6 JCN supplement
2014,Vol 28, No 5
MEDICAL GRADE HONEY
concentration of honey within these
applications can vary from 20–100%.
ACTION OF MEDICAL
GRADE HONEY
Medical grade honey products are
an excellent resource for community
nurses because of the multifactorial
actions that the dressings provide, often
leading to them being described as‘all-
in-one’dressings for effective wound
bed preparation.These include:
Antimicrobial action
Deodorisation
pH-modulating agent
Debridement
Anti-inflammatory action
Scar reduction
Stimulation of new tissue
growth (angiogenesis)
Biofilm control effect
Pain management.
Antimicrobial action
Honey has a proven broad spectrum
of activity against many bacteria and
fungi (Molan, 2005), which delay
wound healing and can result in active
wound infections. Some medical
grade honey contains high levels
of phytochemicals associated with
antibacterial activity (Molan, 2001).
Honey’s antibacterial property is
attributed to the osmotic effect on its
high sugar content and low moisture
content (Weston, 2000; Khan et al,
2007; Mavric et al, 2008). By a process
of evaporation and enzymatic action,
sugar molecules in the honey bind
up the water molecules, denying any
microbes a fuel source for survival
(Cooper, 2005). The enzyme glucose
oxidase in the honey converts glucose
to gluconic acid, making the honey
too acidic for microbes to grow in
(Weston, 2000; Mavric et al, 2008;
Khan et al, 2007). The activation that
oxidises glucose to gluconic acid also
generates hydrogen peroxide (H
2
O
2
).
When diluted, this also creates an
antimicrobial activity (Bang et al, 2003).
However, not all honeys,
including Manuka honey, generate
H
2
O
2
, instead they contain
phytochemical components which
produce the antimicrobial activity
(Simon et al, 2009). Honeys that
exhibit a standard antibacterial
activity are confirmed by
in-vitro
testing methods (Bang et al, 2003).
Deodorisation
The antimicrobial action of honey has a
positive effect in eradicating malodour
in wounds by removing the bacteria
that potentially create it. Having a
wound that is malodorous can have
far-reaching effects on an individual’s
wellbeing, causing social isolation and
distress (Persoon et al, 2004; Briggs
and Flemming, 2007). Malodour,
especially in malignant wounds,
longstanding leg ulceration and deep
pressure damage, is commonly due
to the presence of necrotic tissue in
combination with both aerobic and
anaerobic bacteria within the wound,
which can be, although not always, a
result of infection (Bowler et al, 1999).
This impedes wound healing (Enoch
and Price, 2004).
Bacteria-producing malodorous
substances are the result of amino
acids being metabolised from
decomposed serum and tissue
proteins. However, this is when honey
is most effective, as its high glucose
content provides an alternative fuel
source to the bacteria. This results in
the bacteria metabolising the high
glucose content in preference to amino
acids in the body, thus suppressing
odour and deodorising wounds rapidly
(White and Molan, 2005).
pH-modulating agent
Chronic wounds fail to heal if the pH
level in the wound environment is
elevated.The surface pH of chronic
wounds has been reported to range
from 7.15 to 8.94 (Gethin and
Cowman, 2008). Once medical grade
honey, with a low pH of 3.5–4.5, is
present in the wound bed, it has a
localised effect, reducing the high pH
in the wound to levels comparative
with that of the honey, resulting in an
environment more ideal for promoting
wound healing.
Debridement
The reduction in pH also aids the
body’s natural processes for debriding,
assisting in the removal of necrotic
tissue. Often wound types, such as
pressure ulcers, leg ulcers, diabetic foot
ulcers, contain necrotic or devitalised
tissue which needs to be debrided
rapidly to identify the extent of tissue
damage. Literature suggests that
medical grade honey is an effective
debriding agent (Stephen-Haynes,
2004; Gethin and Cowman, 2009;
Evans and Mahoney, 2013).
Table 1:
Wound types appropriate
for honey dressings
Chronic ulcers (diabetic, venous leg,
pressure)
Infected wounds
Necrotic wounds
Sloughy wounds
Malodorous wounds
Donor and recipient graft sites
Burns
Surgical wounds
Superficial wounds
›
Practice point
Community nurses can be asked
by patients with wounds if they can
use honey to help their wound heal.
It is essential that wound care is
approached with a person-centred
care philosophy that allows patients
with wounds to be active partners
in the planning, assessment and
management of their wound care.
This ensures that the strategies
planned meet their needs and the
collaborative approach results in
better outcomes for patients. In this
respect, community nurses need to
educate patients in the importance
of using medical grade honey and
not honey bought every day from
shop shelves.
Red Flag
Honey dressings
Do not use:
On patients that have a
known sensitivity to honey
or any other component
parts specific to each
dressing (always check
manufacturers’ information)
To control bleeding.
And:
Use with caution in patients
who have a known allergy to
bee venom.
