Blue 767 Maggot Therapy in Wound Care

Maggot Therapy Use in Wound
Management
Policy & Procedure
Reference Number: 767
Kate Purser, Senior Nurse Tissue Viability and

Author & Title: Nicola Heywood, Tissue Viability Nurse
Specialist.
Francesca Thompson
Responsible Director:
Director of Nursing
Review Date: November 2015
Francesca Thompson
Ratified by:
Director of Nursing
Date Ratified: 7 November 2012
Version: 2
Related Procedural Documents RUH Wound Management Policy
Amendment History
Issue Status Date Reason for Change Authorised
2 Approved 7 November 3-year Review Francesca Thompson,
2012 Director of Nursing
1 Approved March 2009 New Policy Operational
Governance
Committee
Document name: Maggot Therapy in Wound Care Ref.:767

Issue date: 15 November 2012 Status: Approved
Authors: Kate Purser and Nicola Heywood Page 1 of 23
Index:
1. Introduction ...................................................................................................... 3
2. Purpose of this policy ..................................................................................... 3
3. Definitions ........................................................................................................ 4
4. Aims and Objectives of this policy ................................................................ 5
5. Duties / Responsibilities ................................................................................. 6
Tissue Viability Nurse ________________________________________________ 6
Ward/department Staff ________________________________________________ 6
Ward/Department Managers ___________________________________________ 7
6. Monitoring Compliance ................................................................................... 7
7. Application, Use and removal of Maggot Therapy ........................................ 8
7.1 Assessing the wound and patient ___________________________________ 8
7.2 Assessment of number of maggots & type of dressing required __________ 9
7.3 Ordering & storing maggots _______________________________________ 11
7.4 Application of sterile maggots _____________________________________ 11
7.5 Items required for performing a dressing for FREE RANGE MAGGOTS ___ 12
7.5 Preparation of dressing trolley _____________________________________ 12
7.6 Preparation of the patient _________________________________________ 12
7.7 Application of maggots ___________________________________________ 13
7.8 Removal of maggots from a wound _________________________________ 16
7.9 Reassessment of the wound: ______________________________________ 16
7.10 Disposal of maggots removed from wounds______________________ 16
7.11 On the death of a patient ______________________________________ 16
8. Further information and Glossary ................................................................ 18
8.1 Glossary of Terms _______________________________________________ 18
8.2 Further information ______________________________________________ 18
9. References ..................................................................................................... 19
Document Control Information ............................................................................. 21
Ratification Assurance Statement _____________________________________ 21
Consultation Schedule _______________________________________________ 22
Equality Impact: (A) Assessment Screening ____________________________ 23

1. Introduction
The purpose of this policy is to provide guidance for staff within the Royal United
Hospital, Bath NHS Trust about the requirements and processes for maggot
therapy. Maggot therapy has long been associated with battlefield wounds and was
widely used until early in the twentieth century, when their use declined with the
introduction of antibiotics and improvements in surgical debridement. However,
since the 1980’s, the use of maggot therapy has been revived, largely due to
antibiotic resistance and the potential problems associated with surgical intervention.
Maggot therapy is now considered a safe, rapid and cost-effective alternative to
other forms of debridement, including surgery (Thomas, 2006). It is particularly
useful in cases where conventional wound management has failed to effect
debridement.
2. Purpose of this policy

This policy has been developed due to the increased use of maggot therapy and its
associated costs and risks, in order to ensure safe, appropriate and effective use.
The policy is designed to support qualified nursing staff to manage wound
debridement utilising maggot therapy in a safe and clinically effective manner that is
acceptable to the patient and carer(s). This policy applies to all individuals in the
employ of the Royal United Hospital Bath NHS Trust and for all adult patients who
require maggot therapy.
Please contact the Tissue Viability Service to consider maggot therapy for
paediatrics (Orkiszewski et al., 2006) or for guidance on how to access maggot
therapy for outpatients.

