt horrible for her. Just can't be around gross smells.

The smell of vomit :grumpy:! I can handle all the other ones just fine. But vomit is my nursing Achilles heel, I grin and deal at work, but at home my husband is the designated vomit picker upper for the kids if he is home lol. I don't know why it makes me gag when no amount if c.diff poo ever does.

Specializes in PICU, Pediatrics, Trauma.
VivaLasViejas said:
Another group that may face criticism is the mentally ill, many of whom neglect to shower for days or even weeks at a time. This is very common in depression, when it seems like too much bother to run the water, get in the shower, wash hair, rinse, dry off, and then dress in clean clothes. Needless to say, this practice makes a person smell bad, and I've seen nurses wrinkle their noses and say unflattering things behind the patient's back. "Why doesn't ____ just take a bath? He REEKS!" they'll say with distaste. They don't know that failure to maintain physical hygiene is a complex issue that has no easy solution.

Yes, and then there are the ones who purposely want to smell bad as a way of protection to keep others away. Especially the homeless/vulnerable ones or the paranoid ones.

Specializes in PICU, Pediatrics, Trauma.
Brenda F. Johnson said:
Gi bleed is an odor that is unmistakable and is very hard to remove from the nose once it's in there!

OH YES! That and sloughing bowel tissue in brain dead patients are the worst for me.

Specializes in LTC, assisted living, med-surg, psych.

Worst smell I ever dealt with was that from a patient who was vomiting bloody feces. I don't think I got that odor out of my nose (and scrubs) for a week.{{{shudder}}}

Specializes in Hospital medicine; NP precepting; staff education.
VivaLasViejas said:

Worst smell I ever dealt with was that from a patient who was vomiting bloody feces. I don't think I got that odor out of my nose (and scrubs) for a week.{{{shudder}}}

Yes, and that was the only time I gagged in the patient's room. I was trying to put in an NGT at the time.

After 20 plus years in Nursing, esp LTC, I have noted that there is apparently a fear involved with the lederly, especially the fear of falling, and some even have the old time fear of catching "their death of a cold". My gag reflex kicks in with staph related (MRSA) sputum and phlegm. I can handle even the nastiest fecal bacteria, but the mucous seems to get me krunked up severely. As an animal, child and elder advocate, I make sure not to ever let them know they caused me this distress, but I kindly do tell them they have a body odor issue, and would they allow a gentle bathing, even if I need to perform this myself, and not ask an aide to deal with an upset patient. I guess after all these years, how my patient feels is more important to me, and getting to the root of the problem by seeking out an answer can save you and your patient emotional pain. I am still also surprised when I run into a patient who was actually raised taking a bath or less a week, still suprised me, but shouldn't. I've done some backwoods rural general nursing, and nothing should suprised me. This was a really interesting discussion to run across. Just remember, you became a nurse for a reason. If that reason is the right one, understanding your patients feelings on hygiene is the most important first step. And you grow from each experience.

I wrote this on another thread, but I recently had to manually drain my dogs impacted anal glands. :wtf:

Let me tell you, the stench was enough to gag a maggot.

Specializes in CVICU CCRN.
WKShadowRN said:

Yes, and that was the only time I gagged in the patient's room. I was trying to put in an NGT at the time.

Me three (Viva). Had a patient found down in the community - apparently for an extended time. Confused and weak as a kitten but refusing an NG with all her might. Bowel obstruction, GI bleed, fecal emesis.... we all learned a lot that night. I never did find out what was going on with the patient, but we had to do an emergent ethics staffing because she was refusing care but too confused to make decisions.

Not a great night. I chucked the scrubs in the biohazard bin on my way out the door.