The Beneficial Use of Honey in Wound Management

Introduction The use of honey for medicinal purposes has been around for thousands of years. It has been documented to the era of the ancient Egyptians, to the days of the Islamic Prophet Muhammad, even to the battles of World War I. The use of honey has so far declined due to the advances in medicine; however, the improvements in antibiotics are not without flaws. Antibiotic-resistant microbes have proved to be a widespread problem in wound management in all health-care settings. This incline of antibiotic-resistance resulted in a renewed interest in honey for the use in wound therapy. Considered by most clinicians as “complementary” or “alternative” medicine, the purpose of the four articles on this specific topic was to provide academic thought into whether honey should be an acceptable form of wound management. The authors of the respectable articles thoroughly discussed each point of view in a matter that created a profound insight of the use of honey and its properties in wound care.
Benefits
According to Sharp (2009), honey “possesses antimicrobial and anti-inflammatory properties, promotes debridement, deodorizes wounds, maintains a moist wound environment and stimulates healing” (p. 66). Honey has been discovered to be rich in antioxidants, maintains a low pH environment, facilitates osmosis to create a moist wound bed, and produces natural hydrogen peroxide from glucose oxidation. These set of elements provide for the beneficial effects of honey in wound care. For instance, because of its low pH property that creates an environment unsuitable for microbes, honey has been found to have a very broad spectrum of antimicrobial activity, effecting both Gram-positive and Gram-negative species. It has also been documented to be effective against antibiotic-resistant strains of Pseudomonads, methicillin-resistant Staphylococcus auerus, and coagulase-negative Staphylococci (Molan, 2011, p. 209). Honey also acts a physical barrier on open wounds, preventing further external contamination. The antioxidant quality of honey also acts an anti-inflammatory agent on wounds. This effect had been demonstrated in burn injuries; in particular, partial-thickness burns wounds were “prevented from developing to full-thickness burn wounds by application of honey dressings” (Sharp, 2009, p. 70). Furthermore, honey increases the activity of the enzyme plasmin, which effectively digests fibrin that attaches slough to the wound surface without digesting collagen matrix needed for tissue repair. A study found that the increased plasmin activity is a result of honey inhibiting the production of plasminogen activator inhibitor (PAI), an enzyme that would have otherwise block the enzymatic activity of plasmin. PAI production is increased with inflammation; hence the decrease of PAI production provides an anti-inflammatory effect on wound therapy as well as wound debridement.
Randomized Controlled Trials Randomized Controlled Trials (RCTs) are experiments conducted in a controlled setting, providing a random assignment to treatment groups of large and diverse samples. Based on the article written by Molan (2011), a total of 19 RCTs, with a total population of 2,554 participants, have been concluded on the clinical uses of honey. In this particular article, the statistical database is a compilation of other research on the effects of honey in wound therapy. The other articles provided no definitive statistical measurement of the multiple RCTs, but rather cites and refers to other studies. For instance, Sharp (2009) more often cited the data from the article composed by Molan (2011).
Results
In the compilation of data researched by Molan (2011), different control treatments were used on 17 different types of wounds for a wide variety of specified focuses. In superficial and partial-thickness burns that were less than 50% of total body surface area, the control treatment used was 1% silver sulfadiazine cream. In this study, the main goal was to see the average healing time of both control and honey. As a result, honey had an average of 18.1 days of healing time compared to the 32.6 days of the control. In the study on sloughy venous leg ulcers, the control treatment used was the usual aid of hydrogel. Both groups received compression bandaging to the wound. This study reflected on the reduction of slough, reduction in wound size, and the proportion healed. The mean reduction in slough in 4 weeks was 34% with honey compared to 13% with the control. The mean reduction in wound size in 4 weeks was 67% with honey and 52.6% with the control. The proportion healed in 12 weeks was 24% with honey and 18% with the control. In the microvascular free tissue reconstruction surgery trial, the control treatment used was conventional dressings. The trial concentrated on the proportion with positive wound swabs 7 days after surgery and the mean duration of stay in the hospital. The proportion with positive wound swabs for honey concluded at 20% compared to the 13% for the control. The mean duration of hospitalization with honey was 16 days compared to the 21 days for the control group.
Discussion
Three of the four articles provided significant research findings that appear to support the clinical use of honey for wound management. However, there is not enough “irrefutable proof to inform best practice guidelines at present” (Cray, 2010, p. 26). The data supplied by Molan (2011) and Sharp (2009) holds promising research and beneficial evidence to standardize the use of honey, but there is not yet enough high-quality unbiased research that can support the claims. In the clinical setting, practitioners more often opt for conventional wound therapy rather than the use of honey. In order to make the use of honey as an evidence-based practice, more thorough and specific research and RCTs are needed to determine the safe and effective use of honey in wound therapy.
Conclusion
The people of ancient times have been documented to use honey products for medicinal purposes. Being rich in antioxidants, having a low pH environment, facilitating with osmosis, and producing hydrogen peroxide are the essential elements of honey that provides its antimicrobial and anti-inflammatory properties, as well as promotion of debridement, deodorization of wounds, and stimulation of healing. Although the properties of honey has been seen to be a better alternative in wound management, the practice is far from close to being considered as safe and effective in the clinical sense. Based on the RCT data alone, it can be said that honey is the bigger choice of the two treatments; nevertheless, most medical practitioners do not favor the use of honey in wound care. This is due to the limited amount of research and data on honey in wound management. In order to convert to an evidence-based practice that is widely used amongst medical practitioners, more research and trials are needed in order to support the use of honey. Even though honey has restricted research data, the properties that have been seen to help with wound management is a promising form of wound therapy for the years to come.

References
Cray, A. (2010). Honey treatments for wounds. Journal Of Community Nursing, 24(2), 22.
Gethin, G. (2007). Healing honey. World Of Irish Nursing & Midwifery, 15(10), 22-23.
Molan, P. (2011). The evidence and the rationale for the use of honey as a wound dressing. Wound Practice & Research, 19(4), 204-220.
Sharp, A. (2009). Beneficial effects of honey dressings in wound management. Nursing Standard. 24(7), 66-74.