3. Definitions
3.1 Definitions
• The term maggot therapy has been established for the application of live
larvae from the common greenbottle fly Lucilia sericata (Diptera: Calliphoridae)
to rapidly debride wounds (Vilcinskas, 2011).
• Maggot therapy is also known as maggot debridement therapy (MDT), larval
therapy, larva therapy, larvae therapy, bio-debridement or bio-surgery.
3.2 Mode of action
• Sterile maggots are produced from Lucilia sericata, the common greenbottle
fly (Acton, 2007).
• The maggots secrete powerful proteolytic enzymes that break down and
liquefy dead tissue which they then ingest (Casu et al., 1996).
• Healthy tissue is not affected by the maggots although their enzymes can
cause excoriation or maceration (Acton, 2007).
• In sufficient numbers, maggots are able to eliminate a wide range of wound
infections, including MRSA (Bexfield et al., 2004), due to the antimicrobial
nature of their secretions and their ability to ingest and destroy bacteria as
they pass through their gut (Huberman et al., 2007; Thomas et al., 1999).
• Maggots can help reduce malodorous wounds and there is evidence to
suggest that their secretions stimulate the development of fibroblasts cells
(Van der Plas et al., 2008).

4. Aims and Objectives of this policy
4.1 Aims
This policy aims to ensure:
 The safe and effective use of maggot therapy in the RUH.
 That no act or omission on the part of clinical professionals leads to the
inappropriate management of a patient’s wound (Nursing and Midwifery
Council (NMC), 2008).
4.2 Objectives
To ensure:
 Comprehensive assessment of health needs, in relation to the use of sterile
maggots in wound care, is undertaken.
 A standardised approach to the use of sterile maggots in wound care within
the framework of holistic care.
 That continuity of care takes place where different nurses may be called upon
to meet the needs of the patient.
 The most appropriate product is utilised for optimum wound healing, patient
comfort and cost effectiveness.

5. Duties / Responsibilities
This policy applies to all members of staff involved in any aspect of maggot therapy.
They have responsibility for ensuring that the principles outlined within this document
are universally applied. The responsibility for the delivery of care of the patient
remains with Trust staff and Nurse in charge of ward
Key organisational duties are identified as follows:
Tissue Viability Nurse

 The Tissue Viability Nurse or the patient’s Medical Consultant will
authorise Maggot Therapy. Maggot therapy is usually only considered for
wounds that have failed to respond to conventional treatment or for
wounds that require rapid debridement (Hall, 2010).
 The Tissue Viability Nurse will ensure that regular training is available for
appropriate staff. The maggot therapy training will be regularly reviewed
to ensure that it is current. Registered nurses have a responsibility to
ensure that their knowledge and skills are up to date, in order to maintain
and develop their competence (NMC, 2008).
 The Tissue Viability Nurse will ensure that self-assessment competencies
are available for those who have undertaken Maggot Therapy training.
Ward/department Staff
 Will at all times follow the Trust procedure for maggot therapy.
 Must complete a comprehensive wound assessment which will be
documented on the Trust wound assessment form.
 Following assessment, ward/department staff will refer the patient to the
Tissue Viability Nurse.
 The patient’s suitability for maggot therapy will be assessed by either the
Tissue Viability Nurse or a trained registered nurse who has completed
RUH Maggot Therapy training and competencies. Please note that
although the term registered nurse is used throughout this document it is
acknowledged that other registered allied health professionals may
undertake maggot therapy after appropriate training. For further
clarification, please contact the TVN. This assessment will be clearly
and accurately documented in the patient’s medical notes by the
registered nurse (NMC, 2009).
 The nurse undertaking maggot therapy will ensure that a photograph is
taken of the wound (with patient consent) prior to and after maggot
therapy.

 The nurse undertaking maggot therapy will gain informed consent prior
to commencement of the therapy and this will be documented in the
Medical Notes. Patients will be advised of the potential benefits and
complications and a patient information leaflet given to them and fully
explained (NMC, 2008).
 The nurse undertaking maggot therapy will ensure that the RUH Maggot
Therapy Care Plan is fully completed.
Ward/Department Managers
 Ward managers are responsible for ensuring that there is adherence
with the policy by their staff.
6. Monitoring Compliance
The Tissue Viability service will review any incidents of non-concordance with the
Maggot Therapy in Wound Care process. Key themes of any non-concordance will
be reported to Divisional Governance Meetings. Ward managers have a
responsibility to ensure that all staff under their supervision are concordant with this
policy. RUH employees have a responsibility to ensure that they follow RUH policies
and protocols in order that their care is based on the best available evidence and, as
such, risks are minimised.

