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Evidence-based Practice: Using Active Leptospermum Honey Dressings in an Indigent Population
Chronic wounds affect 2.8 million patients in the US and the cost of advanced wound care products is expected to grow to $4.6 billion by 2011.1 This and the additional costs of loss of income and loss of employment are unbearable for the indigent patient. An investigation was conducted to find a US Food and Drug Administration (FDA)-cleared, safe, effective, cost-efficient, user-friendly, moist wound healing dressing for use in an indigent outpatient wound clinic.
Over the past decade, researchers have found that active Leptospermum honey (ALH) has unique plant-derived components that make it ideal for managing hard-to-heal wounds and burns.2 The components and properties of ALH help prepare the wound bed: high osmolarity helps draw fluid from the wound and underlying tissue, aiding in debridement of slough and devitalized tissue and decreasing edema. Honey has a low pH and a high sugar content, inducing an environment unsuitable for most bacterial growth.3 Studies on lowering wound pH have demonstrated reduction of slough-producing proteases, increase in oxygen diffusion to tissue, and reduction in wound size.4 ALH is also high in phytochemicals, which have antimicrobial characteristics reported to clear infection5 and reduce or eliminate malodor. Bacteria preferentially metabolize glucose in the honey instead of the amino acids present in tissue and serum, resulting in the formation of lactic acid (instead of odorous amines, sulfur, and ammonia). The antimicrobial action reduces the presence of bacteria and subsequently their ability to cause odor in the wound bed.6 ALH does not lose its antimicrobial activity in the presence of wound fluid. Other mechanisms of action specific to Leptospermum honey include immuno-modulatory7 and strong antioxidant activity.8
Indigent patients attending an outpatient wound clinic present the following problems: poor patient adherence to care plans, multiple wound types and comorbidities, lack of finances, and poor personal hygiene. It was thought that ALH could be useful in addressing many of these issues due to ease of use, cost effectiveness, cleansing properties, and indications for multiple wound types.
The following case report describes the use of ALH calcium alginate dressings (MEDIHONEY®, Derma Sciences, Inc., Princeton, NJ) for the management of severely malodorous, highly exuding venous ulcers.
Case Report
A 66-year-old man with diabetes, venous stasis ulcers, and poorly controlled blood sugar presented with infected, foul-smelling, heavily draining wounds on the lateral and medial aspects of both legs. Prior treatment included compression bandaging along with xeroform, silver nonadherent, or silver foam dressings. Despite these efforts, excessive exudate and malodor were offensive to everyone in the outpatient wound center.
ALH calcium alginate dressings were applied, covered with an absorbent foam dressing, then covered with multilayer compression bandages once weekly. This approach continued until the patient was admitted to a for-profit wound care center and lost to follow-up in our clinic. The odor was eradicated immediately. Exudate and wound size gradually decreased. By week 16, the wounds were well on the way to healing, at which point care was continued elsewhere. The ease of use of this dressing was an important factor with this patient, enabling dressing changes to be performed quickly. Also, the ALH dressings were less expensive than the silver dressings and more effective in controlling exudate and odor.
The ease of use is important in this population because these patients frequently use public facilities to change their dressings. The ALH dressings have replaced enzymes and multiple dressing types in this indigent wound care clinic, aiding in controlling costs and supplies while providing improved outcomes.
The use of ALH calcium alginate dressings with compression therapy was associated with rapid eradication of odor and rapid reduction in exudate and wound size. The patient and staff were pleased with the outcomes.
Making Progress With Stalled Wounds is made possible through the support of Derma Sciences, Inc., Princeton, NJ. The opinions and statements of the clinicians contained herein are specific to the respective authors and are not necessarily those of Derma Sciences, Inc., OWM, or HMP Communications.
This article was not subject to the Ostomy Wound Management peer-review process.
1. Patel NP, Granick MS, Kanakaris NK, Giannoudis PV, Werdin F, Rennekampff HO. Comparison of wound education in medical schools in the United States, United Kingdom, and Germany. J Plast Surg. 2008;8:61–67.
2. Gethin G, Cowman S. Manuka honey vs. hydrogel: a prospective, open-label, multicenter, randomised controlled trial to compare desloughing efficacy and healing outcomes in venous ulcers. J Clin Nurs. 2008;18(3):466–474.
3. Blair SE, Cokcetin NN, Harry EJ, Carter DA. The unusual antibacterial activity of medical-grade Leptospermum honey: antibacterial spectrum, resistance and transcriptome analysis. Eur J Clin Microbiol Infect Dis. 2009;28(10):1199–1208.
4. Gethin GT, Cowman S, Conroy RM. The impact of Manuka honey dressings on the surface pH of chronic wounds. Int Wound J. 2008;5:185–194.
5. Cooper R, Halas E, Molan P. The efficacy of honey in inhibiting strains of Psuedomonas aeruginosa from infected burns. J Burn Care Rehabil. 2002;23(6):366–370.
6. Molan P. Re-introducing honey in the management of wounds and ulcers—theory and practice. Ostomy Wound Manage. 2002;48(11):28–40.
7. Ligouri PA, Peters KL. Limb at risk: use of active Leptospermum honey for the management of an infected foot wound complicated by cellulitis. Poster presented at the Clinical Symposium on Advances in Skin and Wound Care. Las Vegas, NV. October 26–30, 2008.
8. Robson V. Providing evidence on the cost effectiveness of topical antibacterial honey dressing for formulary inclusion. Poster presented at the European Wound Management Association. Helsinki, Finland. May 20–22, 2009.
