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RESULTS Zone of inhibition: Both the buckwheat honey impregnated dressing and the multi floral honey impregnated dressing (5 and 6) showed no zones of inhibition against any species of bacteria. The Leptospermum honey impregnated dressings (1-4) gave zones of inhibition against all three species of bacteria (Figure 1). The staphylococci were more sensitive to this honey than the Pseudomonas aeruginosa (Figure 2). Barrier effect of Dressings: There was no observed growth of either strain of Staphylococcus on the upper surface of the calcium alginate dressings, indicating that all three dressings were acting as a barrier preventing migration of bacteria from the surface of the TSA plate to the upper surface of the dressing (Table 1). The buckwheat and multi floral honey impregnated dressings allowed some translocation of bacteria from the surface of the plate to the upper surface of the dressings, indicating these dressings were not such an effective barrier (Table 1). The Pseudomonas aeruginosa penetrated through to the upper surface of all the dressings (Table 1). This experiment showed that mode of action was mainly bacteriostatic, dressings which had shown large zones of inhibition all allowed growth of organisms from the underside of the dressing once transferred onto fresh agar plates (Figure 3). The exception to this was Leptospermum honey impregnated calcium alginate number two which did not give rise to any colonies once transferred onto fresh plates, it therefore demonstrated a bactericidal mode of action against S. aureus (Figure 4) and (Table 2). DISCUSSION Health care associated infections continue to be a major problem in the health care environment, especially with an increase in the prevalence of antibiotic resistance. These infections can lead to delayed healing and increased morbidity, higher hospital costs and increased risk of spread of infection. References: 1. Cutting, K. F. (2007). “Honey and Contemporary Wound Care: An Overview.” Ostomy Wound Management 53(11): 49-54. 2. Al-Waili, N. S. and K. Y. Saloom (2004). “Topical honey application vs acyclovir for the treatment of recurrent herpes simplex leisons.” Medical Science Monitor 10(8): mt94-98. 3. Cooper RA, Molan PC, Harding KG (1999). “Antibacterial activity of honey against strains of Staphylococcus aureus from infected wounds.” Journal of the Royal Society of Medicine 92(6): 283-285. 4. Cooper R A, Molan PC, Harding KG (2002). “The sensitivity to honey of Gram-positive cocci of clinical significance isolated from wounds.” J Appl Microbiol 93(5): 857-63. 5. Willix D J, Molan PC, Harfoot CG. (1992). “A comparison of the sensitivity of wound-infecting species of bacteria to the antibacterial activity of manuka honey and other honey.” J Appl Bacteriol 73(5): 388-94. 6. Simon, A., K. Traynor, et al. (2008). “Medical Honey for Wound Care – Still the ‘Latest Resort’?” eCAM Advance Access: 1-9. 14 7. Gethin, G. and S. Cowman (2008). “Case series of uses of Manuka honey in leg ulceration.” International Wound Journal 2(1): 10-15. 8. Weyden, V. D. (2003). “The use of honey for the treatment of two patients with pressure ulcers.” British Journal of Community Nursing 8(12): S14-20. 9. Thomas, S. and P. McCubbin (2003). “A comparison of the antimicrobial effects of four silver-containing dressings on three organisms.” Journal of Wound Care 12(3): 101-107. 10. Bogdanov S, Ruoff K, Oddo LP. (2004). “Physicochemical methods for the characterisation of unifloral honeys: a review.” Apidologie 35: S4-S17. 11. Thomas, S. and P. McCubbin (2003). “An in vitro analysis of the antimicrobial pro perties of 10 silvercontaining dressings.” Journal of Wound Care 12(8): 305-308. 12. Edwards-Jones, V. (2006). “Antimicrobial and barrier effects of silver against methicillin resistant Staphylococcus aureus.” Journal of Wound Care 15(7): 285-290. This in vitro study was designed to allow comparison of efficacy between the selected dressings as antibacterial devices and barriers. The results of this study demonstrate that all of the Leptospermum honey impregnated dressings possessed sufficient antimicrobial activity to inhibit the growth of all the organisms tested. This result is not surprising in view of the known broad spectrum activity of Leptospermum honey. The lack of zones of inhibition from the buckwheat and the multi floral honey impregnated dressings reinforces the importance of selecting the appropriate dressing for each wound individually. Not all honey impregnated dressings make antibacterial claims, and have greater potential for stimulating healing rather than having antiseptic properties. The importance of careful dressing choice is again emphasized by the results of the barrier test; the Leptospermum honey impregnated tulle gave large zones of inhibition similar to those of the alginates, however only the alginates prevented migration of the staphylococci through the dressing therefore making honey impregnated alginates a more appropriate dressing if trying to prevent the spread of antibiotic resistant staphylococci into the environment or between individuals 12 . There could be several reasons why the other three dressings did not provide a barrier: the concentration of honey within the dressings may have been low, the antibacterial activity of the honey may have been too low, and the dispersal of honey within the dressings may have been inconsistent. In the case of the motile bacteria they could have penetrated from around the edges in. The methods described here using zone of inhibition and barrier tests gave us semi quantifiable data (no kill rates) but allowed us to see that the honey impregnated dressings had differing modes of action on the bacteria tested 13 . Both bactericidal and bacteriostatic modes of action were observed, this again is probably due to the differing formulations and concentration of honey used within the dressings. 