COMMENT
Does honey have a place in stoma care?
684
‘
Honey offers an alternative natural antibacterial to help maintain the skin’s protective layer when incontinence occurs.
’
to further irritation. The combination of urine and faeces increases the irritant effect causing excoriation and skin breakdown. Faeces contain digestive enzymes that are normally deactivated within the bowel to a near neutral pH of 7. However, when faeces and urine mix, the urea in the urine converts to ammonia causing a shift in the pH of skin and faeces into the alkaline range, which can attack the skin. If the outer layer of the skin is attacked by lipodylic and proteolytic enzymes from loose stools, the physical strength of the stratum corneum is compromised and results in skin erosion (Beeckman et al, 2009). Incontinence associated dermatitis is linked to a
disrupted acid mantle, and these changes in the skin pH become clinically significant as they create a favourable environment for the growth of bacteria. There are many wound dressings and skin barrier products that contain medical-grade honey. I could only find information about one stoma product that contains medicalgrade honey, the new Aura ileostomy bag by Clinimed, who also produce a colostomy bag with the same additive. Described as drainable with medical-grade honey, it features an ovalshaped hyperflex hydrocolloid flange with Manuka honey also, to promote healthy skin around the stoma. The evidence supporting honey as a wound management product is often cited as anecdotal, but there are reports of its clinical usage dating back to the 1950s and the realities are that there have been many reports, case studies and trials (Molan, 2006). I feel that medical-grade honey is an obvious choice to be added to an ileostomy drainage bag as a natural resource, to help maintain skin integrity, to aid reduction of discomfort caused through incontinence-associated dermatitis, to reduce any bacterial load—as antibioticresistance bacteria continue to pose a very serious threat to public health—and help to BJN improve an individual’s quality of life. Beeckman D, Schoonhoven L, Verhage S et al (2009) Prevention and treatment of incontinence-associated dermatitis: literature review. J Adv Nurs 65(6): 1141–54 Burlando F (1978) Sull`azione terapeutica del miele nelle ustoni. Minerva Dermatologica 113: 699–706 Gupta SK, Singh H, Varshney AC et al (1992) Therapeutic efficacy of honey in infected wounds in buffaloes. Indian J Anim Sci 62(6): 521–3 Kumar A, Sharma VK, Singh HP (1993) Efficacy of some indigenous drugs in tissue repair in buffaloes. Indian Veterinery Journal 70(1): 42–4 Molan P (2005) Mode of action In:White R, Cooper R, Molan P (eds) Honey: A modern wound management product. Wounds UK, London Molan PC (2006) The evidence supporting the use of honey as a wound dressing. Int J Low Extrem Wounds 5 (1): 40-54 Oryan A, Zaker SR (1998) Effects of topical application of honey on cutaneous wound healing in rabbits. Zentralbl Veterinarmed A 45(3): 181–88 Postmes TJ, Bosch MMC, Dutrieux R et al (1997) Speeding up the healing of burns with honey. An experimental study with histological assessment of wound biopsies. In: Mizrahi A, Lensky Y (Eds) Bee products: Properties, Applications and Apitherapy. Plenum Press, New York Rippke F, Schreiner V, Schwanitz HJ (2002) The acid milieu of the horny layer: new findings on the physiology and pathophysiology of the skin pH. Am J Clin Dermatol 3 (4): 261–72
Judy Belcher
Tissue Viability Nurse, Worcestershire Acute Hospitals NHS Trust
© 2013 MA Healthcare Ltd
T
hroughout history, humans have used honey, not only as a food product, but also as a therapeutic aid, especially in wound care. Bees concentrate the dilute sugar solutions they collect from plants and add enzymes. As the honey ripens, it is impossible for microbes to grow within it and spoil the stored food (Molan, 2005). Sugar and water molecules bind, denying the microbes water essential for their survival. Another enzyme involved is glucose oxidase, which converts some of the glucose to gluconic acid, ensuring that honey is too acidic for microbes to thrive in (Molan, 2005). This suppresses microbial growth when honey is applied to the skin. Honey also ensures that the wound environment remains