Health Effects and Medical Surveillance for Lead Exposure

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Health Effects andMedical SurveillanceforLead
Exposure
www.oshainfo.gatech.edu
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Objectives

• To provide information regarding the health
  effects of lead exposure.
• To present information about medical surveillance
  programs for employees exposed to lead.

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Personal Factors and Hygiene

• Personal factors can influence the effects of
  exposure
• smoking
• alcohol consumption
• medication use
• gender
• Personal cleanliness and habits are crucial to
  reducing exposure for abatement workers.

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Acute vs. Chronic Effects

• Acute (short-term) effect is a severe immediate
  reaction, usually after a single large exposure.
• Chronic (long-term) effects have latency periods,
  which may take days, months, or years to show up.

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Organ Systems Damaged by Lead Poisoning
Brain Disorders
Nerve Disorders
Hematological Problems
Kidney Problems
Reproductive Problems
Decreased Red Blood Cells
Slower Reflexes
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How Much Exposure?

• Lead concentrations in paint and dust can be very
  high, so small exposures can result in high lead
  intake.
• Lead dusts are a very important exposure pathway
  - especially for children.

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Lead in the Body

• Body Burden of lead - the amount of lead stored
  in the body.
• Lead is a cumulative
• poison.

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Health Effects on Children

• Brain Functions decreased intelligence
• developmental delays
• behavioral disturbances
• seizures/coma (very high levels)
• Growth decreased stature
• Chemical Messengers liver dysfunction
• Blood System anemia
• On the fetus decreased birth weight
• premature birth
• miscarriage and stillbirth (very high levels)

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Effects of Lead on the Blood-Forming System

• Lead impairs the formation
• of heme which is
• extremely important to
• human life because it
• carries oxygen to
• tissues of the body.

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Effects of Lead on the Kidneys

• Interferes with absorbing function of kidneys
• Chronic nephropathy (kidney disease)

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Other Health Effects of Lead Exposure

• Hypertension - long-term, high exposures
• Gastrointestinal pain (called lead colic)
• Reproductive system
• Males
• decreased sex drive
• decreased sperm count and motility, altered
  structure
• impotence and sterility
• Females
• difficulty becoming pregnant miscarriages

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Deposition
Absorption
Soft Tissue
Bone
Sweat Hair Nails
Upper Respiratory Ways
Liver
INHALATION
Blood
Blood
Kidneys
Urine
Colon
Pharynx
GI Tract
INGESTION
Feces
Liver
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Medical Surveillance Program

• Obtain the highest quality occupational medicine
  provider.
• Ensure that your companys surveillance program
  meets or exceeds minimum OSHA regulations.

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Medical Surveillance Program

• Do not minimize provider fees at the expense of
  ultimate costs.
• Educate your employees about their potential
  occupational hazards.
• Develop a corporate culture that facilitates a
  team effort in medical surveillance.

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Prime Medical Judgments

• Prevention of adverse health effects with lead
  exposures limited to 40 mg/dl or below
• Blood lead levels of workers who intend to
  conceive should be maintained below 30
  mg/dl

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Concept of Surveillance

• Monitoring procedures
• Toxic effects and clinical manifestations of lead
  poisoning
• Recommended medical evaluation of the exposed
  worker
• Laboratory tests available for monitoring

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Recommend Medical Evaluation

• The most important principle in evaluating
  a worker for any occupational disease is a high
  index of suspicion on the part of the physician.
• Medical History

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Two Levels of Medical Surveillance(OSHA 29 CFR
1926.62)

• Initial medical surveillance if an employee is
  exposed at or above the Action Level for at least
  one day per year.
• Full medical surveillance program if the employee
  is exposed at or above the Action Level for more
  than 30 days in a year.

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Initial Medical Surveillance

• Required for employees exposed on any one day at
  or above the action level of 30 mg/m3
• Biological monitoring
• Blood lead levels
• ZPP levels

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Full Medical Surveillance Program

• Required for employees who are or may be
  exposed at or above the action level of 30 mg/m3
  for more than 30 days in a consecutive 12 month
  period.
• Biological monitoring
• Medical examination

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Who Participates?

