Tracheostomies and their dressings can obtain strong smells due to secretions and bacterial colonizations/infections. The most appropriate initial action is to continue cleaning the site and change the trach ties. Once the old dressing and ties are discarded and the stoma is cleansed, the nurse can assess for signs of infection. A strong smell of dirty gym socks may be indicative of colonization or infection with Acinetobacter baumannii. If the smell persists, the nurse assesses for signs of infection; a complete blood count (CBC) can help to determine if the patient is experiencing an infection. If the CBC reflects an infection, then a tracheostomy aspirate culture and sensitivity can be performed. A silver-impregnated dressing may be helpful, but this is not the most appropriate initial action.