Authors (including presenting author) :
Lee SC, Mok HT, Hui SL, Tang YM,Lui TC, Li WH, Lam MY, Tse YC, Hui SY, Chau MF
Affiliation :
Community Nursing Service, Kowloon Hospital
Introduction :
In community, a certain number of patients carry chronic wounds, especially pressure injury (PI). The prevalence of this situation mostly due to the aging population and comorbidity of different diseases. Actually, PI wound care are mainly cared in home settings or institutions, rather than in hospitals. In Kowloon Hospital (KH), Community Nursing Service (CNS), many home visits are paid for clients with PI. PI is a significant burden to community nurses. Community nurses often use various wound care products, such as silver impregnated dressing, sodium chloride and povidone iodine, in an attempt to promote the wound healing rate. Apart from these products, honey is an alternative for wound dressing since it has been used in clinical wound care commonly. However, studies showing its effectiveness in the treatment of pressure injury in the community setting are barely existent. Therefore, KH CNS would like to conduct this study to assess the efficacy of medical-grade Manuka honey in pressure injury with povidone-iodine ointment as usual care on wound healing and number of home visits.
Objectives :
1. To compare the effectiveness of topical medical-grade Manuka honey and topical 10% povidone-iodine ointment for wound healing duration, as manifested by the reduction of wound size or wound closure among the groups who are suffered from stage 2 or 3 pressure injury.
2. To compare the number of home visits among topical medical-grade Manuka honey and topical 10% povidone iodine ointment in pressure injuries on the number of home visits paid.
Methodology :
The study samples were the patients being referred to KH CNS for wound care. Participants were randomly assigned into two groups, Manuka honey experimental group (n=16) or 10% povidone iodine ointment control group (n=16). Total 32 participants were recruited. Similar protocols were carried out in two groups, including pressure injury prevention measures, using primary and secondary dressings for 6 weeks or until wound closure. Wound healing rate was measured by the PUSH tool and the total number of home visits for wound care were summarized and compared.
Result & Outcome :
Total 31 subjects completed the study. One subject from the 10% povidone iodine ointment group dropped out due to hospital admission during the study period. The mean age was 81.3 years (65-104), all subjects were Chinese. The most common site of pressure injury (PI) was sacrum (44%, n=14). The second and third common sites were coccyx (19%, n=6) and heel (10%, n=3) respectively. Regarding healing rate in both groups, there was no significant difference in PUSH scores between Medical-grade Manuka honey group and 10% povidone iodine ointment group with t(29)=-0.265, p=0.793. However, there was a significant difference within Medical-grade Manuka honey group. The mean PUSH score reduced from 10.875 in week one to 5.875 in week seven. Paired sample t-test confirmed this reduction to be statistically significant with t(15)=4.804, p=0.000. A significant difference was also found in the 10% povidone iodine ointment group. Its mean PUSH score decreased from 10.600 in week one to 5.467 in week seven. Paired sample t-test confirmed this reduction to be statistically significant with t(14)=5.886, p=0.000.
The total number of home visits for Medical-grade Manuka honey group was 302, whereas that for 10% povidone iodine ointment group was 328. Medical-grade Manuka honey group had 15.95% home visits less than 10% povidone iodine ointment group.
Although this study indicated no statistically significant differences between Medical-grade Manuka honey and 10% povidone iodine ointment, our findings have provided evidence that both topical antimicrobial agents are effective in PI wound healing. Therefore, it is suggested that Medical-grade Manuka honey is an alternative for PI wound care if 10% povidone iodine ointment cannot be used under some circumstances, such as renal impairment and thyroid disease or allergic to 10% povidone iodine ointment.
