Honey: An old or new remedy?

Although used by the ancient Greeks and Romans, researchers are only beginning to understand the healing properties of honey. More recently, nurses used honey as a remedy for pressure ulcers. Before the availability and the wide variety of modern dressings, sugar and honey were combined into a paste consistency. The pressure ulcer was coated with the mixture and then covered. Today, there are products on the market known as medical honey dressings. Research is limited, but studies show that medical honey dressings are a safe, low-cost, and effective treatment alternative in the acute and chronic management of wounds and pressure ulcers.

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In the United States, Europe, and Australia, medical honey on the market that is used for pressure ulcer dressings is from the Leptospermum scoparium tree that is grown in Australia. It is also called manuka, tea tree, goo bush, and jelly bush. Leptospermum is used to manufacture medical honey. In the United States, Europe, and Australia, there are leptospermum products on the market for use in the treatment of pressure ulcers.

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The National Gerontological Nursing Association (NGNA) was founded in 1984, and is dedicated to the clinical care of older adults across diverse care settings. Members include clinicians, educators, and researchers with vastly different educational preparation, clinical roles, and interest in practice issues. For more information, contact the NGNA National Office at 1-800-723-0560 or

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Honey stimulates the healing process, reduces inflammation, provides a comfortable dressing, and reduces wound odor. The hygroscopic properties of honey dehydrate bacteria by removing moisture from the cell wall. This cascade of enzyme activity produces small amounts of hydrogen peroxide and releases oxygen into the wound. The sugar in honey helps to prevent further bacterial growth.4 Medical honey is especially effective against methicillin-resistant Staphylococcus aureus (MRSA).3

Honey is also an anti-inflammatory. Inflammation from wound exudates causes pain and edema. Medical honey contributes to the debridement and removal of slough. The process takes place to reduce edema, pain, and promote wound healing. Medical honey impregnated with calcium alginate is used for heavy exudates.

Honeycolloid dressings are used for light to moderate exudates.5 Dressings are applied for at least 12-24 hours. Depending upon drainage, dressing changes may be needed as often as twice daily. Common practice is to change medical honey dressings every 24 to 48 hours.

Inflammation and exudates contributes to the pH composition of the wound. In contrast to the high pH in wounds caused by exudates, honey has a low pH (4.0). It reduces alkalinity by providing a moist, acidic environment. The mechanism for lowering wound pH in honey is thought to cause a decrease in protease activity, an increase in fibroblasts, and the release of oxygen into the wound.2 Protease activity is linked to proteins necessary for wound healing. Healthy fibers in the wound are associated with fibroblast production. Oxygen is needed to provide nutrients to the tissue for healing.

The sugar content in medical honey relieves pain associated with dressing changes. However, in some instances initial stinging pain is reported when the dressing change is in contact with the wound. This occurs because the pH changes and the pain subsequently resolves. In addition, honey also decreases the odor associated with wounds from anaerobic bacteria and necrosis. The debridement, anti-inflammatory, and antibacterial effects of honey may be factors in the deodorization of wounds.3

In the United States, the overall costs of pressure ulcers are estimated at $11 billion per year. Research shows that the use of medical honey dressings reduces costs because of the decrease in multiple dressing changes and decreased use of enzymatic debridement dressings.

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In one randomized controlled trial,6 pressure ulcers treated with honey dressings healed four times faster than the comparison group. The size and pH was associated with treatment with medical honey dressings. This important study addresses F-tag 314 regulations and The Agency for Healthcare Research and Quality requirements in long-term care for improvement in pressure ulcers 2-4 weeks after treatment begins. Honey dressings may potentially decrease wound size, decrease wound pH, and increase the rate at which wounds heal.

More research is needed on this ancient and time-honored remedy to provide evidence-based practices for complementary and alternative therapies in the treatment of pressure ulcers in long-term care.

Pencil drawing by Sarah Walker, a senior at Central High School, Davenport, Iowa.

Melodee Harris, PhD, APN, GNP-BC, is Director-at-Large for the National Gerontological Nursing Association, President and founding member of the Arkansas Chapter of the National Gerontological Nursing Association, and an Associate Professor at the Harding University Carr College of Nursing. She is a board-certified gerontological nurse practitioner in rural Arkansas nursing homes. For more information, email Dr. Harris at

T2mharris@aol.com.

References

1. Yapucu GU, Eser I. Effectiveness of a honey dressing for healing pressure ulcers. Journal of Wound, Ostomy and Continence Nursing 2007; 34 (2): 184-90.
2. Gethin CT, Cowman S, Conroy RM. The impact of Manuka honey dressings on the surface pH of chronic wounds. International Wound Journal 2008; 5 (2): 185-94.
3. Simon A, Traynor K, Santos K, et al. Medical honey for wound care: Still the ‘latest resort”? eCAM 2009; 6 (2): 165-73.
4. Molan P. Why honey is effective as a medicine. Bee World 1999; 80 (2): 80-92.
5. Maggio D. Evidence-based practice: Active Leptospermum honey dressing for use in an indigent outpatient wound care clinic.Poster presentation at: American Professional Wound Care Association; April 8-11, 2010; Philadelphia.
6. IQH. Nursing home pressure ulcers, 2011.Available at: www.iqh.org.

Long-Term Living 2011 May;60(5):24-25

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