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SurgihoneyRO offers the natural wound healing properties of honey with the potent antimicrobial action of the engineered product.

Its antimicrobial effect is due to the release of Reactive Oxygen®, from the breakdown of hydrogen peroxide, at a controlled antimicrobial potency and therapeutic dose to the infection site for a sustained period. Laboratory testing shows this can be for upto three days.(1)

The topical wound gel destroys all Gram-positive and negative bacteria tested to date, including MRSA, Pseudomonas aeruginonsa and Esherichia coli. It also prevents and disrupts the build-up of bacterial colonies, or biofilm, linked with chronic infection in vitro.(15, 27)

“Given the threat posed by antimicrobial resistance and the ever-increasing need to find new solutions to treat infections, SurgihoneyRO has real potential as a new wound care agent to kill bacteria and disrupt biofilm.”

– Fenella Halstead, clinical scientist, National Institute for Health Research (NIHR) Surgical Reconstruction and Microbiology Research Centre

NIHR clinical scientists Dr Mark Webber and Fenella Halstead

ROS Mode of Action

Reactive Oxygen species (ROS), mainly hydrogen peroxide, occur naturally in the body as a host defence against infection and has multiple roles – killing invading microbes, messaging repair cells and stimulating new tissue growth. (10,13)

The term ROS applies to highly reactive oxygen radicals, including hydrogen peroxide H2O2. Hydrogen peroxide is unstable and rapidly breaks down to H20 and O- ROS appears to kill bacteria by disrupting the cell structures including DNA and cell membranes.(13,15,26)It possesses concentration dependent activity and toxicity.

While hydrogen peroxide is a common disinfectant due to its bacteria-killing properties, it can damage human tissue at higher concentrations and the duration of its activity is too short to be of use as a therapeutic agent. By contrast, SurgihoneyRO gel releases low levels of ROS to the infection site for a sustained period rather than a large amount at the time of dressing.(6,13) It can destroy the most deadly drug-resistant bacteria and is safe to use on healing tissue.

ROS are pivotal in the normal wound healing response 13, 26) They act as secondary messengers to immunocytes and non-lymphoid cells and regulation of angiogenesis perfusion in the wound area. SurgihoneyRO can be particularly useful when there is stalled healing, for example in chronic leg ulcers, pressure injury and infected surgical wounds as well as burns. (26)

Figure : Confocal scanning laser microscopy images of MRSA untreated and so live (green). Following treatment with SurgihoneyROa significant portion of the population have been killed (red).

Source: University of Southampton, Upper Airway Research Group

Battling biofilms:

Scientists from the National Institute for Health Research (NIHR) Surgical Reconstruction and Microbiology Research Centre, the research arm of the NHS, demonstrated SurgihoneyRO is highly effective at tackling a wide variety of bacterial biofilm found in chronic wounds in vitro.(15) Read the paper

The Halstead study found SurgihoneyRO could prevent biofilm for all 16 bacteria tested, both Gram-positive and Gram-negative, including several major drug-resistant strains: MRSA, E.coli and Pseudomonas aeruginosa, Acinetobacter baumanni and CRE Klebsiella pneumonia.

Wound care:

Globally, an ageing population alongside a rise in long-term conditions, such as diabetes and obesity, are creating greater demands for wound care management.

In a multi-centre clinical evaluation, SurgihoneyRO was observed to help a wide range of wounds progress toward healing (16) Read the paper.

The study involved patients with 114 non-healing wounds from both developed and undeveloped countries. They included 33 patients with leg ulcers, 20 with traumatic wounds, 18 with pressure ulcers, 14 with surgical wounds and five with diabetic ulcers.

Wounds were treated with SurgihoneyRO gel. Some 21 per cent healed and 79 per cent improved in the study period. Improvements included a reduction in wound pain, exudate, dead tissue, inflammation and bacterial load.

Prevention of Surgical Site Infection:

In addition to its therapeutic role, there is a growing body of evidence demonstrating SurgihoneyRO can play an important part in surgical prophylaxis and infection prevention. Surgical site infections (SSI) can double the length of hospital stay, significantly increase healthcare costs and reduce quality of life.

