A descriptive study of blood in the mouth following routine oral endotracheal intubation

Oral endotracheal intubation and extubation are two routine procedures performed by anesthesia providers which could lead to breaches of mucosal integrity and slight or moderate bleeding, thereby providing a vector for transmission of a blood-borne disease. This study was designed to determine the incidence of occult or overt blood in the oral and pharyngeal areas during the intubation and extubation periods. A convenience sample of 163 patients from 18 to 70 years of age who underwent an oral endotracheal intubation for general anesthesia were included. Within 15 minutes of endotracheal intubation, the patients were tested at five designated sampling sites for the presence of overt or occult blood. The results demonstrated that blood was present after 34% of the intubations, with 70% of those being positive in the oral/pharyngeal cavity and 52% exhibiting blood on the laryngoscope blade. Upon extubation 72% were positive, with 97% of those being positive at the distal tip of the endotracheal tube. The blood found during both these events was primarily occult. The results suggest that the potential for blood, both overt and occult, to be present in the mouth of patients is significant enough to recommend that all practitioners adhere to the universal barrier precautions to limit their exposure to the transmission of potentially fatal blood-borne viruses.