Transcript Monmouth County Health Department

New Jersey Department
of Health and Senior Services
Sylvia Dellas
Coordinator, Child Health
Has no financial interest or affiliations,
as well as no plan to discuss either a
Non-FDA approved or
investigational use of products or devices
Monmouth County
Health Department
Jeryl Krautle
Kate Andrews
We have no financial interest or affiliations,
as well as no plan to discuss either a
non FDA approved or investigational
use of products or devices.
Effects of Lead on Children
• The long term effects
of lead in a child can
be severe; and may
include
–
–
–
–
–
Learning disabilities
Decreased growth
Behavior problems
Impaired hearing
Long term neurological
damage
*EPA Lead Poisoning and Your
Child, EPA 747-K-00-003 October
2000
Environmental Intervention
of the Lead Poisoned Child
By the end of this session you will:
• Know the substantive proposed
amendments to N.J.A.C. 8:51
• Know how the proposed amendments will
affect local health departments.
Why amendments to N.J.A.C. 8:51
• P.L. 2003, Chapter 311 Lead Hazard Control
•
•
•
•
Assistance Act
Eliminate childhood lead poisoning as a public
health problem
Set forth uniform standards
Improve compliance
Improve communication, tracking prevalence
and incidence, and managing cases
CDC - Standard Surveillance
Definitions and Classifications
June 1, 2009
N.J.A.C 8:51
Childhood Lead Poisoning
• Proposed readoption with amendments,
new rules, and repeals.
• Initially set to expire November 16, 2009.
Notice of Proposal filed to extend
expiration to May 15, 2010.
• Amend chapter name to remove “State
Sanitary Code Chapter XIII”
• Department staff consulted with DCA
Subchapter 1
• Sets forth one location the policies,
guidelines, forms, assessments, and
materials incorporated by reference
• Adds definitions
Subchapter 2
• Reduction of the capillary blood lead level
•
•
•
•
to trigger confirmation
Provision of case management with a
confirmed blood lead level of 10 -14 ug/dL
at least one month apart
Testing of pregnant women in the
household
Assignment of cases
Discharge criteria
Subchapter 3
• DHSS reports to local board of health
blood lead levels of 10 ug/dL or greater
• Must provide all information regarding
local board of health actions to the
primary care provider
• Must report violations and enforcement
procedures to DCA
• Circumstances in which electronic and
written records are maintained and
released
Subchapter 4
• Requires environmental intervention for
•
•
•
confirmed blood lead levels of 15 ug/dL or
greater, or two consecutive test results of
10 -14 ug/dL at least one month apart
All reports of blood lead tests would be
forwarded to the local board of health
Conduct limited hazard assessment at planned
temporary relocation with full hazard
assessment at planned permanent relocation
address
Provide written materials to tenants of all units in
a multi-unit building when an EBLL is identified
in one of the units
Subchapter 4 continued
• Conduct dust sampling in addition to
limited hazard assessment of houses that
do not have a lead-free certificate
• Remediate nonpaint lead hazards
• Environmental Intervention Reports must
be provided to property owners without
the name of the lead burdened child
• Copy of Notice of Violation must be
provided to local construction official
Subchapter 5
• Collection of at least one surface dust
wipe sample on the floor of the primary
entry way and a minimum of six single
surface dust wipe samples per dwelling
• Minimum of two samples of bare soil from
the primary residence that is accessible or
poses a hazard
Subchapter 5 continued
• DHSS will accept other sample collection
or testing methods approved by any
government agency having regulatory
responsibility regarding lead hazards
• Paint, soil, or dust testing methods for
screening purposes but be confirmed for
enforcement purposes
Subchapter 6
• Proposed to allow abatement and/or
interim controls to address lead-based
paint on exterior surfaces
• Establishes standards that the person
performing the work must follow for
abatement and interim controls
• Establishes requirements for abatement
and/or interim controls related to leadcontaminated soil
Subsection 7
• Requires immediate relocation of
occupants to comparable lead safe
housing upon receipt of notice of violation
• Local boards of health shall, when an
owner does not, perform or arrange for
abatement of lead hazards
• Required 10 day notice to DCA
• Local boards of health are responsible to
monitor all lead abatement and/or interim
controls it has ordered
Subchapter 8
• Owner is responsible for obtaining
independent clearance testing within 30
days from the final cleaning
• Owner is to obtain a lead hazard free
certificate for exterior surfaces upon
completion of exterior interim controls
work
Subchapter 9
• Penalties for violations
• DHSS may report a health officer’s failure
to comply with this chapter or with an
order or directive of DHSS
• Sets forth when a local board of health has
to implement an abatement and/or interim
controls notice or order because the
property owner refuses to comply
Subchapter 10
• Sets standards applicable to Childhood
Lead Poisoning Information Database
– Access and limitations
– Required training
– Confidentiality
– User Confidentiality Agreement
– Quarterly quality assurance audit
Grantee NJDHSS
• Piloted lower EBL
Action level to
include
– Nurse case
management
– Environmental
Intervention
How It All Begins
• Notification of EBL (Elevated Blood Lead)
is received by the health department
through Leadtrax notification, phone calls
primary care providers and/or fax from
NJDHSS LP-1
• Confirmed lead
Interventions
• Case manager and lead inspector/risk
assessor are assigned within 24 hours.