7. Application, Use and removal of Maggot Therapy
7.1 Assessing the wound and patient

A Competent Registered Nurse will assess the patient using the RUH
Maggot Therapy Assessment Checklist. A copy of this document must be
filed in the patients’ notes.
Procedure Rationale
Wounds suitable for maggot therapy Maggot therapy is suitable for most
 Infected wounds types of wounds that contain necrotic
 Wet necrotic / sloughy wounds or sloughy tissue, irrespective of
 Leg ulcers aetiology (Acton, 2007; Jones and
 Pressure ulcers Thomas, 2000).
 Surgical wounds
 Malignant wounds
 Diabetic foot ulcers
 Amputation wounds
 Indolent wounds
Wounds not suitable for maggot therapy
 Dry necrotic wounds (require hydration first) The efficacy and / or safety of
 Fistulae maggots has not been demonstrated
 Wounds connecting with the abdominal in these wound types (Acton, 2007;
cavity or other organs Jones and Thomas, 2000).
 Wounds that bleed easily
 Wounds close to major blood vessels or
nerves
 Wounds with poor blood supply
Avoid dressing products containing propylene Propylene glycol may inhibit maggot
glycol (i.e. Intrasite gel) for 48 hours prior to development (Jones and Vaughan,
application of maggots 2005).
Potential side-effects of maggot therapy Maggots liquefy dead tissue, causing
 Increased exudate production increased exudate and odour. Explain
 Pinkish-red exudate this to the patient and colleagues as it
 Increased odour may be interpreted as a sign of
infection (Kitching, 2004; Morris,
2008).
 Patients with ischaemic wounds may Pain is thought to result from changes
complain of wound pain during treatment. in wound pH (Thomas and Jones,
1999). If it cannot be controlled by
the use of analgesics, remove the
maggots

7.2 Assessment of number of maggots & type of dressing required
Procedure Rationale
Assess the size of the area to be treated and The number of maggots required will
determine the number of pots of maggots required. be determined by the size and
It may be more cost effective to use large numbers condition of the wound. One
of maggots for one or two treatment cycles rather container of LarvE® will generally be
than smaller numbers for an extended period - see sufficient for wounds measuring up to
guide to sizing and ordering Biobag® and LarvE® 5 cm x 5 cm. Larger wounds will
require more pots to effect
debridement.
A simple ‘calculator’ that may be used to help The precise nature of the dressing
determine the number of pots required is available system selected will be determined
on the Biosurgical Research Unit website and a by the size and location of the area to
laminated printed version is available upon be treated. Correct selection will
request. facilitate a secure dressing and
prevent maggots escaping from the
wound

Procedure Rationale
‘Free range’ maggots or maggots in bags? Maggots contained in a bag cannot
Maggots are available in two forms. ‘Free-range’ move freely over the wound surface
maggots are applied directly to the wound, and or find their way into sinuses or body
allowed to roam freely over the surface seeking out cavities. However, they are less
areas of slough or necrotic tissue. effective when used this way.
Maggots are also available as ‘Biobag® dressings’.
These are small fabric bags in which the maggots
are contained, and these are placed directly upon
the wound surface. Maggots in bags can be used
in some situations where ‘free-range’ maggots may
be contra-indicated such as wounds near the anus
or other body cavities.
Biobag® Maintenance dressings can only be
ordered following approval by the Tissue Viability
Nurse, please telephone ext.: 1837/1112 to
discuss.
Type of retention system required
For free-range maggots, one of the following will
be required.
Flat Net Dressing- for wounds that are isolated and
easy to dress, available in a variety of sizes.
Available in size 10x10cm/20x20cm/30x30cm.
Sleeve Retention Net - (open at both ends) for
extensive or circumferential limb wounds (arms or
legs).
Full Boot Retention Net – for extensive wounds on
limb extremities (feet, hands, stumps etc.).
Half Boot Retention Net – for toes.

7.3 Ordering & storing maggots
Procedure Rationale
® ®
 Maggot therapy (Biobag or LarvE ) should be
prescribed on the drug chart.
 The dressing size or number of pots required The size of wound is required so that
and the size of wound should be recorded. the correct sized dressing can be
 Maggots can be ordered by pharmacy 9am – supplied.
5pm, Monday to Friday. Orders received before
Sterile maggots are supplied by the
12.00 pm can be delivered the following day.
Biosurgical Research Unit
However, maggots cannot be delivered on a
(Biomonde, previously ZooBiotic) in
Sunday.
Wales.
 Maggots should be used within 8 hours of
delivery. There is no need to store them in a
fridge unless the ambient temperature is high.
In exceptional circumstances they may be
stored overnight in a cool place or appropriate
drug fridge.
If maggots are stored in a fridge they should be: Keeping the maggots cool, but not
 Placed in the bottom tray - not near to the too cold, prolongs their life and
ice making section. ensures that they are at their most
 Allowed to return to room temperature active when applied to the wound.
before use.
7.4 Application of sterile maggots

Procedure Rationale
Maggot therapy should only be undertaken by an Only staff who have completed RUH
individual who has: Maggot Therapy training and
 received training in maggot therapy competencies may undertake the
 experience in wound management procedure in order to promote safe,
 A thorough understanding of the wound effective practice.
healing process.