moist, which promotes healing, and has a high viscosity, which helps to provide a protective barrier that can prevent infection. Medical-grade honey has emerged as a product that can achieve a variety of outcomes and is safe and easy to use. As well as the clinical observations of reduction of inflammation by application of honey to a wound, studies in animal models have demonstrated that honey gives reduced inflammation compared with various controls. Histological observation shows reduced numbers of inflammatory cells present in deep wounds (Postmes et al, 1997), superficial burns (Burlando, 1978) and full-thickness wounds (Gupta et al, 1992; Kumar et al, 1993; Oryan et al, 1998).These
effects were due to components other than the sugar in honey. Although inflammation is a vital part of the normal response to infection and injury, when it is excessive or prolonged it can prevent healing or even cause further damage to the tissues. Suppression of inflammation, as well as reducing any pain for the patient, reduces the opening of blood vessels so reduces oedema and exudate. Damage to the skin from incontinence or the associated dermatitis can be painful and compromise an individual’s quality of life, however, it is avoidable and preventable. Honey offers an alternative natural antibacterial to help maintain the skin’s protective layer when incontinence occurs. The skin’s surface has an average pH of 5.5, making it slightly acidic. This acid mantle helps to hydrate the skin, protecting it from drying and from harmful bacteria.The protective acid coating also prevents infection from entering the body by inhibiting bacterial growth and the action of bacterial enzymes (Rippke et al, 2002). Both urine and faeces are alkaline and on contact with the skin produce a chemical reaction. When microorganisms release urea from urine, ammonia is produced; this increase the pH of the skin leading
British Journal of Nursing, 2013, Vol 22, No 11
British Journal of Nursing. Downloaded from magonlinelibrary.com by 137.189.170.231 on November 13, 2015. For personal use only. No other uses without permission. . All rights reserved.
Does honey have a place in stoma care?
684
‘
Honey offers an alternative natural antibacterial to help maintain the skin’s protective layer when incontinence occurs.
’
to further irritation. The combination of urine and faeces increases the irritant effect causing excoriation and skin breakdown. Faeces contain digestive enzymes that are normally deactivated within the bowel to a near neutral pH of 7. However, when faeces and urine mix, the urea in the urine converts to ammonia causing a shift in the pH of skin and faeces into the alkaline range, which can attack the skin. If the outer layer of the skin is attacked by lipodylic and proteolytic enzymes from loose stools, the physical strength of the stratum corneum is compromised and results in skin erosion (Beeckman et al, 2009). Incontinence associated dermatitis is linked to a
disrupted acid mantle, and these changes in the skin pH become clinically significant as they create a favourable environment for the growth of bacteria. There are many wound dressings and skin barrier products that contain medical-grade honey. I could only find information about one stoma product that contains medicalgrade honey, the new Aura ileostomy bag by Clinimed, who also produce a colostomy bag with the same additive. Described as drainable with medical-grade honey, it features an ovalshaped hyperflex hydrocolloid flange with Manuka honey also, to promote healthy skin around the stoma. The evidence supporting honey as a wound management product is often cited as anecdotal, but there are reports of its clinical usage dating back to the 1950s and the realities are that there have been many reports, case studies and trials (Molan, 2006). I feel that medical-grade honey is an obvious choice to be added to an ileostomy drainage bag as a natural resource, to help maintain skin integrity, to aid reduction of discomfort caused through incontinence-associated dermatitis, to reduce any bacterial load—as antibioticresistance bacteria continue to pose a very serious threat to public health—and help to BJN improve an individual’s quality of life. Beeckman D, Schoonhoven L, Verhage S et