Page 66 - Wound Care at End of Life Content: A Guide for Hospice Professionals - DEMO

Other Therapies

Evidence‐based information is the foundation of choosing any treatment, including an evaluation of
treatment efficacy and safety. The clinician must be aware of less traditional interventions, including
cultural preferences that may contribute to patient comfort and quality of life. However, the same critical
thinking and evidence‐based practice that proves successful in other areas of patient care must also be
utilized when considering non‐conventional treatments.

BIOTHERAPY:
Biotherapy uses living creatures for diagnosis or treatment of human disease. Common modalities include
larvae (maggots), leeches, honey bees, and viruses. Honey and larval therapy are increasingly recognized
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as useful treatments in wound care.

Honey:
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Honey has been used for wound treatment dating back to ancient Egyptians and Greeks. Recent studies
have found that honey has an inhibitory effect on up to 60 species of bacteria, aerobic and anaerobic,
Gram‐positive and Gram‐negative. Antifungal action has also been observed for some yeast and species of
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Aspergillus and Penicillium. Leptospermum (Manuka or tea tree) honey, has an inhibitory effect on
Pseudomonas aeruginosa, methicillin‐resistant S. aureus (MRSA), and vancomycin‐resistant enterococcus
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(VRE).

Honey’s ability to aid in wound healing and treat infections can be linked to various mechanisms of action.
Honey contains glucose oxidase, an enzyme that converts glucose to hydrogen peroxide, an anti‐microbial
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agent. However, hydrogen peroxide concentration in honey is approximately 1000 times less than that
found in the 3% hydrogen peroxide solutions commonly used as an antiseptic, thus avoiding tissue
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damage. Medical grade honey is filtered, gamma‐irradiated, and produced under carefully controlled
standards, but is more expensive. Raw or unpasteurized honey as an alternative to medical grade honey
has been studied and used in various types of wounds. Honey’s therapeutic value can vary and is
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influenced by the flower source, weather, and climatic conditions. Adverse reactions to honey are rare
but may be caused by residual pollen. Medical grade honey used in wound care has most of the pollen
removed via filtration. Some patients may report a mild stinging sensation during initial application, but
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not severe enough to stop treatment.

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Therapeutic benefits of honey:
 Wound bed preparation
 Reduction of exudates due to its anti‐inflammatory properties
 Facilitates autolytic debridement and consequently treatment of odor
 Reduces risk of maceration
 Management of antibiotic‐resistant bacteria
 Prevention of biofilm production
 Prevention of cross‐contamination

Larvae Therapy: 1,5,6
In some countries, larval therapy with maggots is the standard of care for non‐healing wounds. Use of
larval therapy with medical maggots for wounds is uncommon in the U.S. However, maggots are highly
effective for debridement and can eliminate infected and necrotic tissue without harming healthy tissue.
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Growth factors and enzymes secreted by the maggots also seem to assist in wound healing. Not all fly
maggots can be used for larval therapy. Medical maggots are an FDA‐approved medical device for wound
debridement. Medical maggots will only feed on necrotic tissue. Sterile medical maggots can be purchased
from Monarch Labs. Additional information is Available from: http://www.monarchlabs.com.

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