Intelligent Wound Care and Manuka Honey. Main Sponsors:

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1 Intelligent Wound Care and Manuka Honey Main Sponsors:

2 First things first!

3 Georgie Hollis BSc In 2004/5 I began to research the differences between human and veterinary wound management and technologies. Driven by a lack of dedicated veterinary support in this area I began to work Independently to help veterinary clinicians keep up to date with the modern science and developments in advanced wound management.

4 What I do as an independent specialist Lectures and Short courses Articles Advisory support

5 The Veterinary Wound Library A resource for vets and nurses to get advice, trial dressings and support for wound management.

6 Why am I here today? To give you the knowledge you need to understand wound management To familiarise you with the wound care market To show you why Kruuse Manuka Honey is an ideal wound dressing To inspire you to sell loads of it!!

7 So Why manage wounds? Don t they just heal anyway?

8 Yes, but not always in a way that is functional.

9 We need to avoid pain and distress while the wound heals. Particularly where there is a risk of INFECTION!

10 Ensuring a rapid return to normal use..

11 Surgery may be the best option if the wound is fresh..

12 Grafting may be needed if there is tissue deficit. BUT, a CLEAN, HEALTHY wound bed is ESSENTIAL or efforts will fail.

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14 How wounds are treated in practice.. Clean surgical wound Traumatic, dirty wound Prevent infection and cross contamination Reconstructive Surgery, Grafting Healthy granulation Debridement: Surgical, Wet to Dry, Honey Wounds with contamination, complications, tension issues Primary Intention Healing by Secondary Intent

15 UNDERSTANDING WOUND HEALING and WHERE HONEY FITS IN: It works in phases that are predictable Products are used to help the phases progress smoothly We can only optimise what is a natural process by creating the best environment for healing.

16 Normal wound healing Haemostasis and inflammation Injury - platelet aggregation release growth factors and inflammatory mediators - neutrophils, lymphocytes and macrophage activity Proliferation Angiogenisis - granulation tissue - fibroblasts and collagen formation - myofibroblast contraction Maturation Remodelling of collagen, type I replaced by type III Days after injury Wound Contraction Fibroblast differentiation and Myofybrolast contraction

17 Haemostasis

18 Preparation is essential Clipping followed by thorough lavage Gel Clip Wash

19 Wound Lavage Ideally Lactated Ringer s solution. It has an ideal ph and compatibility with tissue. 0.9% Saline at body temperature through a gauge needle. High volume should be used. A litre should not be unusual! Dilution is the solution to pollution

20 Inflammation Exudate and slough builds as the wound cleanses itself through autolytic debridement.

21 400 BC Hippocrates and Galen Wound healing and removal of BIOBURDEN

22 Assisting through debridement Surgical, en-bloc Wet-to-dry dressings Autolytic Debridement Infection RISK!!!!

23 Proliferation New vascular wound bed formed through granulation (starts around day 4) Epithelial margin begins fill deficit and wound contracts (2 weeks)

24 When wounds don t heal: There are 12 factors that delay healing. MOVEMENT INFECTION NECROTIC TISSUE FOREIGN BODY LOCAL FACTORS TISSUE DEFICIT LOSS OF BLOOD SUPPLY POOR TISSUE OXYGENATION CONTINUED TRAUMA HEALTH STATUS IATROGENIC FACTORS TUMOUR TRANSFORMATION

25 Best practice is simple: Prepare: Cleanse and Debride dead tissue, encourage ongoing debridement. Promote: The optimal wound environment for healthy granulation Protect: Avoid 12 factors of healing delay

26 It has been used since records began.

27 2600 BC - Egypt Surgical sutures, pharmaceutical cream and Honey for Wound Management

28 Rediscovered Benefits

29 The IDEAL wound dressing promotes a healthy wound environment for healing. ANTI-MICROBIAL even MRSA DEBRIDES and MAINTAINS MOISTURE ANTI-INLAMMATORY NON TOXIC

30 How it works Debriding Anti-Microbial Anti-Inflammatory

31 Honey: how it works. Debriding: It helps to debride through osmotic action which also reduces swelling and inflammation Antimicrobial: ph 3.7, 83% sugar, Glucose Oxidase Enzyme activity The MANUKA factor (UMF )

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33 The anti-microbial activity of Manuka Honey remains Antimicrobial effect due to: Low ph (approx 3.7) High sugar content Glucose oxidase effect + THE MANUKA FACTOR Debridement: The osmotic action of honey draws out fluid Diluting the anti-microbial effect of standard honey.

34 Antimicrobial Effect: Glucose Oxidase, ph and Sugars Effective against common wound pathogens, includes MRSA, Pseudomonas, E-Coli and Staphylococcus Sp.

35 Honey in Action Horse presents to referral practice after some months of management! Wound is contaminated and necrotic.

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37 Lavage between dressing changes until granulation tissue is formed. Initially one day wear, Increasing to up to 5 days wear time.

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39 Encouraging formation of healthy granulation tissue Fibroblasts deposit collagen as well and some change into myofibroblasts that contract and help to close the wound further.

40 3 Weeks This is doing Really well!

41 Why object to using Kruuse Manuka honey?

42 Handling Objections: Standard Versus Manuka Honey The Unique Manuka Factor (UMF ). +12 will ensure a potent antimicrobial property over and above that of standard honey. Manuka Honey has added antimicrobial properties due to the floral origin of the nectar. Manuka honey is only sourced from New Zealand at present. Some honey products are diluted, blended or derived from sources outside of New Zealand. This may not be clear on the labelling!

43 I use Manuka honey from a pot Shop honey is NOT the same as Medical Grade! Pasteurisation denatures glucose oxidase Clostridium botulinum spores may become viable upon dilution Not always 100% Manuka?? More expensive

44 And not all honey is MANUKA! Medihoney Antibacterial Honey is a standardised antibacterial honey, predominantly Leptospermum sp. NOT 100% manuka! Medihoney Antibacterial Medical Honey is a topical preparation which contains 100% Medihoney Protecting the wound by creating a barrier against wound pathogens including antibiotic resistant strains. Reducing the risk of infection from bacteria and removes malodour

45 Competitors to KRUUSE MANUKA Honey Dressings Standard Honey Silver Antibiotics and Ignorance! Non Manuka Brands - Vetramil Other Manuka Brands?

46 KRUUSE MANUKA a dressing for all wound types: Large open and sloughy wounds MANUKA AD Shallow, fragile or surgical wounds at risk of infection MANUKA ND Abcesses, cavities and stubborn slough Manuka G

47 Selling wound care: Are they treating any wounds at the moment? Most wounds will benefit from honey if they are dirty, sloughy or contaminated.thats most of them! Portfolio sell: Don t forget best practice means lavage, debridement, honey a secondary dressing and bandaging!

48 Key Selling Points for KRUUSE Honey 100% MANUKA Impregnated dressings are easy to apply Good size range Cost effective Sterile Professional!

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50 And finally, if you need me to help you.get in touch! Thank you & Questions?