Reducing the pathogen burden and promoting healing with polyhexanide in non-healing wounds: a prospective study.

Abstract

Polyhexamethylene biguanide (PHMB) is a novel wound antiseptic solution that has a broad antimicrobial spectrum and wound healing promoting effect, with minimal side effects. The aim of present study was to demonstrate the efficacy of the PHMB on the bacterial burden of non-healing wounds, the reduction in wound size or closure of the wound in comparison to Ringer's lactate solution (RLS) after 21 days of wound dressing. A second objective was to investigate the differences in the C-reactive protein (CRP) levels and white blood cell (WBC) counts between the two groups. In this prospective and open-cohort clinical study, patients who underwent cardiac surgery between July 2006 and August 2008 were included and placed in one of two groups, PHMB or RLS, by the block randomisation method. A wound care team, consisting of two surgeons, a wound care nurse and a microbiologist, was created. Classic moist dressings and wet compresses during dressing changes were applied at least once a day or as needed. During the 21 days of hospitalisation the team collected data on the wound healing status daily, on infection parameters every third day, and wound tissue for culture weekly. There were 40 patients recruited of which 9 were excluded, leaving 31 in the intention-to-treat analysis. Of these 15 received PHMB and 16 received RLS. Overall 17 of 31 (66.7% PHMB group, 43.8% RLS group, p=0.181) patients were treated successfully by closure of surgically sutured wounds or healing by secondary intention, the wound tissue cultures of 19 of 31 patients (47.4% PHMB, 52.6% RLS, p=0.886) were negative, and wound size of all the patients were significantly reduced in clinical observations. Although the CRP levels were reduced significantly within group comparisons in both groups (p<0.001), it was significantly lower after 12 days (p<0.05) in the PHMB group compared with the RLS group. The results of this study emphasise that the successful treatment of chronic non-healing wounds require a multidisciplinary team approach under the control of a wound care specialist. Whatever the disinfectant used, consistency in the approach to treatment may be more important. We suggest that increasing the use of PHMB and adoption of this team approach in other cardiac centres or other populations may decrease the healing period, especially in chronic non-healing wounds.