Comparison Study of Bacterial Profile, Wound Healing, and Cost Effectiveness in Pressure Injury Patients Using Treatment Honey Dressing and Hydrogel
DOI:
https://doi.org/10.14228/jprjournal.v9i1.334Keywords:
Honey, Pressure Injury, Wound Healing, Bacterial Profile, CostAbstract
Background : Pressure injury is a localized soft tissue injury caused by prolonged pressure over bony prominence. Most published papers used Manuka honey as dressing, while this product is expensive. As this reason, this study will use local product honey called Nusantara honey, to prove the use of local honey has better healing process, bacterial profile, and cost effectiveness, compared to the standard dressing, hydrogel.
Method : This is a one-month experimental study conducted in patients with pressure injury that referred to our division. Parameter of the bacterial profile was taken from deep-tissue specimen. The healing process was examined with Pressure Ulcer Scale for Healing (PUSH) Tool. Cost was accumulated after all the treatment. Data was analysed with t-Test or Mann Whitney (if the distribution is not normal), with statistical significance was define as p<0.05..
Result : Of 26 wounds, 12 were randomized to hydrogel and 14 to honey dressing. Characteristics were determined by sex, age, body mass index, level of consciousness, mobilization status, immobilization etiology, comorbidities, grade and location of ulcer, hemoglobin, leukocytes, and albumin level. There was clinically significant wound size reduction in honey dressing according to PUSH Tool (p=0.118). The bacterial profile and reduction were similar. Honey dressing appeared to be more cost effective in terms of dressing cost (p<0.001) and lower total cost.
Conclusion: The local honey dressing has better wound healing outcome, although it is not statistically significant. Its capability of decreasing pathogens is similar with hydrogel, with lower cost, particularly the dressing cost. This local honey dressing could be a good choice as wound dressing in areas where the modern dressings are not available.
References
Cavaliere CM, Aliotta RE. Pressure Injuries. In: Chung KC, editor. Grabb and Smith’s Plastic Surgery. 8th ed. Philadelphia: Wolters Kluwer; 2020.
Molan PC. The evidence and the rationale for the use of honey as a wound dressing. Wound Practice and Research. 2011;19 Number 4.
Molan PC. The evidence supporting the use of honey as a wound dressing. Int J Low Extrem Wounds. 2006;5(1):40-54.
Kwon R, Rendon JL, Janis JE. Pressure sores. In: Neligan PC, editor. Plastic Surgery Lower Extremity, Trunk, and Burns. 4. 4th ed. Philadephia: Elsevier; 2018. p. 350-80.
Soopramanien A, Sinfgh S. Pressure Ulcers in Neurologically Compromised Patients. Mani R, Romanelli M, Shukla V, editors. New York: Springer; 2012.
Amir Y, Lohrmann C, Halfens RJ, Schols JM. Pressure ulcers in four Indonesian hospitals: prevalence, patient characteristics, ulcer characteristics, prevention and treatment. Int Wound J. 2017;14(1):184-93.
RSCM ISMU. Pressure Injuries. Jakarta2019.
Gardner SE, Frantz RA, Bergquist S, Shin CD. A Prospective Study of the Pressure Ulcer Scale for Healing (PUSH). Journal of Gerontology. 2005;60A:93-7.
Gunes UY, Eser I. Effectiveness of a Honey Dressing for Healing Pressure Ulcers. J Wound Ostomy Continence Nurs. 2007;34(2):184-90.
Efem SEE, Udoh KT, Iwara CI. The antimicrobial spectrum of honey and its clinical significance. Infection20(1992)No4. 1992.
Diah A, Sundoro A, Sudjatmiko G. Antibacterial Activity of Indonesian Local Honey Against Strains of P. Aeruginosa, S. Aureus and MRSA. Jurnal Plastik Rekonstruksi. 2012;1.
Mukarramah DA, Sudjatmiko G. Accelerated Healing of The Wider Lateral Defects in Adult Cleft Palate Repairs. Jurnal Plastik Rekonstruksi. 2012;1:499-503.
Bangun K, Sudjatmiko G, Mahandaru D. Modified Two-Flap Palatoplasty With Leaving Lateral Periosteum and Application of Honey Pack A Preliminary Study. Jurnal Plastik Rekonstruksi. 2012;1:67-73.
Kreshanti P, Sudjatmiko G, Bangun K. The Effect Of Honey Give As Oral Drops In Precipitating Epithelialization Of Lateral Palatal Defects Post Two-Flap Palatoplasty. Jurnal Plastik Rekonstruksi. 2012;1:504-9.
