Written by Sarah Taylor
Manuka honey has been used since ancient times for reducing infection and for accelerating wound healing (Coulboum, Hampton & Tade, 2009). A question remains, why do some health professionals still hesitate to apply manuka honey as treatment for chronic wounds? It has been widely reported that health professionals rarely use any honey impregnated dressings. I have found that this may be due to the honey melting on hot days or even a lack of education around the benefits manuka honey contains. If these are the only barrier to stopping this treatment being used, I believe it is necessary to find out if the benefits of this treatment outweigh the negatives for the patient.
After conducting a literature review into manuka honey treatments I found that while these treatments can be inconvenient or uncomfortable at times, the benefits to the patient outweigh the inconvenience exceedingly. This review demonstrated that these treatments are cost effective, promote rapid healing, control malodour, have antibacterial properties and lower chronic pain levels (Coulboum et al, 2009). I have found substantial evidence to suggest that this treatment is capable of playing a much more major role in wound care and include a number of recommendations for change.
The following recommendations if applied in practice could enhance patient outcomes:
Wound care plays a major role in district nursing today. Chronic wounds often exhaust many treatment options and absorb a great deal of district nursing resources. In this submission I discuss the implications wound care can have on nursing and how multiple factors can influence nursing time. I then consider reasons why manuka honey treatments should or should not be at the forefront of wound care in district nursing and I then make some recommendations regarding how manuka honey treatment can reach its full potential within district nursing.
This submission ‘Manuka honey use for wound healing’ is about exploring the benefits of manuka honey dressings. Manuka honey has been used since ancient times for reducing infection and for accelerating wound healing (Coulboum, Hampton & Tade, 2009). So a question is raised as to why some health professionals still hesitate to use this as treatment for chronic wounds? Most of the clinical studies with active manuka have been completed primarily in New Zealand and most recently some in the United States (Jenkins, 2008). The therapeutic value of manuka honey is evolving and excelling beyond other gels and dressings such as hydrogels (Gethin & Cowman, 2008).
It is understood some health professionals believe there is little evidence supporting the use of manuka honey as a wound gel or dressing or find them to be sticky and messy. Although the use of manuka honey in wound care is widely reported and also recommended (Coulboum et al, 2009). If these are the only barriers to stopping this treatment being used, I believe it is necessary to find out if the benefits of this treatment outweigh the inconvenience/disturbance that it may bring.
Nursing care delivery to patients with chronic wounds is dependent on multiple factors including: Cost effectiveness, age, nutrition, lifestyle, pain levels, and infections. The more involvement of these factors the more difficult it can be to deliver good nursing care (Coulboum et al., 2009).
Some factors can be altered or changed to promote skin healing, but others are unchangeable. For example nutrition and lifestyle can be altered by promoting healthy food options and encouraging small walks to support circulation. Age however, cannot be altered as the elderly lose elasticity of collagen and there is less fat deposition. Therefore the skin is less protected and becomes fragile, easily damaged and requires more frequent dressing changes (Harvey, 2005).
Research has demonstrated that chronic pain can impact on wound healing in a negative way. Evidence has indicated that pain contributes to stress, anxiety and depression, and research has found that chronic pain and stress contribute to delayed wound healing including acute, surgical and chronic wounds (Upton, Soloweij, Hender & Woo, 2012). Delayed wound healing puts strain on nursing services as treatment options often become exhausted.
Nurses are the main professional group responsible for wound care management. Nurses’ knowledge and attitudes towards patient care are fundamental to effective wound management. If district nurses have little knowledge about treatment options, this may result in inadequate wound management. It is important that nurses are informed and educated about all treatment options so they can educate the patient correctly and work in partnership to establish the right option for them (Hollinworth, 2009).
It is essential that the cost of wound care treatments are reinforced to those making budget decisions, however, establishing how cost effective a treatment is requires us to look at more than just the cost-per-unit of individual dressings. There are also many hidden costs to wound care including the need for on-going analgesia, increased incidence of infection requiring antibiotics, effects of reduced mobility, loss of earnings and increased expenses including transport and medications. A wound dressing may have documented evidence of longer wear times however evidence for more modern dressings may support shorter healing times (Casey, 2012).
So in an ideal world, the best dressing would have antibacterial protection, reduce pain, have evidence of long wear times, promote shorter healing times, as well as being cost effective (Coulboum et al., 2009). If all of these points were achieved in one dressing, less strain would be put onto nursing services. Less treatment options would be required resulting in less time spent caring for these wounds (Baulch, 2007).
Manuka honey wound dressings have been widely researched and evidence shows that manuka honey can assist wound healing to a great extent in some ways other treatments cannot (Gethin & Cowman, 2008). Manuka honey is a natural product that has been known for centuries by Maori for its healing potential (Jenkins, 2008).
Manuka Honey dressings are impregnated with active manuka honey which gives antibacterial protection, assistance to de-slough wounds, and control of malodour and elimination. As exudates mix with the honey a gel complex is formed. This provides an ideal healing environment for the wound (Gethin & Cowman, 2008). It has a unique antibacterial strength that is over and above usual active properties of honey and sets manuka honey apart (Unique Manuka Factor Honey Association, 2013).
