Gengyve for Institutional Use Beyond the Dental Clinic

Gengyve for Institutional Use Beyond the Dental Clinic

Proposal for the Use of Gengyve Mouthwash in Preoperative Cleansing Protocol

This proposal outlines the benefits of using Gengyve mouthwash instead of chlorhexidine in the preoperative cleansing protocol for patients undergoing surgery. It highlights Gengyve's gentleness on oral tissues, lack of staining, and reduced risk of pulmonary inflammation if aspirated. Additionally, it recommends initiating Gengyve use two weeks prior to surgery to reduce the overall bacterial burden and minimize the risk of bacteremia induced by brushing on the day of surgery.

 

Current Stryker Head-to-Toe Cleansing Kit:

 

Reducing Post-Operative Infections with Improved Preoperative Cleansing

The VA has experienced a significant increase in post-operative infections, prompting a renewed focus on improving preoperative cleansing protocols. The current Stryker Head-to-Toe Cleansing Kit utilizes chlorhexidine products, which have been associated with concerns over stimulation of bacteremia (bacteria in blood stream), oral tissue irritation and potential pulmonary complications if aspirated (at least the oral mouthwash).

 

Providing the Full Gengyve Preoperative Cleansing Kit

Originally, it was my thought to just introduce the Gengyve into the Stryker Kit, in place of the Chlorhexidine mouthwash that is in there now…But

Based on the feedback from the OR charge nurse, it makes sense to provide the full Gengyve preoperative cleansing kit instead of just the mouthwash. The current Stryker Head-to-Toe Cleansing Kit relies heavily on chlorhexidine, which can cause issues like stimulating bacteremia and pulmonary complications if aspirated. By offering the complete Gengyve kit, we can help address these concerns and improve the overall preoperative cleansing process for patients.

The Gengyve kit would include the gentle, non-staining mouthwash for oral cleansing, as well as chlorhexidine-free wipes, a nasal swab, and a soft-bristle toothbrush. This comprehensive approach can help reduce the bacterial burden leading up to surgery and minimize the risks associated with the current protocols. We're confident this will be a valuable offering for the hospital.

Cost Comparison: Stryker vs Gengyve Preoperative Cleansing Kits

As the hospital aims to improve preoperative cleansing protocols, the cost of the kits is an important consideration. Let's compare the components and pricing of the Stryker and Gengyve kits to understand the financial implications.

 Item

Stryker Kit

Gengyve Kit

Chlorhexidine Wipes

$0.80 x 6 = $4.80

$0.75 x 6 = $4.50

Povidone Iodine & Nasal

Swabs

$1.50

$0.50 x 2 = $1.00

Mouthwash

$4.50

$8.00

Toothbrush & Oral Swab

$0.50 x 2 = $1.00

Included

Total:

$12.00

$13.50

Actual:

$22.00

$28.00

 

 The Gengyve kit offers a more cost-effective solution, with an overall price tag of $13.50 compared to $12.00 for the Stryker kit. While the Gengyve mouthwash is more expensive, the savings on other components like the wipes and nasal swabs help offset this difference.

This gives us room to negotiate, but we will try to get the higher price. Tell them, we would be happy to run a pilot program with them to determine if starting Gengyve 2 weeks prior to surgery is a viable option. (Paid trial). I also offered to them the use of our Bot, or Avatar to explain the mouth care and cleansing procedures. (This was more than she could think about). At the end of this presentation is a link to the Bot, it's pretty neat.

The charge nurse appreciates that Gengyve's executive team is made up of Veteran's and I think is willing to go a little more than the Stryker price. Tell her, that obviously we care about optimizing Veteran care and are willing to go the extra mile to make that happen.

I do not know if I can actually source those products at that price, I have looked and that's a very approximate price. I think we can get close to it or better.

So, if one protocol gets proved out at one VA OR then the possibility of becoming standard of care for all ORs in the VA system increases dramatically.

For a deal closer tell her we can include the chlorhexidine shampoo cap ($1 each) and a basic ear antimicrobial drop, this would be something like Cortisporin (Otic drops), adds $4.00 to the price, or less if I can find smaller volumes, but if they are serious about head to toe cleansing, then including decontamination of the ears is critical.

Finally, you can always ask, what the average post-operative infection costs the VA? Is the goal to actually address that or just pay lip service to it?

I have been a trusted science advisor for Gengyve and will continue to be so.

 

Advantages of Gengyve over Chlorhexidine

1. Gentler on Tissues

Gengyve is much more gentle on oral tissues compared to chlorhexidine, reducing the risk of irritation and discomfort.

2. No Staining

Unlike chlorhexidine, Gengyve does not cause staining of the teeth, ensuring better patient satisfaction and compliance.