Kreshanti P, Handayani S, Fortuna F, Pancawati J, Susanto AJ, Wangge G, et al. Maxillary Growth Evaluation of Patients with Unilateral Complete Cleft Lip and Palate After Two Flap Palatoplasty with Honey ORal Drops. Jurnal Plastik Rekonstruksi. 2018;2:211-9.
Septrina R, Sudjatmiko G. The Difficulties of Reconstruction in The Achilles Area. Jurnal Plastik Rekonstruksi. 2012;1:281-5.
Hakim IF, Sudjatmiko G. Recurrent Cranial Bone and Scalp Defect A Case Report. Jurnal Plastik Rekonstruksi. 2012;1:159-61.
Raymond B, Sudjatmiko G. Standardization of Honey Application on Acute Partial Thickness Wound. Jurnal Plastik Rekonstruksi. 2012;1:570-4.
Teuku A, M.P. N, Sudjatmiko G, Astrofi SS, Ishandono D. Application of Honey and Transparent Dressing to Split Thickness Skin Graft Donor Site and Its Effect on Epithelialization Rate. Jurnal Plastik Rekonstruksi. 2012;1:333-7.
Djoenaedi I, Sudjatmiko G. Topical Honey Application In Treating Large Ulcerated Wound As a Complication of Vascular Malformation In a 5-Month-Old Baby. Jurnal Plastik Rekonstruksi. 2012;1:182-6.
Fortuna F, Putri NM, Sudjatmiko G. Granulation Red Index To Assess Pressure Ulcer Granulation Tissue Quality Treated By Honey Gauze Dressing By Digital Image Analysis. Jurnal Plastik Rekonstruksi. 2020;6(2):270-5.
Harsono AD, Sudjatmiko G. The Effect of Honey on Granulating Tissue of The Mandibular Bone. Jurnal Plastik Rekonstruksi. 2012;1:338-40.
Mukarramah DA, Sudjatmiko G. Comparison of Wound-bed Preparation Time in Chronic Traumatic Wound Using Topical Honey Application and Conventional Dressing. Jurnal Plastik Rekonstruksi. 2012;1:426-34.
Sundoro A, Nadia K, Sudjatmiko G, Tedjo A. Comparison of Physical–Chemical Characteristic and Antibacterial Effect. Jurnal Plastik Rekonstruksi. 2012;1:341-7.
European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel, Pan Pacific Pressure Injury Alliance A. Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline. The International Guideline. 3rd ed: EPUAP/NPIAP/PPPIA; 2019.
Tepes N. Characteristic Features of Pressure ulcer Infetion. Acta Med Croatica. 2016;70 Suppl 1:45-51.
Livesly NJ, Chow AW. Infected Pressure Ulcers in Elderly Individuals. Aging and Infectious Diseases. 2002;35:1390-6.
Robson V, Dodd S, Thomas S. Standardized antibacterial honey (Medihoney) with standard therapy in wound care: randomized clinical trial. J Adv Nurs. 2009;65(3):565-75.
Tavakoli J, Tang Y. Honey/PVA hybrid wound dressings with controlled release of antibiotics: Structural, physico-mechanical and in-vitro biomedical studies. Mater Sci Eng C Mater Biol Appl. 2017;77:318-25.
Yaghoobi R, Kazerouni A, Kazerouni O. Evidence for Clinical Use of Honey in Wound Healing as an Anti-bacterial, Anti-inflammatory Anti-oxidant and Anti-viral Agent- A Review. Jundishapur J Nat Pharm Prod. 2017;8:100-4.
Moore OA, Smith LA, Campbell F, Seers K, McQuay HJ, Moore RA. Systematic review of the use of honey as a wound dressing. BMC Complementary and Alternative Medicine. 2001;1.
Akhmetova A, Saliev T, Allan IU, Illsley MJ, Nurgozhin T, Mikhalovsky S. A Comprehensive Review of Topical Odor-Controlling Treatment Options for Chronic Wounds. J Wound Ostomy Continence Nurs. 2016;43(6):598-609.
Weyden EAV. The use of honey for the treatment of two patients with pressure ulcers. Woundcare. 2003.
Biglari B, Linden PH, Simon A, Aytac S, Gerner HJ, Moghaddam A. Use of Medihoney as a non-surgical therapy for chronic pressure ulcers in patients with spinal cord injury. Spinal Cord. 2012;50(2):165-9.
Dumville JC, Stubbs N, Keogh SJ, Walker RM, Liu Z. Hydrogel dressings for treating pressure ulcers. Cochrane Database Syst Rev. 2015(2):CD011226.
Jones A, Vaughan D. Hydrogel dressings in the management of a variety of wound types: A review. Journal of Orthopaedic Nursing. 2005;9:S1-S11.
