MEDICAL GRADE HONEY
JCN supplement
2014,Vol 28, No 5
9
When community nurses choose
a honey dressing, they need to
be assured that the honey is of a
medical grade, is registered as a
medical device and is safe to use.
They need to consider that the
variety of honey-based wound
dressing products available offer
different concentrations of honey
and have different consistencies
for use in different wound types.
Importantly, community nurses need
to identify that the medical honey
chosen has an evidence base which
supports the manufacturer’s claims.
Additionally, supporting research
and information should be made
available to patients and colleagues
in order to inform choice and develop
patient-centred care. This ensures
that the practitioner delivers the most
appropriate care for the patient in the
community setting.
REFERENCES
Al-Swayeh OA, Ali ATM (1998)
Hepato
Gastroenterology
45(19):
297–302
Bainbridge P (2013)
J Wound Care
22(8):
407–8, 410–12
Bang LM, Bunting C, Molan PC (2003)
J
Altern Complement Med
9:
267–73
Best Practice Statement (2013)
The use of
topical antiseptic/antimicrobial agents in
wound management
. 3nd edn. Wounds UK
Betts J (2009) In: White R, Cooper R,
Molan P (eds)
Honey in Modern Wound
Management
. Wounds UK, Aberdeen:
80–90
Blair SE, Carter DA (2005)
J Aus Infection
Control
10(1)
: 24–31
Blair SE, Cokcetin NN, Harry EJ, Carter DA
(2009)
Eur J Clin Microbiol Infect Dis
28(10):
1199–208
Bowler PG, Davies BJ, Jones SA (1999)
J Wound Care
8(5):
216–8
Boyd G, Butcher M, Kingsley A (2004)
J
Wound Care
13(7):
265–6
Briggs M, Flemming K (2007)
J Adv Nurs
59(4):
319–28
Cooper R (2005) In: White R, Cooper R, Molan
P, eds.
Honey: A ModernWound Management
Product
.Wounds UK, Aberdeen: 24–32
Cooper RA, Jenkins L, Henriques AF, Duggan
RS, Burton NF (2010)
Eur J Clin Microbiol
Infect Dis
29(10):
1237–241
Dunford C, Hanano R (2004)
J Wound Care
13(5):
193–7
Ali, 1998; Jull et al, 2008) and osmotic
action. However, there is a breadth
of evidence disputing this claim
(Dunford and Hanano, 2004; Gethin
and Cowman, 2008), suggesting that
honey products do not increase the
pain experienced and can in fact
reduce pain (Evans and Mahoney,
2013). Infection, size of the ulcer,
chronicity of the ulcer or the type
of honey used can influence pain
experience (Betts, 2009).
IS THERE A RISK OF
ANTIMICROBIAL RESISTANCE
TO HONEY?
The insurgence of resistant strains
of bacteria such as meticillin-
resistant
Staphylococcus aureus
(MRSA) or multidrug-resistant
Gram-negative bacteria create a
risk to antimicrobials. This results in
ineffective prevention and treatment
of an ever-increasing range of
wound infections caused by bacteria,
parasites, viruses and fungi (World
Health Organization [WHO], 2012).
This can jeopardise patient outcomes
(European Wound Management
Association [EWMA], 2013).
Trials to date have demonstrated
honey-resistant strains of bacteria
cannot be isolated at present (Blair
et al, 2009; Cooper et al, 2010).
Although the results suggest that
the development of future bacterial
strains that are resistant to honey
is unlikely, they do not exclude
this possibility.
As with any topical antimicrobial,
it is essential that community
nurses appropriately choose honey
based on a patient-centred holistic
assessment of the individual’s
wound, with the goal of preventing
and eradicating infection and
promoting wound healing (Best
Practice Statement, 2013).
CONCLUSION
This article demonstrates that
honey has a multifaceted effect
with the ability to encourage
autolytic debridement, reduce odour
and inflammation and act as an
antimicrobial, while providing an
ideal medium to promote a moist
wound healing environment.
JCN
Enoch S, Price P (2004) WorldWideWounds.
Available at: http://tinyurl.com/5kksp8
EuropeanWound Management Association
(2013)
J Wound Care
22(Suppl 5):
S1–S89.
Available at: http://ewma.org/fileadmin/
user_upload/EWMA/pdf/EWMA_Projects/
Antimicrobial/JWC_EWMA_supplement_
NO_CROPS.pdf)
Evans J, Mahoney K (2013)
Wounds UK
Supplement
9(1):
30–6
Gethin G, Cowman S (2008)
J Wound Care
17(6):
241–7
Gethin G, Cowman S (2008)
Int Wound J
5:
185–94
Gethin GT, Cowman S (2009)
J Clin Nurs
18(3):
466–74
Grothier L, Cooper R (2011)
Medihoney™
Dressings made easy
. Wounds UK, London.
Available online: http://www.wounds-uk.
com/pdf/content_10137.pdf
Hutchinson J (1992)
The Wound Programme
.
Centre for Medical Education, Dundee
Jull A. Walker N ParagV Molan, P, Rogers A
(2008)
Br J Surg
95(2):
175–82
Khan FR, Abadin UI, Rauf N (2007) Medscape
Today. Available online: http://www.
medscape.com/viewartide/565913
Mavric E,Wittmann S, Barth G, Henle T (2008)
Mol Nutr Foods Res
52:
483–9
Merckoll P, Jonassen TO,Vad ME, Jeansson
SL, Melby KK (2009)
Scand J Infect Dis
41(5):
341–7
Molan PC (1992)
Bee World
73(1):
5–28
Molan PC (2001) Available at: www.
›
Practice point
Individual pain should be
considered when starting honey
treatment. A clear explanation
should be given to the patient
as to the possibility of increased
pain, this has been described as
‘a drawing or stinging sensation’
(Pieper, 2009). Pain levels may
increase when starting the use
of honey dressings, due to the
initial increased osmotic action of
the fluid being drawn out of the
tissues and a reduction in pH on
the wound bed. If the pain the
individual experiences persists
and cannot be managed with an
analgesic, remove the dressing,
cleanse area and discontinue use.
