That ratio seems really high, but the smell doesn't necessarily indicated lack of cleanliness. I work at a LTC facility for children w/MR and Autism and many of them wet the bed every night. No matter how quickly you change the sheets, the pull-ups, the trash with the dirty pullup, clean the mattress, mop the floor, etc.... the smell just lingers. It gets in the walls, I think. We have those odor-absorbing blocks, but as long as the clients continues to wet, the smell stays. But the big thing, IMO, is that most facilities either have non-openable windows or it's too cold/hot, etc to open it. No matter what, if there is never fresh air, the smell is never really going to go away.