Efficacy of medicinal honey to reduce skin colonization of intensive care patients

Catheter-related bloodstream infections form a serious problem in critically
ill patients. These infections may originate either from the skin microflora
(extraluminal source), or from contaminated hubs or fluids (intraluminal
source). Although the skin is intensively disinfected prior to catheter
insertion and a sterile dressing is applied, micro-organisms residing in e.g.,
hair follicles re-colonize the skin under the dressing. Application of medical
grade honey might result in prolonged disinfection of skin around
catheter-insertion sites.
Medical grade honey has antimicrobial activity through its high sugar content,
the presence of glucose-oxidase producing hydrogen peroxide, low pH and
additional yet unidentified bactericidal compounds. Honey has been tested for
its clinical applicability with promising results.
At the department of Medical Microbiology at the AMC, the antimicrobial
activity of medical grade honey was determined. In a pilot-study with healthy
volunteers, we showed that medical grade honey strongly reduces colonization of
forearm skin (unpublished data). We aim to assess the efficacy of medical grade
honey to reduce skin colonization and prevention of catheter-associated
infections.

Determine the efficacy of medical grade honey to reduce or prevent bacterial
colonization at skin of intensice care patients.

After the pilot study with healthy volunteers, we aim to assess the efficacy of
medical grade honey for intensive care patients. The procedure is as follows:

1. Two areas of skin (3 x 3 cm) of each forearm are sampled with cotton swabs,
which are quantitatively cultured to assess skin microflora prior to
application of
medical grade honey.
2. Two skin patches on the right forearm are disinfected en sampled again with
cotton swabs to assess the efficacy of disinfection.
3. All four patches of skin are covered with standard wound dressing
(Tegaderm®), two with and two without medical grade honey.
4. After 2 days, the wound dressings are removed and the skin under the
dressings is sampled with swabs and quantitatively cultured. After this
procedure all four skin patches are disinfected.

see 'study design'

Four Tegaderm dressings will be applied on forearm skin, two with and two
without medical grade honey. After 2 days the dressings will be removed. Prior
to, and after two days incubation, the skin segments are sampled using a cotton
swab to determine bacterial colonization.