AGENDA ENVIRONMENTAL LEAD INVESTIGATION

Transcription

1 ENVIRONMENTAL LEAD INVESTIGATION Office of Environmental Health & Engineering Albuquerque Area Indian Health Service Bob Bates, MS, RS District Environmental Health Officer CAPT Mike Lewis, MPH, R.E.H.S, CRPSIII Albuquerque Area IEH Officer AGENDA History and Risks Albuquerque Area Elevated Blood Procedure Standard Operating Procedure Investigations Risk Assessments Where does this lead from here? 1

2 History: 8500 year old statue in Turkey 8,000 year old lead objects found in Egyptian tombs was fashioned into currency in ancient Syria Historical and Biblical references 3500 years ago Greek and Roman referenced lead frequently Romans-First Practical uses of Greeks-First to document lead poisoning, it has not always been recognized as hazardous Medical Dictionary listed lead as being cures for consumption, diabetes, dysentery and Epilepsy. Dissolved in vinegar, it would cure sores and skin diseases. Modern day uses for Pottery Ammunition Wheel weights Sinkers Electrical storage batteries Toys Plumbing Traditional Medicines 2

3 in paint additives, gasoline additives, solder and pipes has been reduced or eliminated. It was used in paint before 1971 as a pigment. It was very durable, allowed faster drying and was corrosion resistant. At that time some paint contained 50% lead. Greatest exposure to lead comes from man-made processes and products Major source of exposure to lead for most adults comes from the work place. Young children exposures are from lead in dust and soil (hand-to-mouth) Residential Homes 64,000,000 contain some LBP 14,000,000 contain deteriorating LBP 4,000,000 have children under 6 years old 3

4 Why is Paint appealing to Children Easy accessible Sweet taste in adult brain Who gets lead poisoning? Children -Mother passes it to child during pregnancy - based paint form windowsills -BLL Peaks at months, then a slow decline -tank full (i.e. bones are saturated) competes with Calcium in bones Adults -Industrial --battery recycling/electronics, mining, welding 4

5 Houses built prior to 1940 at greater risk contain higher concentrations of lead more coats of paint poorly maintained dwellings. HUD and EPA has established the following Levels for Floors (in dust) 40 µg/ft² Window Sills 250 µg/ft² Play Areas 400µg/g Non-play areas of the yard 1200 µg/g Water-15 ppb or 15 µg/l or mg/l Other Sources of Home Remedies (folk medicines) Hobbies Vinyl mini-blinds Imported crayons/toys Painted metal playground equipment Calcium supplements 5

6 Head Start Performance Standard 45 CFR (a)(1)(ii) Preventive care schedule must incorporate..cms Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program of the Medicaid agency of the state. Centers for Medicaid/Medicare EPSDT -CMS requires that all children receive a screening blood level test at 12 months and 24 months of age. Children between the ages of 36 and 72 months must receive screening if not previously screened. Recommendations for Blood Screening of Young Children Enrolled in Medicaid: Targeting a Group at High Risk Children enrolled in Medicaid are entitled by federal law to all necessary follow-up services allowable under the Medicaid program (10). Current HCFA policy requires that all state Medicaid programs cover a one-time environmental investigation to determine the source of lead and the necessary case-management services Yet many states have failed to establish reimbursement mechanisms for these covered services (20). As of early 1999, only 22 state Medicaid agencies reported covering environmental investigation, whereas 20 reported covering case management (6,20). Vol. 49 No. RR 44 MMWR December 8, 2000 Managing Blood Levels IHS 6

7 Standard Operating Procedures Establish systematic methods & procedures for investigating environmental lead sources Methods for lead exposure prevention Obtain information to evaluate risk of exposure to lead sources Environmental Health s Role Referral by physician-following confirmed level of 15 µg/dl BLL Conduct an environmental lead investigation Conduct a lead risk assessment Provide recommendations for lead hazard control measures Work with case management team 7

8 Environmental Investigation Form Demographic & Medical Information Environmental Sources -based paint & contaminated dust hazards in soil hazards Water lead hazards Occupational/Hobby Sources Other Household Sources Child Behavior Risk Factors Observations & Follow-ups CPSC Recall Picture Book 8

9 Sampling Risk Assessment Hazard Control Measures Communication with case management team Completing the Circle Follow-up with case management team Family Housing Other entities Where does this lead from here 9

10 NEWS from CPSC U.S. Consumer Product Safety Commission Office of Information and Public Affairs Washington, DC 20207FOR IMMEDIATE RELEASE January 8, 2009 Release #09-086CPSC Recall Hotline: (800) CPSC Media Contact: (301) CPSC Clarifies Requirements of New Children s Product Safety Laws Taking Effect in February Guidance Intended for Resellers of Children s Products, Thrift and Consignment Stores When the CPSIA was signed into law on August 14, 2008, it became unlawful to sell recalled products. All resellers should check the CPSC Web site ( for information on recalled products before taking into inventory or selling a product. The selling of recalled products also could carry civil and/or criminal penalties. Pr event io n Week October 19-23, 2009 Children: is more dangerous to children under the age of 6. Children s brains and nervous systems at this age are more sensitive to the damaging effects of lead. Their growing bodies absorb more lead. Babies and young children put their hands and objects in their mouths. Children with high levels of lead in their bodies and not detected early can suffer from the following: Damage to brain and nervous system; Behavior and learning problems like hyperactivity; slowed growth; hearing problems; headaches. Even children who seem healthy can have high levels of lead in their bodies. Adults: Women of childbearing age with high lead levels in their system prior to pregnancy would expose the fetus to lead through the placenta. Exposure to lead also increases chance of illness during pregnancy and harm to a fetus, including brain damage or death. Damage to lead in Adults can lead to fertility problems in both men and women; high blood pressure; digestive problems; nerve disorders; memory and concentration problems; muscle and joint pain. Some Other Sources of : Many imports such as toys, jewelry, snaps and buttons, vinyl goods, plastic mini-blinds, lead glazed pottery and furniture. Drinking water through lead pipes or solder in plumbing and some occupations. Even some hobbies and folk remedies that contain lead. Prevention: Check for lead on homes build before1978; Clean floors, window frames, window sills and other surfaces weekly making sure to rinse sponges and mop heads after cleaning dirty or dusty areas. Wash children s hands often, especially before they eat, nap and bed time. Keep play areas clean. Keep children from chewing window sills or other painted surfaces. Clean or remove shoes before entering your home. Make sure children eat nutritious, low-fat meals high in iron and calcium. Children with good diets absorb less lead. For more information: Consumer Product Safety Commission Environmental Protection Agency Dept. of Housing and Urban Development Contact & Other information Bob Bates robert.bates@ihs.gov CAPT. Mike Lewis paul.lewis@ihs.gov Consumer Product Safety Commission Environmental Protection Agency Dept. of Housing and Urban Development 10

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