What
Physicians Need to Know About Occupational Lead Exposure |
|
David
Valiante
NJ Dept. of Health and Senior
Services
Under
the New Jersey Administrative Code (N.J.A.C. 8:57-3.2), physicians are
required to report adult lead toxicity (blood lead _>
25 ug/dl or urine lead _> 80 ug/1) to the New Jersey Department
of Health and Senior Services.
The report must include
the following information about the case:
- Name and Address
of Employer at Time of Exposure
- Name
- Sex
- Date of Onset
of Illness
- Year of Birth
- Telephone Number
- Home Address
As
a Health Care Provider you have, under the OSHA Lead Standards (29 CFR
1910.025 and 29 CFR 1926.62) primary responsibility for evaluating lead
toxicity in the workers who are your patients.
In
compliance with state regulations, the New Jersey Department of Health
& Senior Services collects and records occupational blood and urine lead
reports. The Department also offers assistance to health care providers
through consultations, surveillance reports and educational materials
For More Information
Contact:
The Lead Project
Occupational Disease and Injury Services
(609) 984-1863
|
Who is covered Under the
OSHA Lead Standards?
All workers exposed
to metallic lead, inorganic lead compounds, and organic lead soaps. The
employer should establish a medical surveillance program for employees
who are or may be exposed above the action level of 30 micrograms of airborne
lead per cubic meter of air averaged over an 8-hour period for more than
30 days per year.
What Jobs are Associated
with Lead Poisoning?
- Producing or smelting
lead
- Melting and casting
brass, copper or lead
- Demolishing old
structures
- Stripping or sanding
old paint
- Welding old, painted
metal
- Machining and
grinding lead alloys
- Manufacturing
batteries
- Repairing radiators
- Handling scrap
metal
- Soldering lead
- Using indoor firing
ranges
- Mixing ceramic
glazes
Where is Lead Found the
Environment?
- PAINT in houses
built before 1978
- DRINKING WATER
from pipes with lead
- SOIL and AIR near
buildings and factories where people work with lead
What are the Physician's
Responsibilities Under The OSHA Lead Standards?
The physician has
a primary responsibility for evaluating potential lead toxicity in the
employee and providing a written report to the employee detailing the
results of this evaluation. The physician also should provide a summary
to the employer detailing the fitness for duty and any special equipment
required, limitations, or restrictions from performing full job duties.
Employees should
be medically removed
(TRANSFERRED TO A NON-LEAD EXPOSED JOB WITHOUT LOSS OF PAY OR BENEFITS)-from
the worksite:
- General Industry
for blood lead levels greater than or equal to 60 ug/dl or an
average of three readings greater than 50 ug/dl;
- Construction
for blood lead levels greater than or equal to 50 ug/dl; or
for medical conditions that place the employee at increased risk of
impairment of health due to lead exposure.
How Often Should Employees
Have Medical Evaluations?
Physical examinations
and laboratory testing should be conducted with the following frequencies:
- prior to employment
or assignment in a lead- exposed area;
- at least annually
for any employee with a blood lead level in the past 12 months
at or above 40 ug/dl;
- as soon as possible
for any employee who complains plains of signs or symptoms consistent
with lead exposure;
- as soon as possible
for any worker who demon- demonstrates breathing difficulties while
wearing a respirator.
What Constitutes a Medical
Evaluation?
- OCCUPATIONAL
HISTORY
with attention to previous lead exposure;
- MEDICAL HISTORY
of past and present medical conditions involving specific organ systems;
- PERSONAL HISTORY
of hygiene habits, smoking, alcohol consumption, hobbies;
- BLOOD PRESSURE;
- PHYSICAL EXAMINATION
with special attention to neurological, gastrointestinal, cardiovascular
and renal systems;
- PULMONARY STATUS
if respirators are used on the worksite;
- LABORATORY
TESTING FOR
Blood lead level; Hemoglobin, hematocrit, red cell indices and
examination of peripheral smear morphology; Zinc protoporphyrin level
(ZPP); BUN and serum creatinine; Routine urinalysis.
How Often Should Biological
Monitoring be Performed?
BLOOD
LEAD LEVELS
|
FREQUENCY
|
Less
than 40 ug/dl (last result) |
Every
6 months |
Last
result between 40 ug/dl and level requiring medical removal |
Every
2 months until two consecutive blood samples indicate a blood lead
level below 40 ug/dl |
Greater
than 60 ug/dl or when the average of the last three blood samples
taken during the previous 6 month period is 50 ug/dl or greater for
general industry; or greater than 50 ug/dl for construction industry. |
At
least monthly during the removal period of each employee removed from
exposure to lead due to an elevated blood lead level. |
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