Odor control: not just a cover-up: based on an interview with Charles O'Brien, Ecolab.

If you look at almost any written guide or Web site devoted to helping people shop around for a nursing home or other long-term care facility for a loved one, you will find it suggests that you ask yourself an important question: "How does the facility smell?" If it smells anything like an old bedpan, you are urged to keep looking. If the air is laden with a heavily perfumed smell, aimed at covering up malodors, that's probably another good indication that you should continue your search.

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Because odor control is such a significant issue in long-term care--a marketing deal maker or deal breaker, really--Nursing Homes/Long Term Care Management asked Charles O'Brien, a tech support specialist with Ecolab's Shared Technical Services Department, to comment on recent advances in odor control in the healthcare environment and how various products are best applied. His answers follow.

Naturally, the first and most important step in any odor-control strategy is to try to eliminate the source of malodors rather than merely trying to combat the odors themselves. Disinfectants, enzymatic agents, and detergents are the first and best line of defense against malodors, because these products can remove or kill the material causing the unpleasant smells. Not all malodors can be fully controlled by cleaning and disinfecting alone, however. In such cases, the second line of defense is odor-control products.

There are basically three types of odor-control products: air fresheners, odor counteractants, and odor-eliminating products. Odor control has improved significantly in recent decades, with the development of odor counteractants, followed by the development of odor eliminators. These advances have allowed healthcare housekeeping and maintenance departments to move away from using fragrances designed simply to mask unpleasant smells with pleasant ones.

Air fresheners have come to be used less and less often as the odor counteractants and odor eliminators have become more sophisticated. Nevertheless, some facility managers prefer to have a fresh scent in the air to give a good impression, and there are many choices of fragrances available in these products.

On the other hand, odor counteractants are chemical compounds that are paired up with malodorous materials in such a way as to prevent the human olfactory sense from perceiving the malodors. When counteractants are in use, instead of only smelling the unpleasant odor, people are exposed to two different compounds: the malodor and the chemical matched with it that changes how their noses sense it. A classic example of this would be using lemon juice on fish: The fish odor is still present, but the scent of the lemon changes how it is perceived.

Odor eliminators are the third generation of odor control products. They chemically bind with a malodorous compound and change its nature, so that it no longer emits an unpleasant smell. Some of these products are bactericidal, actually killing the bacteria that are causing the malodor; as such, they are really as much a part of the cleaning process as they are part of odor control. With these products, it is sometimes possible to eliminate odors before they are even detectable which, of course, is preferable.

It helps to use the right "tool" for each odor-control job. For example, for organic materials such as urine, feces, and vomit, as mentioned earlier, the first step is always to clean them up. Having done that, you can handle any lingering odors with odor counteractants. Similarly, in a resident room or any area where ostomy care is given, if there are issues of cleanliness and contamination, those must be dealt with first, followed by odor counteraction.

The odor counteractants aren't, by the way, a "one-product-fits-all" proposition. There are several different compounds used to produce odor pairs--for example citrus, pine, and other formulations. It's a good idea to try several counteractants in order to find which one is most agreeable to the people in the environment where it will be used. These products are also well suited for controlling kitchen and bathroom odors. In fact, generally speaking, the odor counteractants are best suited for controlling any malodors in the air.

The odor-elimination products, on the other hand, may be required in places where malodors might have penetrated, such as curtains, carpeting, and furniture (either upholstered or not). These products are designed to penetrate the surface and actually chemically alter the malodorous materials, hence stopping them from smelling bad.

Another area where odor control might be needed in a long-term care facility is in the heating, ventilation, and air-conditioning (HVAC) system. Some systems introduce malodors by pulling in malodorous air from outside; in other cases, the source of unpleasant smells might be somwhere within the HVAC system itself. Again, it would be foolish not to first focus one's attention on eliminating the sources of any malodors, if possible, such as mold, mildew, or soil material within the system. But if the quality of the air source can't be controlled or if the source of the malodor is somewhere difficult to reach for cleaning, such as in the middle of a long section of ductwork, odor control products can help.

There are solids, liquids, and gels that can be placed in the HVAC system that dissolve into the system over time at a rate that can be predicted by the rate of airflow. In other words, if there is a constant flow of air, they will dissolve faster than in an environment with static or no air movement. These could either be air fresheners, odor counteractants, or odor eliminators.

As with any products used in an inhabited environment, it's important that all these products be used according to the safety information supplied with them. If anyone experiences discomfort or irritation where a product is being used, it should be discontinued or only used when that person isn't present in the particular space.

In summary, it is vitally important to recognize that odor control is a two-tiered process. The first, and primary, tier involves the cleaning and disinfecting of all soiled surfaces. The second tier, which is also important, entails the treatment of odors that sometimes persist despite the most fastidious cleaning and disinfection efforts.

Odor control is not only an issue of quality of life for long-term care residents, but it is also an issue of first impressions. What visitors to a nursing home can perceive with their noses might very well be the first impression they get. It ought to be a pleasant one.

Charles O'Brien is a tech support specialist, Shared Technical Services Department, Ecolab. For more information, phone [phone] or visit www.ecolab.com. To comment on this article, please e-mail [e-mail].