7.5 Items required for performing a dressing for FREE RANGE MAGGOTS
(ZooBiotic, 2009).
Procedure Rationale
Prepare a dressing trolley containing the following
items: The dressings selected will be
 LarvE® pack containing vials of sterile maggots, determined by the size and location
a tube of sterile saline and a nylon net dressing, of the area to be treated, but for a
boot or sleeve, hydrocolloid dressings or simple procedure these items will
Sudocrem, a roll of plastic surgical tape generally suffice
 Sterile dressing pack, including sterile gloves
 Pair of sterile scissors
 Absorbent dressing pad / surgipad
 Adhesive tape (Micropore® or similar)
 Lightweight retention bandage if required
 Yellow bag
7.5 Preparation of dressing trolley
Procedure Rationale
Open the dressing pack and related materials and The maggots are sterile and should
layout on a clean dressing trolley. be applied using aseptic technique.
7.6 Preparation of the patient
Procedure Rationale
Verbally check the identity of the patient by asking Ensure correct patient received
for name and date of birth. If not possible - check correct therapy
patients ID bracelet (Benbow, 2008).
 Ensure that patient has received a full Informed consent must be obtained.
explanation regarding the potential benefits and This will also reassure the patient and
complications of maggot therapy. Record address any concerns they might
verbal consent in the patients’ medical records have.
(Richardson, 2004).
 Provide the patient with a Trust maggot
Therapy information leaflet
 Ensure the patient is in a comfortable position Wounds that require maggots are
where the dressing can be easily applied often in difficult to dress areas and
this will facilitate easier application
and patient comfort

7.7 Application of maggots
Procedure Rationale
a) Preparation of the wound site Some dressing residues, i.e.
Remove old dressing and clean the wound to hydrogels that contain propylene
remove any dressing residues glycol, may inhibit maggot
development (Jones and Vaughan,
2005).
b) Skin preparation This protects the peri-wound skin and

 Cut a hole in a hydrocolloid sheet the size and forms a layer upon which to attach
shape of the wound and place securely onto the nylon net.
the surrounding skin.
 Alternatively cut strips of hydrocolloid dressing
and place around the wound.
 If the wound is small and shallow, a double
layer of hydrocolloid may be applied to form a
deeper cavity. This gives the maggots room to
 If the wound is relatively small and of limited develop and prevents them from
depth, a double layer of hydrocolloid may be being squashed.
applied to form a shallow chamber into which
the maggots are introduced.
c) Removing maggots from their container

 Add 5 ml of sterile saline to the pot containing This releases all the maggots from
the maggots. Gently agitate the pot. If more the top and side of the pot into the
than one pot of maggots is to be applied, pour solution. Accumulating all the
the contents of the first pot into the second and maggots in a single pot in this way
agitate as before. Repeat this process as facilitates the process of application.
necessary.
 Pre-moisten a piece of sterile gauze with
normal saline
 Place the sterile nylon net (LarvE ® Net) that is When the saline containing the
supplied with each pot over the saline-soaked maggots is poured out onto the net in
sterile gauze. this way, the liquid drains away,
 Slowly pour the saline containing the maggots leaving the maggots in a heap on the
onto the piece of net surface, overcoming the effects of
surface tension

Procedure Rationale
d) Applying free range maggots to a wound
 Invert the net over the wound and tape securely If the maggots are poured out too
to the hydrocolloid sheet using the waterproof quickly, the saline (and some of the
adhesive tape contained in the pack. The maggots) may run off the net.
maggots will not fall off the net when it is
inverted, as they will be held in place by surface
tension.
 The central part of the net must remain un- This forms an enclosure that prevents
occluded in order to permit free drainage of the maggots from escaping onto the
exudate and allow the maggots to obtain an surrounding skin.
adequate supply of oxygen.
e) Completing the dressing

