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Health Effects and Medical Surveillance for Lead Exposure

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Medical examination. 21. Who Participates? ... Medical Examination. To be performed: ... Medical Exam Consists Of: Detailed work and medical history. Thorough ... – PowerPoint PPT presentation

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Title: Health Effects and Medical Surveillance for Lead Exposure


1
Health Effects andMedical SurveillanceforLead
Exposure
www.oshainfo.gatech.edu
2
Objectives
  • To provide information regarding the health
    effects of lead exposure.
  • To present information about medical surveillance
    programs for employees exposed to lead.

3
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.

4
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.

5
Organ Systems Damaged by Lead Poisoning
Brain Disorders
Nerve Disorders
Hematological Problems
Kidney Problems
Reproductive Problems
Decreased Red Blood Cells
Slower Reflexes
6
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.

7
Lead in the Body
  • Body Burden of lead - the amount of lead stored
    in the body.
  • Lead is a cumulative
  • poison.

8
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)

9
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.

10
Effects of Lead on the Kidneys
  • Interferes with absorbing function of kidneys
  • Chronic nephropathy (kidney disease)

11
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

12
Deposition
Absorption
Soft Tissue
Bone
Sweat Hair Nails
Upper Respiratory Ways
Liver
INHALATION
Blood
Blood
Kidneys
Urine
Colon
Pharynx
GI Tract
INGESTION
Feces
Liver
13
Medical Surveillance Program
  • Obtain the highest quality occupational medicine
    provider.
  • Ensure that your companys surveillance program
    meets or exceeds minimum OSHA regulations.

14
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.

15
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

16
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

17
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

18
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.

19
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

20
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

21
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

22
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

23
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

24
Areas of Medical Evaluation
  • General
  • HEENT
  • Cardio-pulmonary
  • Gastrointestinal
  • Neurologic
  • Hematologic
  • Musculo-skeletal

25
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)

26
Laboratory Studies
  • Blood lead level
  • Complete blood work up
  • Blood urea nitrogen
  • Serum creatinine
  • Routine urinalysis
  • ZPP level
  • Other tests as necessary

27
Laboratory Evaluation
  • Blood lead levels remain the single most
    important test to monitor lead exposure.
  • Bone
  • Soft tissue
  • Urine
  • ZPP vs. FEP

28
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

29
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

30
Second Opinion
  • Employees may consult another physician for a
    second opinion, to review initial results, or
    conduct an examination and laboratory testing.

31
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.

32
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.

33
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.

34
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?

35
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?

36
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?

37
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?

38
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?
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