MediHoney

1. MediHoney Sylvia Assiamah Temi Doyin Shanakay Haughton Kimberly Jenkins Viven Walker-Marable Pritika Prasad

2. Introduction • Name: Medihoney • Classification: Antibacterial • Pharmacodynamics: • Antibacterial Action • Odor Reduction • Debriding • Anti-Inflammatory Effect (Robson, Dodd, and Thamas, 2009)

3. Antibacterial Action • Broad spectrum antibacterial activity r/t high sugar content and low water content • Heat stable antibacterial component, known as methylglyoxal (MGO) • Formed from dihydroxyacetone, typically found in the nectar of manuka flowers (Robson, Dodd, and Thamas, 2009)

4. Manuka Flower

5. Odor Reduction Reduction in odor is due to inhibition of anaerobic bacteria that are able to ferment amino acids to malodorous organic amines (Robson, Dodd, and Thamas, 2009)

6. Debriding Effects Osmotic action of honey encourages lymph fluid to rehydrate devitalized tissue, helping to remove slough and necrotic tissue by moving fluid away from the wound bed. (Robson, Dodd, and Thamas, 2009)

7. Antiflammatory Effect Low pH, which help to decrease protease activity in the wound thus decrease Inflammation (Robson, Dodd, and Thamas, 2009)

8. Indication Used for light to moderately exuding wounds such as: diabetic foot ulcers, leg ulcers (venous stasis ulcers, arterial ulcers and leg ulcers of mixed etiology), pressure ulcers/sores (partial- and full-thickness), first- and second-degree partial-thickness burns, donor sites, and traumatic or surgical wounds ("Medihoney,”)

9. Indication • Medihoney paste, the most commonly used medihoney product can be used for hard-to-dress wounds and other wounds normally requiring gel or paste • Maintains the effectiveness of wound treatment even in the presence of wound fluid, blood and tissue. ("Medihoney,”)

10. Indication • Advantageous to wound healing • High osmolality concentration • Provides cleaning and debridement action for wound base • Quickly progresses to healing time • Quickens wound healing time even for wounds with stalled healing ("Medihoney,”)

11. Adhesive Honeycolliod Dressing • (Active Leptospermum Honey content – 63%) • Absorbs 2.5x the amount of fluid of leading hydrocolloids • Cooling and soothing upon application • Two versions: Adhesive and non-adhesiveFor dry to moderately exuding superficial to partial thickness wounds ("Medihoney,”)

12. Medihoney Gel • 80% Active Leptospermum Honeyand 20% Natural gelling agents • Optimal for partial to full thickness wounds • More viscous formulation with increased stability at the wound site ("Medihoney,”)

13. Medihoney Paste • Paste100% Active Leptospermum Honey • For dry to lightly exuding wounds, or for hard to dress areas ("Medihoney,”)

14. Non-Adhesive Honeycolloid Dressing • DressingAdhesive and Non-Adhesive ("Medihoney,”)

15. Calcium Alginate Dressing • Calcium Alginate DressingFor moderate to heavy exuding wounds ("Medihoney,”)

16. Contraindication Despite its natural and non-toxic components, there are some contraindication to using Medihoney. This include allergies to: • Honey or alginic acid • Plant pollen • Bee sting venom ("Medihoney top”)

17. Contraindication 1. Known hypersensitivity to, or intolerance of, honey; 2. Current or recent (within 4 weeks) treatment with an antibiotic administered by any route; and 3. Nasal carriage of mupirocin-resistant S. aureus. 4. Diabetes 5. Wounds with suspected malignancy ("Medihoney top”)

18. Patient #1 A 79-year-old male paraplegic (Th4) patient with sacral ulcer grade 3. • First photo documentation. • Second photo, 2 weeks after Medihoney treatment. • Third photo, 4 weeks use of medihoney as a non-surgical therapy for chronic pressure ulcers in patients with spinal cord injury (Adapted from “Use of medihoney as a non-surgical therapy for chronic pressure ulcers in patients with spinal cord injury by Biglari et al., 2012)

19. Patient #1

20. Patient #2 A 35-year-old male paraplegic (Th1)patient with ischial and scrotal ulcer grade 3–4 . • First photo documentation. • Second photo, after primary surgical debridement and 2-week Medihoney treatment. • Third photo, 4 weeks after Medihoney treatment. Use of medihoney as a non-surgical therapy for chronic pressure ulcers in patients with spinal cord injury (Adapted from “Use of medihoney as a non-surgical therapy for chronic pressure ulcers in patients with spinal cord injury by Biglari et al., 2012)