 Apply a gauze swab moistened, but not If this is not done the young maggots
saturated, with saline over the outside of the may die.
net.
 Complete the dressing with a surgipad held in The young hatchlings are quite
place with tape or bandage as appropriate. delicate and need to be kept moist.
Occlusive or film dressings should not be used.
 Any unused larvae should be disposed of, as
they are no longer sterile.
Application of maggots using a LarvE® boot or half
boot.
 For an extensive wound on the foot, a net boot These are easier to apply than the
is available. Smaller boots (half-boots) are standard dressing and provide a
produced for the treatment of necrotic toes. more effective method of preventing
 When using the boot, place a ‘collar’ or ring of the maggots from escaping.
hydrocolloid dressing around the limb above The collar should be applied in two
the wound. overlapping pieces without excessive
 Apply the boot over the limb and fix the open tension to prevent any possible
end to the hydrocolloid ring using waterproof tourniquet effect
adhesive tape.
 Areas of healthy skin enclosed within the net
boot should be protected with a piece of This is to protect the intact skin from
hydrocolloid, a thin layer of zinc paste, white the action of the maggots enzymes
soft paraffin, or Cavilon
 When using the boot system, instead of pouring
the maggots out onto a piece of net or into the The maggots will adhere to the wet
bag prior to application, pour the maggots onto material, removing them from the
a moistened non-woven gauze swab and gently swab.
wipe the swab over the wound surface.
 Apply a suitable outer dressing as described See ‘Completing the dressing’ in the
previously. previous section

Procedure Rationale
Application of maggots using a LarvE® sleeve
 For extensive or circumferential wounds on the This technique allows large areas to
leg, a net sleeve, open at both ends, can be slid be dressed whilst ensuring that the
into place over the affected area and sealed on maggots are maintained within the
to hydrocolloid collars, placed above and below wound.
the margins of the wound.
 When using this technique, slide the net into This is the easiest way of applying
position, fix to the upper collar and pull up the the sleeve without scraping the
lower part of the net to expose the wound. maggots of the wound surface.
 Protect the healthy skin enclosed within the
sleeve as previously described, and apply the See ‘Application of maggots using a
maggots to the wound using a swab as LarvE® boot or half boot’.
described above.
 Once the maggots are in place, slide the open
end of the sleeve down over the wound and fix
to the second hydrocolloid collar.
 Apply the outer dressing as described See ‘Completing the dressing’ in a
previously previous section
Application of Biobag®
 Before applying Biobag® to the wound, it is See ‘Application of maggots using a
advisable to protect the surrounding skin from LarvE® boot or half boot’.
excoriation. It is usually sufficient to protect the
peri-wound skin with Sudocrem® opposed to a
hydrocolloid dressing when Biobag® dressings
are used
 A sufficient number of Biobag® to cover the
wound surface are then removed from their
transit containers and placed in position. The
bags are then covered with moist gauze and a
suitable absorbent pad held in place with tape
or a bandage as appropriate.
 Because maggots in bags grow more slowly
than the free-range variety they may be left in
place for 4-5 days

7.8 Removal of maggots from a wound
Procedure Rationale
 Removal of maggots is a simple process.
 Position a yellow clinical waste bag under the
wound. This is to catch any maggots that fall
 Remove the net retention dressing with or out of the wound.
without the hydrocolloid frame, and gently It is generally easier to remove the
remove the maggots with a gloved hand or a hydrocolloid and net in one piece.
pair of forceps.
 If the wound is gently irrigated with sterile water
or saline, any remaining or missed maggots in They have to come to the surface to
the wound should come to the surface. breathe
 If any maggots are left in the wound, these can
be retrieved at the next dressing change.
Maggots will not pupate or turn into
flies within a wound and they cannot
multiply or ‘breed’.
7.9 Reassessment of the wound:
Procedure Rationale
When all the maggots have been removed,
reassess the wound to see if further maggot If full debridement has been
therapy is required or whether a change to this facilitated, further maggot therapy
therapy is indicated. should not be required.
7.10 Disposal of maggots removed from wounds
Procedure Rationale
Maggots removed from a wound must be treated Prevention of cross-infection
as clinical waste in accordance with RUH policy.
7.11 On the death of a patient
Procedure Rationale
If a patient dies during maggot therapy, the This is to respect the dignity of the
maggots should be removed from the wound as patient and the sensitivities of the
soon as possible (prior to the transfer of the patient family.
to the mortuary).
Dispose of the maggots as above
8. Further information and Glossary
8.1 Glossary of Terms
Biobag® Biobag® dressings contain larvae sealed within a net