Bacteria found in most chronic wounds are what create malodour, fluid loss, and discoloured exudate. In one particular study into manuka honey dressings and chronic wounds, a swab was taken on day one and day 14 and there is no doubt that bacterial loading was reduced significantly (Coulboum et al., 2009). Reducing bacteria loading should be a main goal in wound care which in turn will reduce odour, fluid loss and often pain. It is the osmotic effect of honey that helps to remove odour in the wound by removing bacteria, while the gel complex maintains moisture which will debride and de-slough. These are all positive steps towards effective wound management and healing (Jenkins, 2008).
Reports have suggested that honey causes a stinging pain when applied to wounds. This is due to the acidity of honey but this pain is not experienced when neutralised honey is used, as manuka honey dressings are (Coulboum et al., 2009). This pain is not indicative of further damage being done to the wound, as wounds have healed rapidly in instances when patients endure pain and benefit from the stimulation of healing that they see (Upton et al., 2012). There is also evidence that manuka honey stimulates nocioceptors resulting in these nerve endings becoming more sensitised and more responsive to the organic components of manuka honey (Coulboum et al., 2009). In recent studies few patients have experienced pain on application and if they do this, pain rapidly resolves within 10 minutes. In these studies if the patient is warned about the possibility of pain they often tolerate it for the 10 minutes and any pain the patient had previously, quickly reduces as bacterial loading is reduced (Upton et al., 2012).
Manuka honey products such as Algivon or Medihoney are at extremely low cost when compared with other dressings. This makes most manuka honey dressings very cost effective given that bacterial loading is quickly reduced and healing is achieved rapidly (Jenkins, 2008). These dressings many at first need to be changed every 1-2 days but once past that initial period, they can be left on for up to 7 days. This reduces strain on district nurses and also reduces cost as they can be effective for longer periods (Coulboum et al., 2009).
It is possible that the reluctance to use these manuka honey treatments in practice is a result of little knowledge about the treatment. In the article by Smith, Greenwood and Searle (2010), they discussed wound care procedure before and after education about dressings. Their research found that by carrying out educational training, practice had improved resulting in more appropriate wound care and a reduction in wound care costs. If health professionals were educated about the benefits of manuka honey, they may have a better understanding of when, why and how to use it and may reduce wound care costs.
No wound care treatments are 100% ideal, and given the benefits of manuka honey impregnated dressings, I would consider it to be a shame if the possibility of the dressing becoming sticky is the only barrier to making good use of this highly effective treatment. Living with chronic wounds is never pleasant and manuka honey dressings may be inconvenient in hot weather. However, if the benefits of this treatment option are explained to a patient prior to using it, the patient may become more able to tolerate this inconvenience for some time in order to be more comfortable, pain free, and protected from infection in the future (Coulboum et al., 2009).
Overall I find that manuka honey impregnated dressings come fairly close to an ideal dressing. They are cost effective, have long wear times, rapid healing times, have antibacterial properties and reduce pain levels. I believe that the benefits of this treatment significantly outweigh the negatives and I consider this to be a highly useful treatment for chronic wounds.
This research has led me to make the following recommendations:
Some health professionals do not use manuka honey dressings often, however there is significant evidence to show that manuka honey dressings possess significant benefits in wound care that other treatments do not offer.
Working in partnership with the client to establish an effective treatment is vital. Explaining the positives and negatives with the client before using a manuka honey treatments may help prepare them for any downfalls of using this treatment and allow them to cope better with these. This is important especially when putting manuka honey on a wound as in selected cases it has caused pain.
Staff education on all the possible treatments is vital to effective practice. If a nurse has limited knowledge about treatment options then this limits their wound management capabilities.
Casey, G. (2012). Modern advances in wound care. Continuing
Professional Development, 18(5), 20-24.
Coulboum, A., Hampton, S., & Tade, M. (2009). Algivon: manuka honey v
complex wounds. Journey of Community Nursing,23(6), 25-28
Baulch, J. (2007). Skin integrity and wound care. In J,Dempsey., J,
French., S, Hillege., & V, Wilson (Eds). Fundamentals of Nursing & Midwifery, A person centred approach to care (pp. 909-915). New South Wales: Read International books Australia
Gethin, G., & Cowman, S. (2008). Manuka honey vs. hydrogel – a
prospective, open label, multicentre, randomised controlled trial to compare desloughing efficacy and healing outcomes in venous ulcers. Journal of Clinical Nursing,18, 466–474.
Harvey , C. (2005). Wound Healing. Orthopaedic Nursing, 24(2), 144-157.
Hollinworth, H. (2009). Wound related pain: evaluating the impact of
education on nursing practice. EWMA Journal, 9(1), 5-8.
Jenkins, U. (2008). The power of manuka wound honey: the proof is in the
results. Profiles in Excellence 2008,27(4), 200.
Smith, G., Greenwood, M., & Searle, R. (2010). Ward nurses use of wound
dressings before and after bespoke education programme. Journal of Wound Care, 19(9), 396-402.
Unique Manuka Factor Honey Association. (2013). What is UMF Honey?
Retrieved from http://www.umf.org.nz/what-is-umf-honey
Upton, D., Soloweij, K., Hender, C., & Woo, K. (2012). Stress and pain
associated with dressing change in patients with chronic wounds. Journal of Wound Care, 21(2), 53-58.