21. Patient #2

22. Patient #3 A 51-year-old male paraplegic (L1) patient with ankle ulcer grade 3 with Methicillin-resistant Staphylococcusaureus. • First photo documentation. • Second photo, 2 weeks after Medihoney treatment. • Third photo, 4 weeks after Medihoney treatment, with eradication of Methicillin-resistant Staphylococcus aureus. (Adapted from “Use of medihoney as a non-surgical therapy for chronic pressure ulcers in patients with spinal cord injury by Biglari et al., 2012)

23. Patient #3

24. Precaution • Imperative to monitor the progress of wounds • Wound not responsive after 14 days of treatment • Wound is malodorous • Signs of further breakdown • No precautionary are required for diabetics

25. Review of Literature • Used for centuries across the world in the treatment and management of wounds • Used to accelerate the healing of infected slow healing wounds • Accelerated process is linked to its organic composition and its antibacterial properties • In 2007 after numerous trails, in all age groups, the US Food and Drug Administration (FDA) approved its use in market for treatment in honey-based wounds

26. Literature Review • Laboratory studies support honey having antibacterial properties and have been effective against broad spectrum pathogens preventing treatment resistance as seen in antibiotics use. • As a result of this action the wound pH change to acidic which in turn stimulate the activation of phagocytes leading to a decrease bacterial growth • Medihoney products that go directly in the wound accelerate healing by: promoting a moist wound environment, thus making it easy for necrotic tissue to slough off and debridement to occur.

27. Literature Review • Honey had a mean 67% reduction of slough • New epithelial tissue was visible 15 days earlier in honey than other dressing products • Dressing has proven to be safe, low cost and effective in the treatment for non-responsive wounds in all age groups

28. Implementation Action of honey • Bringing about clearance of infection in wounds • Accelerating healing through activation of autolytic debridement • Anti-inflammatory activity • Antioxidant activity • Stimulation of growth of cells for tissue repair, • An osmotic action.

29. Implementation • Prepared by application of the honey to a non-adherent sterile contact layer that was placed on top of a sterile dressing pad • Honey applied at a thickness of approximately 3 mm and conformed to the shape of the ulcers

30. Cultural Considerations, Age, Ethnicity • There is no cultural consideration • Participants of any age with an acute or chronic wound • No limitation on ethnicity

31. Special Considerations • 'peppery' or stinging sensation when Medihoney is applied to wound • Symptoms secondary to honey exposure • Diarrhea • Vomiting • Bloating • Cramping • Abdominal Pain

32. References Biglari, B., Vd Linden, P.H., Simon, A., Aytac, S., Gerner, H. J., & Moghaddam, A. (2012). Use of medihoney as a non-surgical therapy for chronic pressure ulcers in patients with spinal cord injury. Spinal Cord, 50(2), 165-9. Cooper, G. (2011). Medihoney dressing made easy. Wounds, 6(2): 1-6 George, N.M. & Cutting K.(2007). Antibacterial Honey (Medihoney): In-vitro Activity Against Clinical Isolates of MRSA, VRE, and other Multiresistant Gram-negative Organisms Including Pseudomonas. Wounds, 19(9), 231- 236. Grothier, L., & Cooper, R. (2011). Medihoney Dressing made easy products for practice. Wounds UK, 6(2), 1-6. Retrieved from http://www.wounds-uk.com/made easy/medihoney-dressing-made-easy---products-for- practice

33. Reference Medihoney top. (n.d.). Retrieved from http://www.webmd.com/drugs/drug-163032. Medihoney Top.aspx?drugid=163032& Medihoney. (n.d.). Retrieved from http://www.dermasciences.com/products/advanced-wound- care/medihoney/inside-the-u-s/\ Mustafa, F., Nguyen, T., & Lim, L. (2007). Honeybee venom secretory phosholipase A2 induces leukotriene production but not histamine release from human basophils. Clinical and Experimental Immunology, 151: 94-100. Pieper, B. (2009, January). Honey-based dressings and wound care: An option for care in the United States. J WOCN, 60-66.

34. Reference Robson, V., Dodd, S., & Thomas, S. (2009). Standardized antibacterial honey (Medihoney™) with standard therapy in wound care: randomized clinical trial.Journal of advanced nursing, 65(3), 565-575. Simon, A., Traynor, K., Santos, K., Blaser, G., Bode, U., & Molan, P. (2009). Medical honey for wound care – still the ‘latest resort’?. Advance Access Publication, 6(2): 165-173.

35. Questions • What is the most commonly used medi honey product? Medihoney Paste • True/False Medihoney reduce inflammation in wounds.True • True /False Medihoney have antibiotic properties that promote wound healing. True • Honey has antibacterial action against range of bacteria except the growth of which organisms? S. Marcescens and C. Albicans

36. Questions 5. Medihoney is used for which type of wounds select all that apply? All of the above 1. Diabetic Ulcer 2. Venous Statis Leg Ulcers 3. Arterial Leg Ulcers 4. Pressure Ulcers (all 4 stages)