Caesarean wound infection is a major cause of comorbidities with wound infections nationally around 10 per cent. A pilot study at a NHS hospital trust found application of SurgihoneyROimmediately after surgery in women undergoing caesarean sections reduced infection rates by 60 per cent from 5.4 per cent before intervention to 2.15 per cent when using the product.(3)

Two further clinical evaluations of its use in the prevention of surgical wound infections are underway, including one at University College London Hospital.

A separate pilot study showed SurgihoneyRO could reduce infection rates associated with cancer patients receiving chemotherapy through intravenous lines – even those colonised with Carbapenem-resistant Enterobacteriaceae (CPE), a Gram-negative bacteria resistant to the carbapenem class of antibiotics, considered the drug of last resort for such infections (4,7)





How to apply

SurgihoneyRO is applied directly to the wound bed or surgical incision site.  To ensure optimum results please follow the following guidelines:

  • Cleanse the wound as per local guidelines
  • Apply 2mm thickness directly to the wound bed. Alternatively, SurgihoneyRO can be applied to an inert wound contact or secondary dressing then placed on the wound bed
  • Select an appropriate secondary dressing for exudate level and to maintain moist wound healing environment
  • A tube of SurgihoneyRO may be used on a single patient, multiple times, for up to 28 days

It is recommended that SurgihoneyRO™ is applied every 72 hours (3 days) and more frequently in critical wound infections to maximise effect.

  • For critically infected wounds, it is recommended that SurgihoneyRO is applied daily then reduce to alternate days, then to every 3 days over the first 2 weeks (subject to individual clinical scenario). If there is no improvement in the wound condition and microbial status use should be reviewed
  • For surgical incision sites, it is recommended to apply SurgihoneyROonce immediately after closure to assist healing and as a secondary infection prevention measure

SurgihoneyRO may be used under compression bandaging for up to 7 days however potency will decrease after day 3.

With a low therapeutic dose of H202 there are no contraindications associated with long term use and it is non-toxic to healthy tissue. It may be used on children.

Indications for use

SurgihoneyRO™ is a safe and effective multi-action product without the drawbacks of other antimicrobial wound dressings. The bioengineering ensures a consistent level of therapeutically active Reactive Oxygen® which aids the antimicrobial activity for up to 3 days.

SurgihoneyRO™ is indicated for infected, chronic and acute wounds through to wound healing.

Chronic wounds including:-

  • Diabetic foot ulcers
  • Pressure ulcers
  • Leg ulcers

Infected wounds

Acute wounds including:-

  • Surgical wounds
  • Traumatic wounds, cuts and abrasions
  • Burns
  • Donor and recipient sites

Why is it different?

Medical-grade honey is an established topical treatment for wounds and burns due to its antimicrobial and wound healing promotion activity. It provides rapid autolytic debridement, reduces odour, and decreases wound-related pain and bio-burden1. Honey works in a different way to antibiotics – it is hypersomolar, restricting the availability of water to bacteria and dehydrating bacteria by osmosis.

Natural honeys vary hugely in their antimicrobial properties and there is little consistency in antimicrobial effects because there can be no control over nectar source, sugar content and other contaminants in entirely natural products. Many medicinal honeys are based on Manuka honey, which is one of the more antimicrobial natural honeys.

Different mechanisms of action have been suggested for the antimicrobial effects of honey, but the main ones are the high-sugar concentration, H2O2, the 1,2-dicarbonyl compound methylglyoxal (MGO), the cationic antimicrobial peptide bee defensin-1 and the low pH2. Some patients may experience momentary stinging or a drawing sensation when using honey therapies due to its autolytic debriding properties and the drawing of fluids by osmosis away from the wound3.

SurgihoneyRO™ has all the natural healing-inducing, desloughing and tissue regenerative properties of the honey carrier, but it has been bioengineered to deliver precisely controlled level of Reactive Oxygen®. When SurgihoneyRO™ comes into contact with moisture, Reactive Oxygen® is instantly released and sustained for over 72 hours4.