• All employees exposed to lead at or above the
  action level (30 ug/m3 gt30 days per year)
• All potentially exposed employees if the employer
  has reason to believe they will be exposed at or
  above the Action Level for more than 30 days per
  year
• Recommended for all workers on LBP abatement sites

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Medical Examination

• To be performed
• as soon as employer has reason to believe the
  employee will be exposed gt AL for gt30 days/year
• at least annually if blood tests have been gt 40
  ug/dl within preceding 12 months
• as soon as employee exhibits symptoms
• for employees medically removed

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Frequency of Medical Examinations

• Required for employees who are or may be
  exposed at or above the action level of 30 mg/m3
  for more than 30 days in a consecutive 12 month
  period.
• Annually if BLL gt 40 m g/dl in past 12 months.
• Signs and symptoms
• As medically appropriate

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Areas of Medical Evaluation

• General
• HEENT
• Cardio-pulmonary
• Gastrointestinal
• Neurologic
• Hematologic
• Musculo-skeletal

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Medical Exam Consists Of

• Detailed work and medical history
• Thorough physical examination
• Blood pressure measurement
• Blood sample and analysis
• Routine urinalysis
• Pregnancy or male fertility testing (if requested
  by the employee)

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Laboratory Studies

• Blood lead level
• Complete blood work up
• Blood urea nitrogen
• Serum creatinine
• Routine urinalysis
• ZPP level
• Other tests as necessary

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Laboratory Evaluation

• Blood lead levels remain the single most
  important test to monitor lead exposure.
• Bone
• Soft tissue
• Urine
• ZPP vs. FEP

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Information for Physician

• Copy of lead regulations
• Employees duties
• Employees exposure or anticipated level
• Description of PPE
• Prior blood lead levels
• Prior written medical opinions

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Written Medical Opinions

• Detected medical condition(s)placing employee at
  increased risk
• Recommended PPE
• Respiratory protection limitations
• Blood lead levels
• Should not contain diagnoses unrelated to
  occupational exposure

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Second Opinion

• Employees may consult another physician for a
  second opinion, to review initial results, or
  conduct an examination and laboratory testing.

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Medical Removal

• Employee can be removed either because of BLL
  test results 2 blood tests gt 50 ug Pb/dl, or by
  recommendation of the physician.
• Employee receives same pay benefits for at
  least 18 months.
• Employee can be assigned other duties in areas
  where exposure is ltAL.

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Medical Surveillance Record Keeping

• Employers must retain the following employee
  information for at least 30 years after the
  employee leaves the job
• Name, social security number and job description
• Copy of physicians medical opinion.
• Results of airborne exposure monitoring done for
  that employee and representative values provided
  to the physician.
• Any employee complaints related to lead exposure.

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Conclusion

• The effects of lead exposure are non-specific.
• Medical surveillance is an important part of the
  employers health and safety program.
• Some health professionals recommend more frequent
  BLL monitoring and lower allowable BLLs.
• This description of the medical surveillance
  program is the minimum requirement for the
  employer.

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Lead Surveillance Questionnaire

• 1. Have you ever been diagnosed with anemia?
• 2. Have you recently had abdominal pain or
  discomfort?
• 3. Have you had weakness of your arms or legs?
• 4. Have you had unexplained weight loss?

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Lead Surveillance Questionnaire

• 5. Have you had difficulty sleeping?
• 6. Have you had problems with constipation?
• 7. Have you noted a blue or black/blue
  pigmentation of your gums?
• 8. Have you been unusually tired?

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Lead Surveillance Questionnaire

• 9. Have you had a persistent metallic taste in
  your mouth?
• 10. Have you recently lost your appetite?
• 11. Have you ever had numbness or tingling in
  your arms or legs?
• 12. Have you had difficulty concentrating
  recently?

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Lead Surveillance Questionnaire

• 13. Have you ever had seizures (convulsions/fit
  s)?
• 14. Have you ever had difficulty conceiving
  (having a baby)?
• 15. Have you ever had any reproductive
  problems?
• 16. Have you ever worked with lead in the past?

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Review

• What are the health effects of lead exposure?
• When must employees undergo initial medical
  surveillance.
• When must employees undergo full medical
  surveillance?
• What exposure level requires medical removal?