Report on the use of Algivon in complex wounds

Report on the use of Algivon in complex wounds

Sylvie Hampton, Tissue Viability Consultant, Tissue Viability Consultancy Services

Introduction

The assignment Brief was to evaluate Advancis Medical Manuka Honey Dressing for patients with malodorous wounds. The project was to conduct a 10 patient evaluation at weekly intervals over a 2 week period, totalling 3 visits.

The project objectives were to:

  • Subjectively assess levels of wound odour on a scale of 1-10
  • Ask the patient to assess levels of wound odour on a scale of 1-10
  • Take swabs of wound on day 1 and day 14
  • Assess absorbency and frequency of dressing change
  • Assess surrounding skin integrity
  • Assess ability to debride and stimulate wound bed
  • Assess pain relief associated with use of dressing
  • Identify wound changes through assessment, planimetry and photographs
  • Monitor progress through wound healing continuum
  • Observe ease of dressing application and removal
  • Highlight product characteristics
  • Report on findings from the trial

Methods

  • TVCS identified 12 patients with malodorous wounds (leg ulcers, pressure ulcers etc).
  • Patients were recruited from a variety of community settings, including nursing homes, residential care and GP surgeries.
  • Patients were visited on 3 occasions over a 2 week period (day 1, day 4 and day 14.
  • Ease of application, wear time and ease of removal was observed.
  • Photographs and planimetry measurements were taken at each visit to assess wound healing
  • Photographs were used to demonstrate wound changes
  • A case report file will be used to enhance the clinical findings.

Exclusion criteria included:

  • Patients with known hypersensitivity
  • Clinically infected ulcers
  • Pyoderma Gangrenosum
  • Rheumatoid Disease
  • Those refusing to take part
  • Dry wounds

Results

Observation of pH levels are thought to be a valuable method of identifying (a) wound healing and (b) identifying a change in bacterial loading (Hampton and Collins 2003).

Obtaining pH levels was through a test strip. This strip identifies the level of pH between 5 and 9.

2 cases out of the 12 assessed actually increased in level from 7 to 8 and 7.5 to 8. All other patients wounds reduced in pH levels (see chart 1 and 2).

Chart 1

 

Chart 2

Pain levels and use of Algivon

Chart 3 and 4 demonstrates the pain levels were reduced considerably in all patients

Chart 3

 

Chart 4

 

Table 1

Wound odour

Wound odour and bacterial loading are definitely related. Each bacteria has its own odour. Each wound was swabbed on day 1 and day 14. The results show there is a slight correlation between wound odour and pH levels in each wound (table 2).

 

Table 2

Wound bacterial loading

The outcomes from the swab results are difficult to assess as generally the colonization reduced (chart 5), but mainly the bacterial type changed over the two weeks (see table 1). One wound that contained the very harmful haemolytic strep on day 1 altered to a simple colonisation of staph by day 14. It is therefore, difficult to say categorically, that the reduction of one + is a reduction in the bacteria because, in fact, the bacteria that the wound did originally contain was now obliterated completely. However, the wound now contains staph of two ++, and this would affect the results when only viewing the ++ results. Nevertheless, the harmful bacteria was no longer there and this had left the wound open for a simpler bacteria to colonise and this could be seen as a positive.

Table 1

haemolytic strep +++ staph ++ Haemolytic strep is particularly nasty bacteria in a wound as it generally rapidly increases the size of the wound
mixed enteric flora +++ mixed enteric flora ++ Reduced by one +
nil (antibiotics) nil No change
mixed enteric flora +++ Coliform ++ Different bacteria – reduced by one +
mixed enteric flora +++ mixed enteric flora +++ No change
coliform +++ mixed enteric flora + Different bacteria – reduced by two ++
mixed enteric flora +++ staph +++ Different bacteria – no change in +++
mixed enteric flora +++ staph +++ Different bacteria – no change in +++
MRSA +++ MRSA +++ No change
mixed enteric flora +++ mixed enteric flora +++ No change
proteus +++ coliform ++ Different bacteria – reduced by one +
mixed enteric flora +++ mixed enteric flora + Reduced by two ++

 

Chart 5

There is absolutely no doubt that Algivon reduced the bacterial loading in the wounds.

 

Pain and the use of Algivon

Pain is the worst symptom of complex wounds, and it has been thought that honey could increase pain. Certainly, the osmotic ‘pull’ of honey has been implicated in wound pain. However, this small study did not support that belief as pain dropped in every case (see chart 6). This could have been due to the equal reduction of bacterial loading in each wound.

Certainly there is a slight correlation between pain and pH levels (table 3) in a wound. Algivon would reduce the pH levels making the wound more alkaline and thereby increasing the healing potential. At the same time, the reduction in the acidic level may well coincide with the reduction in pain.

 

Chart 6

 

Table 3

Surrounding skin

 There were zero problems of maceration with Algivon in any of the 12 cases.

 

Ease of removal

Algivon was extremely easy to remove, without causing discomfort to any patient.

 

Conclusion

 There is a case for Algivon to be considered for any complex wound. Observation of pH levels are a valuable method of identifying (a) wound healing and (b) identifying a change in bacterial loading (Hampton and Collins 2003). This provided an excellent picture of Algivon and the relationship to healing, reduction of pH and reduction of pain.

Algivon Maunuka honey dressing should be first line in the treatment of complex wounds.

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