SurgihoneyROis a fast acting, effective antimicrobial.

The speed of cidal activity is shown by the time-kill curves to be extremely rapid, by 30 mins the bacteria had fallen 1,000-fold. All bacteria were killed within 48 hours4.


Reactive Oxygen®

SurgihoneyRO™ is the first published, antimicrobial wound dressing that has been tested against the 12 priority MDR bacterial strains, and has been shown to be effective against almost all these organisms1.

The term reactive oxygen species (ROS) describes highly reactive molecules containing reduced oxygen or oxygen atoms with extra electrons. Members of the ROS family include superoxide anion O22, peroxide O22, hydrogen peroxide H2O2.

ROS are naturally occurring in the body. Basal ROS levels maintain normal cell functioning and homeostasis2, while increased amounts induce a cell-mediated antimicrobial defence response3.

ROS are part of the innate immune response, and play a critical role in wound healing and infection control at the wound site4. They are released within minutes of epithelial injury, signalling rapid recruitment of leukocytes5. ROS directly damage microbes that invade tissues6. In wound healing, ROS are secondary messengers to many immunocytes and non-lymphoid cells, and regulate angiogenesis, haemostasis and tissue repair7.

Reactive Oxygen® is the antimicrobial mechanism for SurgihoneyRO™. In contact with moisture, SurgihoneyRO™ releases Reactive Oxygen®.

Reactive Oxygen Diagram

In vitro studies have shown that Reactive Oxygen® at close to naturally occurring levels:

  • Stimulates proliferation of human fibroblasts and vascular endothelial cells5,13
  • Stimulates angiogenesis via vascular endothelial growth factor (VEGF) signalling14
  • Promotes keratinocyte cell migration and proliferation15

A controlled and sustained level of H2O2 that is non-harmful and non-toxic to surrounding tissue, is a therapeutic opportunity for wound care. SurgihoneyRO™ does this through the release of Reactive Oxygen®.

Scientists from the National Institute for Health Research (NIHR) Surgical Reconstruction and Microbiology Research Centre, the research arm of the NHS, demonstrated SurgihoneyRO is highly effective at tackling a wide variety of bacterial biofilm found in chronic wounds in vitro.

“Given the threat posed by antimicrobial resistance and the ever-increasing need to find new solutions to treat infections, SurgihoneyRO has real potential as a new wound care agent to kill bacteria and disrupt biofilm.” – Fenella Halstead, Clinical scientist, National Institute for Health Research (NIHR) Surgical Reconstruction and Microbiology Research Centre

SurgihoneyRO™ has been successfully used for infection prevention, eradication of MDR bacterial strains and prevention of surgical site infections and intravascular line care in vivo 15,16,17.

The Reactive Oxygen® released by SurgihoneyRO™ is a broad-spectrum antimicrobial against wound-relevant MDR bacterial strains and has been shown to prevent and disrupt and eradicate mature biofilm.

SurgihoneyRO™ presents one option against the growing global issue of antimicrobial resistance.




What is SurgihoneyRO™?

SurgihoneyRO™ is a cutting-edge technology, an antimicrobial wound gel utilising bioengineered honey to deliver Reactive Oxygen® (RO™).

SurgihoneyRO™ provides enhanced healing and a powerful antimicrobial action to reduce the microbial load thus removing the barriers to wound healing. Unlike other medical grade honeys, SurgihoneyRO™ has been bioengineered to enhance and precisely control its antimicrobial potency.

  • Kills a wide range of bacteria in vitro1,2,3
  • Prevents biofilm in vitro1
  • Fast acting antimicrobial action2
  • Substantially eradicates mature biofilm in vitro4,5
  • Effective against multi drug-resistant microorganisms commonly found in chronic wounds6
  • Effective debridement
  • Assists the natural wound healing environment and promotes new tissue growth

SurgihoneyRO™ is the only published, proven antimicrobial wound dressing tested against the WHO priority pathogens6.