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Louisiana Louisiana Childhood Lead Childhood Lead
Poisoning Poisoning Prevention Prevention ProgramProgram
Child Care Health Consultant Video Child Care Health Consultant Video ConferenceConference
November 13, 2008November 13, 2008Presented by LACLPPP StaffPresented by LACLPPP StaffAnn Bludsaw, GSW, Case ManagerAnn Bludsaw, GSW, Case Manager
Colleen Clarke, BS, Program CoordinatorColleen Clarke, BS, Program CoordinatorNgoc Huynh, M.D., MPH, Surveillance Ngoc Huynh, M.D., MPH, Surveillance
Epidemiologist Epidemiologist Caroland Randall,BA, M.A.O.M, Environmental Caroland Randall,BA, M.A.O.M, Environmental
CoordinatorCoordinator
OBJECTIVESOBJECTIVES
1.1. Define Childhood lead poisoning.Define Childhood lead poisoning.
2.2. Recognize sources of lead poisoning.Recognize sources of lead poisoning.
3.3. Discuss the components of the comprehensive Childhood Discuss the components of the comprehensive Childhood Lead Poisoning Prevention Program.Lead Poisoning Prevention Program.
4.4. Describe the components of the Louisiana Childhood Describe the components of the Louisiana Childhood Lead Lead
Poisoning Prevention Program.Poisoning Prevention Program.
5.5. Determine lead screening requirements.Determine lead screening requirements.
6.6. Determine case management requirements.Determine case management requirements.
7.7. Discuss lead inspection requirements.Discuss lead inspection requirements.
What is lead What is lead poisoning?poisoning?
Lead is Lead is especially especially dangerous dangerous for young for young children.children.
They:They:
• are still developingare still developing• absorb it more easilyabsorb it more easily• are more likely are more likely
to put things in to put things in their mouthstheir mouths
Lead affects Lead affects the the
brain and brain and nerves.nerves.
This may cause:This may cause:
• learning problemslearning problems• physical problemsphysical problems
More effects More effects of leadof lead• stunted growthstunted growth
• behavior problemsbehavior problems• other issuesother issues
Effects of Effects of high lead high lead
levelslevels• damage to the damage to the nervous system, nervous system, including the brainincluding the brain
• convulsions convulsions or comaor coma
• deathdeath
Sources of LeadSources of Lead
• LEAD PAINTLEAD PAINT• DUST AND SOILDUST AND SOIL• WATERWATER• PARENTAL OCCUPATIONS PARENTAL OCCUPATIONS
OR HOBBIESOR HOBBIES• HOME REMEDIESHOME REMEDIES• FOOD FOOD • OTHEROTHER
Lead-based Lead-based paint paint
and lead dust and lead dust are are
the leading the leading sources.sources.• chipped or chipped or
flaking paintflaking paint• dust from dust from
deteriorating deteriorating paintpaint
• dust from dust from renovationsrenovations
Lead Lead may be may be in water.in water.
• lead plumbing lead plumbing fixtures in fixtures in your homeyour home
• lead in lead in the water the water supply systemsupply system
It can come from:It can come from:
Hobbies Hobbies may be may be
a source of a source of lead.lead.• stained-glass or stained-glass or
pottery makingpottery making
• fishingfishing• refinishing refinishing
furniturefurniture
Lead Lead may may be in be in food.food.
It can come from:It can come from:
• soil or watersoil or water
• dust on dust on hands or hands or preparation surfacespreparation surfaces
• leaded crystalleaded crystal
• lead-soldered canslead-soldered cans
• some glazed potterysome glazed pottery
Comprehensive Approach Comprehensive Approach to Childhood Lead to Childhood Lead
Poisoning Poisoning • Assess children’s exposure to leadAssess children’s exposure to lead• Develop policies for childhood lead Develop policies for childhood lead
poisoning preventionpoisoning prevention– Primary PreventionPrimary Prevention– Secondary PreventionSecondary Prevention
• Assure performance of activities to Assure performance of activities to prevent childhood lead poisoningprevent childhood lead poisoning
• Monitoring (surveillance)Monitoring (surveillance)- Monitoring children’s BLL’s- Monitoring children’s BLL’s- Monitoring for risk for lead elevation- Monitoring for risk for lead elevation
Head Start RequirementsHead Start Requirements
• It is a Medicaid EPSTD requirement that a lead It is a Medicaid EPSTD requirement that a lead screening blood test be performed to determine screening blood test be performed to determine a lead toxicity level for all Medicaid-eligible a lead toxicity level for all Medicaid-eligible children.children.- A “risk assessment” (i.e. a paper and pencil - A “risk assessment” (i.e. a paper and pencil questionnaire or parent interview) does not meet questionnaire or parent interview) does not meet this requirement.this requirement.If parents are unable to provide written If parents are unable to provide written documentation that their child received a lead documentation that their child received a lead screening test at ages, 12 and 24 months, then screening test at ages, 12 and 24 months, then CMS requires that the children receive a lead CMS requires that the children receive a lead screening blood test between the ages of 36 and screening blood test between the ages of 36 and 72 months.72 months.