al (2009) Prevention and treatment of incontinence-associated dermatitis: literature review. J Adv Nurs 65(6): 1141–54 Burlando F (1978) Sull`azione terapeutica del miele nelle ustoni. Minerva Dermatologica 113: 699–706 Gupta SK, Singh H, Varshney AC et al (1992) Therapeutic efficacy of honey in infected wounds in buffaloes. Indian J Anim Sci 62(6): 521–3 Kumar A, Sharma VK, Singh HP (1993) Efficacy of some indigenous drugs in tissue repair in buffaloes. Indian Veterinery Journal 70(1): 42–4 Molan P (2005) Mode of action In:White R, Cooper R, Molan P (eds) Honey: A modern wound management product. Wounds UK, London Molan PC (2006) The evidence supporting the use of honey as a wound dressing. Int J Low Extrem Wounds 5 (1): 40-54 Oryan A, Zaker SR (1998) Effects of topical application of honey on cutaneous wound healing in rabbits. Zentralbl Veterinarmed A 45(3): 181–88 Postmes TJ, Bosch MMC, Dutrieux R et al (1997) Speeding up the healing of burns with honey. An experimental study with histological assessment of wound biopsies. In: Mizrahi A, Lensky Y (Eds) Bee products: Properties, Applications and Apitherapy. Plenum Press, New York Rippke F, Schreiner V, Schwanitz HJ (2002) The acid milieu of the horny layer: new findings on the physiology and pathophysiology of the skin pH. Am J Clin Dermatol 3 (4): 261–72
Judy Belcher
Tissue Viability Nurse, Worcestershire Acute Hospitals NHS Trust
© 2013 MA Healthcare Ltd
T
hroughout history, humans have used honey, not only as a food product, but also as a therapeutic aid, especially in wound care. Bees concentrate the dilute sugar solutions they collect from plants and add enzymes. As the honey ripens, it is impossible for microbes to grow within it and spoil the stored food (Molan, 2005). Sugar and water molecules bind, denying the microbes water essential for their survival. Another enzyme involved is glucose oxidase, which converts some of the glucose to gluconic acid, ensuring that honey is too acidic for microbes to thrive in (Molan, 2005). This suppresses microbial growth when honey is applied to the skin. Honey also ensures that the wound environment remains moist, which promotes healing, and has a high viscosity, which helps to provide a protective barrier that can prevent infection. Medical-grade honey has emerged as a product that can achieve a variety of outcomes and is safe and easy to use. As well as the clinical observations of reduction of inflammation by application of honey to a wound, studies in animal models have demonstrated that honey gives reduced inflammation compared with various controls. Histological observation shows reduced numbers of inflammatory cells present in deep wounds (Postmes et al, 1997), superficial burns (Burlando, 1978) and full-thickness wounds (Gupta et al, 1992; Kumar et al, 1993; Oryan et al, 1998).These
effects were due to components other than the sugar in honey. Although inflammation is a vital part of the normal response to infection and injury, when it is excessive or prolonged it can prevent healing or even cause further damage to the tissues. Suppression of inflammation, as well as reducing any pain for the patient, reduces the opening of blood vessels so reduces oedema and exudate. Damage to the skin from incontinence or the associated dermatitis can be painful and compromise an individual’s quality of life, however, it is avoidable and preventable. Honey offers an alternative natural antibacterial to help maintain the skin’s protective layer when incontinence occurs. The skin’s surface has an average pH of 5.5, making it slightly acidic. This acid mantle helps to hydrate the skin, protecting it from drying and from harmful bacteria.The protective acid coating also prevents infection from entering the body by inhibiting bacterial growth and the action of bacterial enzymes (Rippke et al, 2002). Both urine and faeces are alkaline and on contact with the skin produce a chemical reaction. When microorganisms release urea from urine, ammonia is produced; this increase the pH of the skin leading
British Journal of Nursing, 2013, Vol 22, No 11
British Journal of Nursing. Downloaded from magonlinelibrary.com by 137.189.170.231 on November 13, 2015. For personal use only. No other uses without permission. . All rights reserved.