3. Reduced Risk of Pulmonary Inflammation

Gengyve does not cause acute pulmonary inflammation if accidentally aspirated into the lungs, mitigating a potential complication associated with chlorhexidine.

 

Concerns with Current Chlorhexidine Protocol

1. Brushing-Induced Bacteremia

Using chlorhexidine mouthwash immediately before surgery might be counterproductive due to the potential for brushing to stimulate bacteremia in about 23-68% of patients, with a mean incidence of around 50%.

2. Risk of Postoperative Infections

This could introduce bacteria into the bloodstream right before a surgical procedure, increasing the risk of postoperative infections.

3. Pulmonary Inflammation Risk

Moreover, chlorhexidine's potential to cause pulmonary inflammation if aspirated raises additional safety concerns.

 

Proposed Protocol with Gengyve

1. Replace Chlorhexidine with Gengyve

Utilize Gengyve as it is gentler on tissues, avoids staining, and has a lower risk of causing pulmonary inflammation if aspirated.

2. Initiate Gengyve Use Two Weeks Prior

This approach will help reduce the overall bacterial burden in the oral cavity, thereby minimizing the risk of bacteremia on the day of surgery.

 

Supporting Evidence

 Gentleness on Tissues

Reduced Pulmonary
Inflammation Risk

Bacteremia Risk with
Brushing
Studies by Tartaglia et al. have demonstrated that Gengyve is formulated to be gentle on oral tissues, reducing the risk of irritation and discomfort compared to chlorhexidine. Chlorhexidine has been associated with the risk of pulmonary inflammation if accidentally aspirated, with studies indicating that even low concentrations can cause pulmonary toxicity. In contrast, Gengyve does not pose this risk, making it a safer choice for preoperative oral care. Research indicates that tooth brushing can induce transient bacteremia in approximately 23-68% of patients, with a mean incidence of around 50%. This poses a significant risk when performed immediately before surgery.

No Staining

Reduced Bacterial Load
Unlike chlorhexidine, which is known to cause tooth staining, Gengyve does not have this side effect, ensuring better cosmetic outcomes and patient satisfaction. Studies have demonstrated that increased oral care and the use of antimicrobial mouthwash significantly reduce bacterial load over a period of two weeks. This reduction in bacterial burden can help minimize the risk of postoperative infections.

 

Evidence from Studies

 Study Evidence

Tartaglia et al. (2019)

 

Gengyve is formulated to be gentle on oral tissues, reducing irritation and discomfort compared to chlorhexidine.

Bagis et al. (2011)

Chlorhexidine causes tooth staining, while Gengyve does not have this side effect.

Hirata & Kurokawa (2002), Xue et al. (2011)

 Chlorhexidine can cause pulmonary inflammation if aspirated, while Gengyve does not pose this risk.

Tomás et al. (2012), Lockhart et al. (2008)

 Tooth brushing can induce transient bacteremia in 23-68% of patients, with a mean incidence of around 50%.

Tadakamadla et al. (2020), Leite et al. (2021)

 Antimicrobial mouthwash significantly reduces bacterial load over two weeks, minimizing postoperative infection risk.

 

Benefits of the Proposed Control

Improved Patient Safety

By using Gengyve and initiating its use two weeks prior, the risk of pulmonary inflammation and bacteremia-induced postoperative infections is reduced.

Enhanced Patient Satisfaction

Gengyve's lack of staining and gentleness on oral tissues contribute to better patient satisfaction and compliance.

Commitment to Quality Care

Implementing this evidence based protocol change aligns with our commitment to providing high-quality care and improving patient outcomes.

Conclusion

Implementing Gengyve in place of chlorhexidine mouthwash and initiating its use two weeks prior to surgery can significantly reduce the risk of bacteremia and improve patient outcomes. This protocol change aligns with our commitment to patient safety and quality care. By adopting these evidence-based changes, we can enhance our infection control protocols and ensure safer surgical outcomes for our patients.

Using the Gengyve Bot for Preoperative Instruction

To ensure veterans effectively use the Gengyve mouthwash as part of the pre-surgery head-to-toe preparation kit, we can leverage our Gengyve chatbot. This AI-powered assistant can guide veterans through the proper usage of the mouthwash, including instructing them to begin use two weeks prior to their scheduled procedure. The bot can also provide step-by-step demos on how to use the other components of the kit, such as the antiseptic wipes and skin cleanser, to ensure a thorough preoperative cleansing routine.

By making the Gengyve bot available to veterans, we can empower them to take an active role in their pre-surgical preparation and increase their confidence in properly executing the recommended protocol. This will help drive greater compliance and maximize the benefits of the Gengyve mouthwash in reducing postoperative infection risk.

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