Course Content Page 7

Case Management of Elevated Blood Lead Levels

Childhood

The healthcare provider, the local public health agency, or a qualified case manager may perform case management of children less than six years of age. DHSS has developed guidelines for case management based upon recommendations by CDC's publication, " Managing Elevated Blood Lead Levels Among Young Children: Recommendations from the Advisory Committee on Childhood Lead Poisoning Prevention."

Refer to the Childhood Blood Lead Testing and Follow-up Guidelines Chart.

Prenatal

All health care facilities serving pregnant women should take the appropriate steps to refer pregnant women with EBL levels for follow-up to a health care provider or physician practicing medicine in any of its branches and licensed pursuant to chapter 194 RSMO. All health care providers shall report any blood lead level in a pregnant woman within three days of first knowledge or suspicion as required in 19 CSR 20-20.020. The lead levels shall be reported to the local health authority or to Missouri Department of Health and Senior Services.

Childhood Blood Lead Testing and Follow-Up Guidelines

Environmental Controls

Peeling, chipping, chalking or cracking lead-based paint is a hazard and needs immediate attention. Lead-based paint may also be a hazard when found on surfaces that children can chew or that get a lot of wear-and-tear. These areas include:

  • Windows and windowsills
  • Doors and door frames
  • Stairs, railings, and banisters
  • Porches and fences

Environmental controls can be Interim or Abatement measures. Share the suggested measures with your patients.

Interim - reduces lead risk temporarily

  • Includes cleaning, repairs & maintenance, painting, sealing floors and other porous surfaces, temporary containment, and resident education. If you think there may be lead in your patient's environment:
Indoors
  • Tell all adults in the house to be alert to the threat and watch children closely.
  • Educate the patient on proper household cleaning techniques. Floors in the house should be mopped with a wet mop and windowsills wiped with a wet cloth. Inform adults that hardware stores my carry lead-specific cleaning products.
  • Remind patients that damaged lead-painted surfaces should be painted over.
Outdoors
  • Instruct patients to use lead-free sand in children's sandboxes so children can play safely.
  • Encourage patients to plant gardens in a safe lead-free area away from painted buildings and busy roads.
  • Encourage patients to plant grass to cover soil with high lead levels.
  • Remind patients that damaged lead-painted surfaces should be painted over.

Abatement - permanently removes the lead risk

Removing the lead source is important. But in general, inform patient's not to remove it themselves.

Warning: Improper removal of lead can make the problem worse.

Warn patients before having any lead source removed, they should get local or state advice and ask about:

  • Hiring a professional
  • Health and safety requirements and precautions
  • Safely removing paint or covering it with paneling or plaster wallboard
  • Safely replacing woodwork, windows, etc.
  • Removing contaminated soil properly
  • Correcting lead problems in plumbing safely

Inform patients NOT to:

  • Use a belt-sander, propane torch, heat gun, dry scraper, or dry sandpaper to remove lead-based paint. These actions create large amounts of lead dust and fumes. Lead dust can remain in your home long after the work is done.

Inform patients to:

  • Follow all health and safety requirements
  • Have all occupants stay away until after cleanup
  • Store furniture, rugs, food, dishes, etc., away from home until after cleanup

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