Beruflich Dokumente
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in clinical practice
Abstract
In the current healthcare environment, clinicians are increasingly
under pressure to use wound care products that are cost-effective. This
includes products that can be used in a variety of wounds to achieve
different outcomes, depending on the wound-bed requirements.
Medical grade honey has emerged as a product that can achieve a
variety of outcomes within the wound and is safe and easy to use.
This article reviews the use of a medical grade honey (Medihoney)
in various clinical applications, with a view to placement on the
wound care formulary in both primary and secondary care. It
provides an in-depth account of case studies featured in a poster
presentation at the 2008 European Wound Management Association
meeting in Lisbon, Portugal.
Key words: Formulary n Honey n Medical grade n Tissue viability
n Wound care
I
n recent years, honey has re-emerged as a wound
care product that can be used on a variety of wounds.
Honey is produced by bees as their food store for the
hive during winter. Honey consists of 20% water and
80% sugar (Molan, 2005) and contains enzymes added by
the bee. In more recent years, honey products have become
available as a sterile, regulated medical device and are often
referred to as medical grade honey. These products have
been shown to be effective in treating a variety of wound
types, including venous leg ulcers, pressure ulcers, burns,
surgical wounds, necrotizing fasciitis, diabetic foot wounds,
grafts and various oncological wounds (White and Molan,
2005; Molan, 2006; White and Acton, 2006; Emsen, 2007;
Gethin and Cowman, 2008).
Currently there is a need to source wound care products
that are safe, effective and easy to obtain in both primary and
secondary care, to enable continuity of care and reduce the
need for many different products throughout the wound-
healing process. Not all medical grade honeys work in the
same way, so they should not be referred to collectively
Claire Acton, Gillian Dunwoody
(Molan, 2002). Clinicians need to be aware of how individual
honey products work within the wound environment before
using them in practice.
This article provides an in-depth account of the case
histories featured in a poster presentation to the 2008
European Wound Management Association meeting in
Lisbon, Portugal. The poster used case studies to illustrate the
effects of a medical grade honey in clinical practice in both
primary and secondary care settings; the aim was to show
that medical grade honey is an effective product, and should
be included in a wound care formulary.
Medical grade honey
There are many medical grade honey products available
for use in wound management; Medihoney (Medihoney,
Slough) is one example. However, not all honey products
are the same: for example, they have differing antibacterial
potencies, which affects the efficacy of the mode of action
(Molan, 2002).
Medihoney consists of a blend of Leptospermum honeys.
The genus Leptospermum comprises more than 80 species of
plants, including two Australian species (L. semibaccatum and L.
polygalifolium), also known as jelly bush, and a New Zealand
species (L. scoparium), also known as manuka. Only honey from
these specific Leptospermum species have been shown to have
exceptional antibacterial activity (Cooper, 2005; 2008).
Medical grade honey has been identified as having five key
modes of action: antimicrobial; anti-inflammatory; promotes
debridement in sloughy and necrotic wounds; provides a
moist, wound environment; and reduces wound malodour.
Antimicrobial: The high-sugar, low-water content of medical
grade honey means that bacteria within a wound dressed
with a honey product have insufficient water to support their
growth (Molan, 2002), while the low pH of 3.9 inhibits their
growth (White, 1979; Dissemond et al, 2003). The low levels
of hydrogen peroxide produced by the dilution of honey
in wound exudate also have an antibacterial action (Molan,
2005), as do the naturally occurring phytochemicals found
only in Leptospermum honey (Simon et al, 2006).
Anti-inflammatory: The osmotic action of honey draws lymph
out of the cells, thereby reducing oedema (Molan, 2005).
Promotes debridement in sloughy and necrotic wounds: Honey
maintains a moist wound environment, aiding autolytic
debridement (Robson, 2002). Because of the speed of
debridement when using honey, there is likely to be an
associated enzymatic action; it has been suggested that honey
may activate plasmin, which then breaks down the blood clots
binding necrotic tissue to the wound bed (Molan, 2005).