13. Thorn, R. M. S., J. Greenman, et al. (2005). “In vitro method to assess the antimicrobial activity and potential efficacy of novel types of wound dressings.” Journal of Applied Microbiology 99: 895-901. 14. Holland, K. T. and W. Davis (1985). “A note on an in vitro test system to compare the bactericidal properties of wound dressings.” J. Appl. Bact 59: 61-63. 15. Cooper, R. A. (2007). “Iodine revisited.” International Wound Journal 4: 124-137. 16. Cooper, R. A. (2008). “Using honey to inhibit wound pathogens.” Nursing Times 104(3): 46-49. 17. Molan, P. and J. A. Betts (2004). “Clinical usage of honey as a wound dressing: an update.” Journal of Wound Care 13(9): 353-356. 18. Maeda, Y., A. Loughrey, et al. (2008). “Antibacterial activity of honey against community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA).” Complementary Therapies in Clinical Practice 14: 77-82. EWMA Journal 2008 vol 8 no 3
Limitations of the Study: The bacteria tested here were grown in pure culture and it is likely that this does not closely representing the multi microorganism environment of a wound. The pH and oxygen availability of the wound would also be different to that of the agar plates 14 . Care must be taken when taking in vitro data into the clinical environment, as this study investigated the antimicrobial properties of these dressings and therefore did not take into account the wound healing properties or fluid handling capacity of the dressings. The results here show that Leptospermum impregnated honey dressings have more effective antimicrobial properties than those impregnated with buckwheat or multi floral honeys and that the alginates were more effective as barriers. These results could vary if tested with a different model in vitro or if tested in vivo, as there would be more variables 15 . CONCLUSION There is much evidence for honey as both an antibacterial and a wound healing agent and therefore impregnated dressings are desirable16-18 . It has been demonstrated in this in vitro test that the Leptospermum honey impregnated calcium alginates exhibited not only effective antibacterial activity but also worked efficiently as barriers to staphylococcal spread. It also revealed that although all the dress- DMS 1205-6 Intern.PressMap.EWMAad 2/24/06 2:07 PM Page 1 Pressured to Prevent Heel Ulcers? Choose Heelift ® Suspension Boot The Pressure-Free Solution Now there’s proof that Heelift ® Suspension Boots provide a pressurefree environment to help eliminate the onset of pressure ulcers and to help heal existing ulcers. Using a 16-sensor force sensing pad affixed to the heel of the subject patient, pressure was “mapped” using various pressure reduction products. In all tests, Heelift ® provided a pressure-free solution! Heelift ® Suspension Boot Pressure Reduction Mattress Heel Protector Heel Pillow Heelift ® has added design features for more comfort, support and easier, one-handed closure. • Extended stitching along the top rim narrows the forefoot, increasing support to protect against foot drop, equinus deformity or heel cord contracture • Two non-abrasive, soft straps with D-ring closures permit easy adjustment of strap tension Darco (Europe) GmbH Gewerbegebiet 18 • 82399 Raisting Tel: +49-8807-9228-0 • Fax: +49-8807-9228-22 info@darco-europe.com www.darco-europe.com Moorings Mediquip Mobility & Independent Living Centre 51 Slaght Road • Ballymena Co Antrim BT42 2JH • N.Ireland Tel: +44 28 2563 2777 • Fax: +44 28 2563 2272 e-mail: sales@mooringsmediquip.co.uk Science, Practice and Education ings are honey impregnated, that there were differences in the properties of these dressings. Great care should be taken in selecting the appropriate one for use in a clinical situation. Implications for Clinical Practice n Care should be taken when selecting a dressing to ensure that it is appropriate for the use intended. Those dressings with highest antibacterial activity may not give highest wound healing activity. n Leptospermum calcium alginates have potential as an effective barrier to prevent spread of MRSA through the dressing. Further Research: n Future research could investigate the performance of these dressings under a different model system. n There is a need to explore the other wound healing properties of dressings to get a view of the efficacy of the dressings as a whole. m Heelift ® Original and Smooth Patent No. 5449339 Additional patents pending ©2006 DM Systems, Inc.
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