pouch containing pieces of hydrophilic polyurethane
foam, moistened with saline. The dressings are applied
directly onto the wound and the larvae remain confined in
the dressing during treatment.
Biobag® Maintenance Biobag® Maintenance Dressings contain larvae sealed
within a net pouch containing pieces of hydrophilic
polyurethane foam, moistened with saline. The number of
larvae in these dressings is reduced compared to the
standard Biobag® Dressing and designed to maintain a
clean wound after debridement. The Biobag®
Maintenance Dressings are placed directly onto a
debrided wound and the larvae remain confined in the
dressing during treatment.
Debridement The removal of devitalised or contaminated tissue.
Debridement can be sharp, chemical, enzymatic, autolytic
or biological (maggots) (Collins et al., 2003).
Free Range Maggots that are allowed to roam freely over the surface
of the wound.
LarvE® LarvE® are pots of maggots (approximately 300 per pot),
which are applied directly to the wound and are allowed
to roam freely over the surface.
Maggot therapy The use of sterile maggots in wound management refers
to larvae of the greenbottle (Lucilia sericata) provided in
two formats, Biobag® and LarvE®.
Necrosis Death of tissue, which can occur in response to injury,
disease or occlusion of blood flow (Collins et al., 2003).
Slough A mixture of dead white cells, dead bacteria, rehydrated
necrotic tissue and fibrous tissue (Collins et al., 2003).
Wound A wound may be defined as a defect or break in the skin
that results from physical, mechanical or thermal damage
or that develops as a result of the
8.2 Further information
For further information please contact:

 Tissue Viability Team, Practice Development Office, Royal United Hospital,
Combe Park, Bath. BA1 3NG. Tel: 01225 821837/01225 821112. Fax: 01225
826298. Mobile: 07891495890. Pager: 07623 942124. Email:
Tissueviabilitynurse@ruh-bath.nhs.uk
 Biomonde (previously ZooBiotic), Units 2-4 Dunraven Business Park, Coychurch
Road, Bridgend, CF31 3AP. Tel: 0845 2306806. Fax: 01656 668047. Website:
www.zoobiotic.com. Email: maggots@zoobiotic.com
Produced with thanks to the Biosurgical Research Unit
9. References
 Acton, C. (2007) A know-how guide to using larval therapy for wound
debridement, Wound Essentials, 2, pp. 156-159.
 Benbow, M. (2008). Update on larval therapy. J. Community Nursing, October

2008, vol./is. 22/10, pp. 30-3.
 Bexfield, A., Nigam, Y., Thomas, S. and Ratcliffe, N.A., (2004). Detection and
partial characterization of two antibacterial factors from the excretions/secretions
of the medicinal maggot Lucilia sericata and their activity against methicillin-
resistant Staphylococcus aureus (MRSA). Microbes infect. 6: pp. 297-1304.
 Casu, R.E., Eisemann, C.H., Vuocolo, T. and Tellman, R.L. (1996). The major
excretory/secretory protease from Lucilia cuprina larvae is also a gut digestive
protease. Int J Parasitology 26(6): pp. 623–8.
 Collins, F, Hampton, S and White, R (2003) A-Z Dictionary of wound care. Mark
Allen Publishing, Wiltshire.
 Hall, S. (2010). A review of maggot debridement therapy to treat chronic

wounds. Br. J. Nursing, August 2010, vol./is. 19/15(S26-S31 supplement).
 Huberman, L., Gollop, N., and Mumcuoglu, K. (2007). Antibacterial properties of

whole body extracts and haemolymph of 'Lucilia sericata' maggots. J. Wound
Care, March 2007, vol./is. 16/3 (123-7).
 Jones, A. and Vaughan, D. (2005). Hydrogel dressings in the management of a

variety of wound types: a review. Journal of Orthopaedic Nursing 9 (1), pp. S1-
S11.
 Jones M. & Thomas S. (2000). Larval Therapy. Nursing Standard, vol. 14, no. 20,
pp.47-51.
 Kitching, M., 2004. Patients' perceptions and experiences of larval therapy. J.

Wound Care, January 2004, vol./is. 13/, pp.25-9.
 Morris, C., 2008. Supporting a person undergoing larval wound dressing therapy.
Br. J. Healthcare Assistants, November 2008, vol./is. 2/11, pp.530-3.
 Nursing and Midwifery Council, 2009. Record Keeping: Guidance for Nurses and
Midwives. London: Nursing and Midwifery Council.