Whittle H, Fletcher C, Hoskin A, Campbell K. Nursing Management of Pressure Ulcers Using a Hydrogel Dressing Protocol- Four Case Studies. Rehabilitation Nursing. 1996;21:239-42.
BSN. Cutimed® Sorbact® gel 2020 [Available from: https://www.bsnmedical.in/products/wound-care-vascular/alphabetical-product-search/c/cutimedr-sorbactr-gel.html.
Bates-Jensen BM, McCreath HE, Harputlu D, Patlan A. Reliability of the Bates-Jensen wound assessment tool for pressure injury assessment: The pressure ulcer detection study. Wound Repair Regen. 2019;27(4):386-95.
Scotland HI. General wound assessment chart v3 2009 [Available from: http://www.healthcareimprovementscotland.org/our_work/patient_safety/tissue_viability_resources/general_wound_assessment_chart.aspx.
NPIAP. PUSH Tool Information [Available from: https://cdn.ymaws.com/npiap.com/resource/resmgr/online_store/push_tool_information_form.pdf.
Berlowitz D, Ratliff C, Cuddigan J, Rodeheaver G. The PUSH tool: A survey to determine its perceived usefulness. Advances in skin & wound care. 2005;18:480-3.
Choi EP, Chin WY, Wan EY, Lam CL. Evaluation of the internal and external responsiveness of the Pressure Ulcer Scale for Healing (PUSH) tool for assessing acute and chronic wounds. J Adv Nurs. 2016;72(5):1134-43.
Rondas AALM, Schols JMGA, Halfens RJG, Stobberingh EE. Swab Versus Biopsy for the Diagnosis of Chronic Infected Wounds. Advances in skin & wound care. 2013.
Bradshaw CE. An in vitro comparison of the antimicrobial activity of honey, iodine and silver wound dressings. Bioscience Horizons. 2011;4(1):61-70.
Norman G, Dumville JC, Moore ZE, Tanner J, Christie J, Goto S. Antibiotics and antiseptics for pressure ulcers. Cochrane Database Syst Rev. 2016;4:CD011586.
Xu Z, Han S, Gu Z, Wu J. Advances and Impact of Antioxidant Hydrogel in Chronic Wound Healing. Adv Healthc Mater. 2020;9(5):e1901502.
Langemo DK, Hanson D, Anderson J, Thompson P, Hunter S. Use of Honey for Wound Healing. Advanced in Skin and Wound Care. 2009;22:3
Almeleh R, Spontaneous Accelerated Epithelialization in Deep Dermal Burns Using an Oxygen-Delivering Hydrogel: A Report of Two Cases. WOUNDS. 2013;25(10):E18-E25.
Pastar I, Stojadinovic O, Yin NC, Ramirez H, Nusbaum AG, Sawaya Andrew, et al. Epithelialization in Wound Healing: A Comprehensive Review. Adv Wound Care (New Rochelle). 2014 Jul 1;3(7):445-464
David CP, Normal Flora. In: Baron S. Medical Microbiology. 4th ed. Texas: University of Texas Medical Branch at Galveston; 1996.
Byrd AL, Belkaid Y, Segre JA. The human skin microbiome. Nature Reviews Microbiology, 16(3), 143–155
Grive EA, Segre JA. The skin microbiome. Nat Rev Microbiol. 2011 April; 9(4): 244–253.
Ruffin M, Brochiero E. Repair Process Impairment by Pseudomonas aeruginosa in Epithelial Tissues: Major Features and Potential Therapeutic Avenues. Front. Cell. Infect. Microbiol. 9:182.
Serra R, Grande R, Butrico L, Rossi A, Settimio UF, Caroleo B, et al. Chronic wound infections: the role of Pseudomonas aeruginosa and Staphylococcus aureus, Expert Rev. Anti Infect. Ther. 13(5), 605–613 (2015)
Unal S, Ersoz G, Demirkan F, Arslan E, Tutuncu N, Sari A. Analysis of Skin-Graft Loss Due to Infection, Infection-Related Graft Loss. Ann Plast Surg 2005;55: 102–106
Brem, H, Lyder C. Protocol for the successful treatment of pressure ulcers. American Journal of Surgery 188 (Suppl to July 2004) 9S–17S
Jaul E, Barron J, Rosenzweig JP, Menczel J. An overview of co-morbidities and the development of pressure ulcers among older adults. Jaul et al. BMC Geriatrics (2018) 18:305
Karahan A, Abbasoglu A, Isik SA, Cevik B, Saltan C, Elbas NO, et al. Factors Affecting Wound Healing in Individuals with Pressure Ulcers: A Retrospective Study. Ostomy Wound Management 2018;64(2):32–39
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