Efficacy of medicinal honey to reduce catheter insertion site 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forearm skin (unpublished data).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 central venous catheter insertion site colonization.

We aim to study the efficacy of honey to prevent skin colonization with
microflora at central venous catheter insertion sites.

1. Prior to insertion of the catheter, a 3 x 3 cm area of skin at the catheter
insertion site is sampled with a saline-moistened cotton swab which is
quantitatively cultured to assess skin microflora.
2. Standard procedures will be performed for skin disinfection.
3. The 3x3 cm area of skin at the catheter insertion site is sampled again to
assess colonization after skin disinfection.
4. Catheter is inserted according to standard procedures.
5. In the treatment group, medical grade honey is applied on a sterile gauze
which is placed on the skin at the catheter insertion site. In the control
group a gauze without honey will be applied. Subsequently, the catheter
insertion sites are covered with standard wound dressing (Tegaderm®).
6. Catheter insertion site dressings will be changed on a daily basis. After
removing the dressing, the skin will be sampled with saline-moistened cotton
swabs to assess the colonization. Next, the insertion site will be disinfected
according to standard intensive care procedures, and new dressings with or
without honey will be applied.

see 'study design'

During the insertion period of the catheter, a gauze with or without honey will
be changed on a daily basis. Immediately prior to and after disinfection of
skin before insertion of the catheter, and at daily dressing change, the skin
will be sampled with saline-moistened cotton swabs to assess colonization.