Claire Acton is Tissue Viability and Vascular Nurse Specialist,
Surgical Directorate, Queen Elizabeth Hospital NHS Trust, London,
and Chairperson of the Tissue Viability Nurses Forum (South); and
Gillian Dunwoody is Tissue Viability Clinical Nurse Specialist,
Bromley Primary Care Trust, Kent
Accepted for publication: September 2008
S38 British Journal of Nursing, 2008 (TISSUE VIABILITY SUPPLEMENT), Vol 17, No 20
present for 6 months and were slow to heal, and there were
continuous infections requiring systemic antibiotic therapy.
Medihoney was selected as an appropriate dressing to
achieve the treatment goals, which were to:
Debride necrotic tissue from the wound bed
Reduce bacterial load
Promote the growth of granulation tissue, enabling the
wound to progress through the healing phase.
Medihoney wound gel was used with hydrofibre
secondary dressing under compression bandaging. Figure 1b
shows the ulcer after 101 days treatment. Previously the
patient had received no compression therapy, and dressing
pads had been applied to the ulcers to mop up the fluid,
but without success. There appeared to be a reduction in
the bacterial load at the wound bed; as a result, the patient
no longer required antibiotics, unlike previously, and the
wound showed granulation tissue formation. The nursing
staff found the product easy to use and the patient was
comfortable with the dressing in place.
Case study 2
An 85-year-old woman, who was immobile and bed bound,
presented with a grade 3 pressure ulcer (European Pressure
HONEY
British Journal of Nursing, 2008 (TISSUE VIABILITY SUPPLEMENT), Vol 17, No 20 S43
Figure 4a. Chronic
grade 4 (EPUAP)
ischial pressure ulcer.
Figure 4b. Wound bed
showing successful
debridement of slough
and necrosis after
61 days treatment
with Medihoney
wound gel and
Sorbion Sachet S
secondary dressing.
Figure 5a. Venous
leg ulcer of 3 years
duration.
Figure 5b. Wound bed
is clean, granulation
tissue is forming and
healing has begun,
following 59 days
treatment with
Medihoney wound
gel and N-A Ultra
dressing under
compression bandaging.
chosen as the secondary dressing for its ability to absorb
exudate and reduce maceration. Within 16 days of treatment,
malodour was no longer evident and debridement of
devitalized tissue was complete (Figure 6b).
Conclusion
The clinical case study outcomes demonstrate the
effectiveness of Medihoney in all the documented modes
of action, as outlined previously and in the research (Molan,
2005), and on a wide variety of wounds (Molan, 2006). In
clinical practice the product was safe and easy to use.
The inappropriate use of wound care products can be
costly, both for the healthcare trust and for the patient,
and there is a drive for healthcare practitioners to use
products that are cost-effective and ensure optimum
clinical outcomes. The versatility of medical grade honey
and its ability to achieve different clinical outcomes in a
variety of wounds reduces the need for multiple product
use during the wound healing process, thereby helping
less experienced clinicians when selecting an appropriate
product for a particular wound.
In each of the clinical cases described, medical grade
honey demonstrated effectiveness in more than one mode
of action. Results were obtained rapidly, were clearly
defined, and achieved the outcomes selected for each
individual.
Within a wound care formulary, medical grade honey
does not have to be restricted to a single category but could
be placed in a number of categories. Clinicians should
consider adding medical honey to their formularies.
BJN
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KEY POINTS
n The properties of honey from different sources vary, and
only certain types of honey are beneficial in wound care.
n Only medical grade honey should be used in wound care.
n Medical grade honey has five modes of action, which
means that it can be used in a variety of wounds to
achieve varied clinical outcomes simultaneously.
n Medical grade honey is safe and easy to use for the
inexperienced practitioner.
n Medical grade honey is a valued addition to the nurses
toolkit and fits into various categories within a wound
care formulary in both primary and secondary care.
Figure 6b.
Debridement of
devitalized tissue is
complete after 16 days
treatment with
Medihoney wound gel
and Sorbion Sachet S
secondary dressing.
Figure 6a. Venous
leg ulcer on the left
medial malleolus,
extending laterally
and showing extensive
maceration and skin
breakdown.
S44 British Journal of Nursing, 2008 (TISSUE VIABILITY SUPPLEMENT), Vol 17, No 20