Episode 15: Honey in Wound Therapy

Hello, my name is Dr. Abdul Sekham and I'm the Stroke Research and Innovation Manager for Stroke Hub Wales based at Cardiff Metropolitan University. Welcome to this episode of the Leg Club podcast. Today I will be discussing the history and use of honey in medicine. So my contents include an introduction, honey and its use in medicine, in wound healing, why honey works, honey wound care products and I will look at some of my PhD studies. So the ancient use of antimicrobial therapies began with primitive societies who used a plethora of animal, vegetable and mineral agents. Some of the animal agents included bile, blood, butter, cobwebs and also egg white. Vegetable agents, honey, dyes, bark, fruit, herbs, leaves and more. Minerals such as clay, alum, copper salts, lead salts, potassium salts, zinc salts, to mention but a few. And these were all documented by Forrest in 1982. Medical knowledge of these agents developed in Mesopotamia and Eastern Mediterranean, the Far East, India, South America and Polynesia. The The use of these agents were used either singly or in combination by different cultures within the world. Nowadays, there are a range of products available on the market including silver, iodine, chlorhexidine, octenidine and honey. However, their use depends on the efficacy, cytotoxicity and effectiveness. Honey has been used in medicine for millennia and nowadays is being used due to its bioactive components and antimicrobial properties. Many civilizations used honey, the Anglo-Saxons used it in eye disease, they used it in infective and chronic ulcers to remove scabs, tumors, wounds resulting from amputation and reducing exudate. Arabs used it in burns, diseases of the eye, skin and gut, fever for hemorrhoids and respiratory ailments. The Chinese for smallpox lesions to reduce scars and wounds. In Finland and Germany, they used it for wounds. The Greeks used it for respiratory ailments, wound dressings, particularly for infected wounds and ulcers, animal bites and head lice. Indians used it for burns, constipation, eye and respiratory infections, internal disorders and wound ulcers. Other civilizations also used honey in many ways, such as the Romans, Mexicans, Brazilians and other South American cultures and the Sudanese. These have been well documented by various authors from around the world. So why does honey work? These therapeutic properties are largely attributed to its antimicrobial and anti-inflammatory activities. So much has been written about the bioactivities of honey by Professor Molen and various other authors. The antimicrobial activity, methylglyoxal and leptosin contribute to antibacterial activity as well as B. diffansin. honeys produce hydrogen peroxide. Manuka honey does not produce detectable levels. Other properties include deodorizing action, debriding action, the osmotic effect, the anti-inflammatory activity, antioxidant activity, enhanced rate of healing. Essentially, honey can be regarded as an antimicrobial agent with the ability to promote wound healing. We must say that not all honeys are equal and new bioactivities are being discovered. Honey has been used against a plethora of wound microorganisms such as gram-positive staph MRSA, VRSA, VRE, and gram-negatives such as Pseudomonas aeruginosa. Honey wound care products. Licensed wound care products containing medical-grade honey first became available in 1999 and are now widely used. there are many honey products on the market and they've been used for various wound types. I will now take a look at my various PhD studies. So I did a preliminary survey, a knowledge and attitudes of wound assessment, treatment and management amongst wound care professionals and an interpretive immunological analysis study, a patient's lived experience of been treated with medical grade honey. So the aim of the preliminary survey was to determine underlying knowledge of topical antimicrobial interventions in wounds with a particular emphasis on honey. So using face-to-face interviews with delegates attending a wound healing conference, knowledge of the use of antimicrobial interventions for wounds was explored with a mixture of open-ended and closed questions. Convenience sampling was employed to select 10 participants and their response recorded and evaluated by descriptive statistics and thematic analysis. So the results. Of the 10 respondents, six were tissue viability nurses with an average of more than 10 years wound care experience. Themes concerning best practice were six participants with a holistic approach to wound care and two with evidence-based medicine as a driver. The majority of delegates 80% interviewed were aware of the use of honey in medicine through articles 70%, lectures 50% and clinical practice evidence-based research 50% respectively. Reflections on their clinical experience with honey were reported by seven participants. Two participants did not recommend the use of honey due to patients reporting a drawing painful sensation. So in the discussion, the observations made during this pilot study provide a user-centered perspective on topical antimicrobial interventions in wounds. This information, together with a review of the literature, informed the development of an attitude questionnaire. So the aim of the quantitative research was to investigate the relationship between perceptions, knowledge, experience, opinions and feelings with the respect of the use of topical antimicrobial agents in wound healing. So in conclusion, the preliminary survey indicated that there is some knowledge about the theory and application of honey in treating wounds amongst the small cohort of wound care practitioners. There was a variety of levels of knowledge and experiences in this cohort. Now I'm going to look at the interpretive immunological analysis, the lived experiences of using medical-grade honey on wounds amongst patients. It is important to mention that this has been published in the British Journal of Nursing Supplement. So patients' experiences are really examined and taken into consideration their perspective on the wound type, the treatment and care are increasingly recognized and important for our healthcare organizations. Hawkins and Lindsay in 2006 also suggest that underlying experiences of patients living with leg wounds helps us understand the experience of being a patient and living with these wounds. And patients play important roles in optimizing the power of the patient's experiences towards physical, mental, social, spiritual, and cultural and psychological healing. Currently, outcomes and patient experiences are at the heart of the NHS reforms. There's an NHS initiative, No Decision About Me Without Me. So if I give you some insight into some of the patient experiences. So one of the questions I asked is how did you view honey in the treatment of wounds? It's a bit of background about one of the respondents. A 60 year old female with venous leg ulcers, right leg healed with honey in three to four months and the left leg still being treated. This is her account. The honey appeared to be doing its job. You could see the wound heal week to week. I was more than grateful for it. Physically, it did its job. It healed the wound. Personally, as I said, if the job had eventually stopped the pain I was in, that was good enough for me. That was great. And I think that's what the majority of people will tell you. If it does the job well enough and takes you out of a situation where you're in quite a lot of pain to a situation where you're in no pain and it's healed, then that's all I can ask of something. Another respondent, an 83 year old female with a history of poor circulation and venous leg ulcers. Treatment over 30 years with various conventional wound dressings. This is what she had to say. I would welcome it. Welcome it because it is a natural substance and not chemically produced. we ought to use our natural reserves of opportunities to use it so I welcome welcome the use of honey. I've never talked to anyone that has had a bad result from honey but personally I've put my faith in honey with anything else that I've tried. We can see from these two accounts that honey has worked for these two patients however honey does not work for all patients. Good wound care comes from good holistic assessment by the clinician. The clinician needs to astain whether the honey would be useful for the patient's wound. Is it applicable to the wound? And also, is the patient accepting of the honey dressing? Also, contraindications should be considered and discussed. If the patient is allergic to bee venom or bee stings, honey should not be used. So the use of honey is important for wound care and as discussed has been used throughout history. However, as mentioned previously, good wound care and the use of honey comes from good holistic assessment and practice. the use of up-to-date evidence by the clinician and also whether the patient is on board with the use of honey in their wound care regime. Honey has been described as a remedy rediscovered by Zumla and Lulat. So hopefully this has provided you with a bit of insight into the history of honey and some of the research I have done. Thank you for your time and goodbye.