ManagementManagement
• The most important step is The most important step is identification of source and identification of source and separation of child from the sourceseparation of child from the source
• Rapidity of response depends on the Rapidity of response depends on the levellevel– Medical evaluationMedical evaluation– Environment evaluation for sources.Environment evaluation for sources.
• Decrease risk factors – nutrition, Decrease risk factors – nutrition, anemiaanemia
Primary Objectives of Case Primary Objectives of Case ManagementManagement
• Reduce the child’s blood lead level Reduce the child’s blood lead level (BLL) below the level of concern (BLL) below the level of concern 1010µg/dLµg/dL
• Give the highest priority to children Give the highest priority to children with both the highest BLLs and those with both the highest BLLs and those less than 2 years of age.less than 2 years of age.
Client Identification and Client Identification and Outreach for Case Outreach for Case
ManagementManagement• Lead poisoning risk assessment (screening Lead poisoning risk assessment (screening
questionnaire) – assess level of poisoning questionnaire) – assess level of poisoning threat on all children beginning at six months threat on all children beginning at six months of age and each medical screen through age of age and each medical screen through age six years.six years.
• Blood lead screening – begin with any “yes” Blood lead screening – begin with any “yes” answers on risk assessment, then screen answers on risk assessment, then screen yearly as high risk. If low risk screen at one yearly as high risk. If low risk screen at one and two years of age.and two years of age.
• Counsel parents on lead poisoning prevention Counsel parents on lead poisoning prevention at each visit.at each visit.
Reporting RequirementsReporting Requirements
• Physicians are required to report blood lead Physicians are required to report blood lead levels that are 15 ug/dL or greater immediately levels that are 15 ug/dL or greater immediately to LACLPPPto LACLPPP
• Physicians are required to submit Environmental Physicians are required to submit Environmental Lead Investigation Form immediately to Lead Investigation Form immediately to LACLPPP with Blood lead levels that are 15 LACLPPP with Blood lead levels that are 15 ug’dL-19 ug.dl after 2 venous tests or ug’dL-19 ug.dl after 2 venous tests or >> 20 ug/dL 20 ug/dL
• Follow CDC Summary Chart Lead Poisoning Follow CDC Summary Chart Lead Poisoning Management to determine when a child needs to Management to determine when a child needs to repeat a blood lead level test, when to make a repeat a blood lead level test, when to make a referral, or when an environmental inspection is referral, or when an environmental inspection is needed.needed.
Required Reporting Required Reporting InformationInformation
• Complete LACLPPP Lead Case Reporting Complete LACLPPP Lead Case Reporting form, then fax to 504-219-4452form, then fax to 504-219-4452
• Complete the Request for Environmental Complete the Request for Environmental Lead Investigation form if needed, then Lead Investigation form if needed, then fax to 504-219-4452fax to 504-219-4452
• Forms can be obtained from OPH website Forms can be obtained from OPH website – – http://www.genetics.dhh.la.govs.dhh.la.gov
Follow-UpFollow-Up• Monitoring of blood lead levelMonitoring of blood lead level• Continued assessment for symptomsContinued assessment for symptoms• Attention to nutrition and iron statusAttention to nutrition and iron status• Environmental follow-up to ensure hazard Environmental follow-up to ensure hazard
reductionreduction• Contact provider to ensure child is in care, Contact provider to ensure child is in care,
provide health education materials to provide health education materials to family/guardian and physicians as neededfamily/guardian and physicians as needed
Environmental Case Environmental Case Management definedManagement defined
• Following - up on Following - up on eligibleeligible children children• Coordinating environmental Coordinating environmental
investigations investigations • Notifying parents, medical providers Notifying parents, medical providers
and property owners of and property owners of investigation results investigation results
• Coordinating remediation and/or Coordinating remediation and/or abatement strategiesabatement strategies
Environmental Environmental Investigations/Investigations/
Environmental Risk Environmental Risk AssessmentsAssessments• Visual InspectionVisual Inspection
• An Extensive An Extensive Questionnaire Questionnaire
• Dust, soil and paint Dust, soil and paint sampling (if sampling (if chipping) chipping)
• Investigation Report Investigation Report – Results & AnalysisResults & Analysis– Hazard Control PlanHazard Control Plan
• Cost Estimates of Cost Estimates of Hazard ControlsHazard Controls
Most Common Sources of Most Common Sources of Lead PoisoningLead Poisoning
Identified Lead Sources
Dust17%
Soil18%
Paint43%
Miniblinds14%
No Source8%
DustSoilPaintMiniblinds
No Source
Sources of childhood lead poisoning identified and recorded through lead inspections & risk assessments (1999 – 2003) through the Office of Public Health
Contact UsContact Us
Louisiana Childhood Louisiana Childhood Lead Poisoning Lead Poisoning
Prevention ProgramPrevention Program3101 W. Napoleon 3101 W. Napoleon
AvenueAvenueMetairie, LA 70001Metairie, LA 70001
504 – 219-4413504 – 219-4413800 – 242 – 3112 800 – 242 – 3112
www.genetics.dhh.louisiana.gwww.genetics.dhh.louisiana.govov