 Nursing and Midwifery Council, 2008. The Code: Standards of Conduct,
Performance and Ethics for Nurses and Midwives. London: Nursing and
Midwifery Council.
 Orkiszewski, M., Madej, J. and Kilian, T. (2006). The use of maggot therapy in
paediatric surgery: a case report [online]. Available from:
http://www.worldwidewounds.com/2006/march/Orkiszewski/Use-Maggot-
Therapy-Paediatric-Surgery.html [Accessed 18 March 2011].
 Richardson, M. (2004). The benefits of larval therapy in wound care. Nursing

Standard, October 2004, vol./is. 19/7, pp.70-6.
 Thomas, S. (2006). Cost of managing chronic wounds in the UK, with particular
emphasis on maggot debridement therapy. J. Wound Care, November 2006,
vol./is. 15/10, pp.465-9.
 Thomas S. & Jones M. (1999). The use of sterile maggots in wound

management. Wound Care Society, vol. 6, no. 4.
 Thomas et al. (1999). The anti-microbial activity of maggot secretions. Journal of

Tissue Viability, vol. 9, no. 6, pp.127-132.
 Van der Plas, Jukema GN, Wai SW, et al. (2008) Maggot excretions/secretions
are differentially effective against biofilms of Staphylococcus aureus and
Pseudomonas aeruginosa. J Antimicrob Chemoth 61: pp.117–22.
 Vilcinskas, A., 2011. From traditional maggot therapy to modern biosurgery.

Insect Biotechnology 2 (1), pp. 67-75.
 ZooBiotic, 2009. Application guide for ‘Free Range’ LarvE® ZooBiotic: Bridgend.

Document Control Information
Ratification Assurance Statement
Dear Francesca
Please review the following information to support the ratification of the below named
document.
Name of document: Maggot Therapy in Wound Care – Reference 767
Name of author: Kate Purser Nicola Heywood

Senior Nurse Tissue Viability
Job Title: & Safeguarding Lead Tissue Viability Nurse Specialist.
I, the above named author confirm that:
• The Policy presented for ratification meets all legislative, best practice and other
guidance issued and known to me at the time of development of the Policy;
• I am not aware of any omissions to the Policy, and I will bring to the attention of the
Executive Director any information which may affect the validity of the Policy
presented as soon as this becomes known;
• The Policy meets the requirements as outlined in the document entitled Trust-wide
Policy for the Development and Management of Policies (v4.0);
• The Policy meets the requirements of the NHSLA Risk Management Standards to
achieve as a minimum level 2 compliance, where applicable;
• I have undertaken appropriate and thorough consultation on this Policy and I have
documented the names of those individuals who responded as part of the
consultation within the document. I have also fed back to responders to the
consultation on the changes made to the Policy following consultation;
• I will send the Policy and signed ratification checklist to the Policy Coordinator for
publication at my earliest opportunity following ratification;
• I will keep this Policy under review and ensure that it is reviewed prior to the review
date.
Signature of Author: Date:

Name of Person
Ratifying this policy: Francesca Thompson
Job Title: Director of Nursing
Signature: Date: 7 November 2012

To the person approving this policy:
Please ensure this page has been completed correctly, then print, sign and
post this page only to: The Policy Coordinator, John Apley Building.
The whole policy must be sent electronically to: ruh-tr.policies@nhs.net
Consultation Schedule
Name and Title of Individual Date Consulted
Name and Title of Individual Date Consulted
Francesca Thompson, Director of Nursing 6/4/11
Modern Matrons 6/4/11
Clare Warren, Vascular Sister 6/4/11
Jacqui Strange, Acting Dermatology Nurse Specialist 6/4/11
Jo Flint, Vascular Ward Manager 6/4/11
Kim Harman, Lead Podiatrist 6/4/11
Vascular Consultants:
Professor Horrocks, Mr Budd, Mr Pai 6/4/11
Diabetic Consultants:
Eluned Higgs, Tony Robinson 6/4/11
The following people have submitted responses to the consultation process:
Name and Title of Individual Date Responded
Name of Committee/s (if applicable) Date of

Committee
Medical Board 2011
Surgical Board 2011

Equality Impact: (A) Assessment Screening
To be completed when submitted to the appropriate Executive Director for
consideration and approval.
Person responsible for the assessment:

Name: Nicola Heywood
Job Title: Tissue Viability Nurse Specialist
Does the document/guidance affect one Yes/No Comments

group less or more favourably than another
on the basis of:
Race Yes No
Ethnic origins (including gypsies and travellers) Yes No
Nationality Yes No
Gender (including gender reassignment) Yes No
Culture Yes No
Religion or belief Yes No
Sexual orientation Yes No
Age Yes No
Disability
(learning disabilities, physical disability, sensory impairment and Yes No
mental health problems)
Is there any evidence that some groups are affected

differently? Yes No
If you have identified potential discrimination, are there

any valid exceptions, legal and/or justifiable? Yes No
Is the impact of the document/guidance likely to be

negative? Yes No
If so, can the impact be avoided? Yes No N/A

What alternative is there to achieving the
document/guidance without the impact? Yes No N/A
Can we reduce the impact by taking different action? Yes No N/A
If you answered NO to all the above questions, the assessment is now complete, and no
further action is required.
If you answered YES to any of the above please complete the

Equality Impact: (B) Full Analysis


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Maggot Therapy Use in Wound

Reference Number: 767

Kate Purser, Senior Nurse Tissue Viability and

Review Date: November 2015

Date Ratified: 7 November 2012

Related Procedural Documents RUH Wound Management Policy

Document name: Maggot Therapy in Wound Care Ref.:767

Document name: Maggot Therapy in Wound Care Ref.:767

2. Purpose of this policy

Document name: Maggot Therapy in Wound Care Ref.:767

3.2 Mode of action

Document name: Maggot Therapy in Wound Care Ref.:767

Document name: Maggot Therapy in Wound Care Ref.:767

Key organisational duties are identified as follows:

Tissue Viability Nurse

Document name: Maggot Therapy in Wound Care Ref.:767

Document name: Maggot Therapy in Wound Care Ref.:767

7.1 Assessing the wound and patient

Document name: Maggot Therapy in Wound Care Ref.:767

Document name: Maggot Therapy in Wound Care Ref.:767

Document name: Maggot Therapy in Wound Care Ref.:767

7.4 Application of sterile maggots

Document name: Maggot Therapy in Wound Care Ref.:767

7.5 Preparation of dressing trolley

7.6 Preparation of the patient

Document name: Maggot Therapy in Wound Care Ref.:767

b) Skin preparation This protects the peri-wound skin and

c) Removing maggots from their container

Document name: Maggot Therapy in Wound Care Ref.:767

e) Completing the dressing

Document name: Maggot Therapy in Wound Care Ref.:767

Document name: Maggot Therapy in Wound Care Ref.:767

7.9 Reassessment of the wound:

7.10 Disposal of maggots removed from wounds

7.11 On the death of a patient

Biobag® Biobag® dressings contain larvae sealed within a net

8.2 Further information

For further information please contact:

 Benbow, M. (2008). Update on larval therapy. J. Community Nursing, October

 Hall, S. (2010). A review of maggot debridement therapy to treat chronic

 Huberman, L., Gollop, N., and Mumcuoglu, K. (2007). Antibacterial properties of

 Jones, A. and Vaughan, D. (2005). Hydrogel dressings in the management of a

 Kitching, M., 2004. Patients' perceptions and experiences of larval therapy. J.

Document name: Maggot Therapy in Wound Care Ref.:767

 Richardson, M. (2004). The benefits of larval therapy in wound care. Nursing

 Thomas S. & Jones M. (1999). The use of sterile maggots in wound

 Thomas et al. (1999). The anti-microbial activity of maggot secretions. Journal of

 Vilcinskas, A., 2011. From traditional maggot therapy to modern biosurgery.

Document name: Maggot Therapy in Wound Care Ref.:767

Name of document: Maggot Therapy in Wound Care – Reference 767

Name of author: Kate Purser Nicola Heywood

Signature of Author: Date:

Job Title: Director of Nursing

Signature: Date: 7 November 2012

Document name: Maggot Therapy in Wound Care Ref.:767

The following people have submitted responses to the consultation process:

Name and Title of Individual Date Responded

Name of Committee/s (if applicable) Date of

Document name: Maggot Therapy in Wound Care Ref.:767

Person responsible for the assessment:

Does the document/guidance affect one Yes/No Comments

Is there any evidence that some groups are affected

If you have identified potential discrimination, are there

Is the impact of the document/guidance likely to be