• Current time frames for initial visits
– Nurse –
• PB 10-14 visit within 3 weeks
• Pb 15 – 44 visit within 2 weeks
• Pb 45 – 69 visit within 48 hours
• Pb 70 or greater – visit within 24 hours
Intervention Time Frames
– Inspection time frames
• Blood Lead Over 69
• Blood lead 45-69
• Blood lead 20-44
• Blood lead 15-19
• Blood lead 10-14
within
wihtin
within
within
within
24 hours
48 hours
1 week
2 weeks
3 weeks
Joint Visit
• Goals –
– Educate parent
– Lead Hazard Assessment
Questionnaire
– Inspect and Evaluate potential
sources of lead
– Implement/Recommend
immediate hazard reduction
methods
– Possibly recommend the removal
of child from hazards/dwelling
– Identify additional locations that
may be contributing sources
Lead Hazard Assessment
Questionnaire
• Grantee – draft of revised form
• Case manager and inspector share joint
responsibility for this questionnaire
• Both must sign off the areas completed
and review each others section
Questionnaire explores
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
Background information physical characteristics and residential use pattern
Previous inspections
Potential sources in the neighborhood
Hazard Assessment Questionnaire
Visual inspection – interior & exterior
Testing defective paint, interior, other buildings on premises, furniture, toys and
play structures
Testing of intact paint on friction surfaces
Testing intact paint on chewable surfaces, if indicated by questionnaire
or evidence of chewing
Testing on impact surfaces, if evidence of impact damage
Dust sampling of window sills and floors in rooms identified in the Lead Hazard
assessment questionnaire as play areas, hiding areas or areas where the child is
most likely to come into contact with dust
Soil sampling when indicated by questionnaire, of bare soil – min. of 2
Evaluation of exterior – “if no lead hazard found in interior
Testing of soil, if no lead hazard found in interior or exterior
Other possible sources as indicated by questionaire
–
Nonpaint lead hazards
–
Other sites
Lead Paint Hazard
• Common Routes of
Exposure
Window sills and wells
Impact and friction
surfaces
Areas of chipping and
peeling
Dust
• Sampling
• Sampling equipment – LIFT
grant
• LHD collect single surface
paint and other surface coating
samples in conformance with
sampling procedures found in
HUD guidelines
• Shall collect dust wipe samples
– One sample on floor of the
primary entrance way
– Minimum of six samples
per dwelling
Water
• Municipal Water
• Well – case in Howell
• Plumbing pre-1984
Soil
• EPA guidelines with
•
action levels
Remediation
– Remove or interim
controls
Occupational/Hobbies
•
•
•
•
•
Sinkers
Work clothes
Stained Glass
Furniture refinishing
Shooting ranges
Other sources
•
•
•
•
•
•
Cosmetics
Home remedies
Herbals
Spices
Candy
Cooking
vessels/utensils/storage
• Toys
• Furniture
• And the list goes on
Immediate Hazard Reduction
Methods
•
•
•
•
Duct tape
Moving furniture
Cleaning methods
Hepa-vaccuum - loans
Interim Controls - Exterior
• Paint stabilization
• Siding
• Aluminum Wrap
Importance of Nurse Case
Manager/Lead Inspector/Risk Assessor
Communication
• Case management visits
• Departmental differences
• Difficulties with harassing/evicting tenants
• Work has begun
• Resident moved
Importance of Nurse Case
Manager/Lead Risk Assessor
Communication (con’t)
• Exchange of information regarding
sources, drug activity, developmental
issues, parenting issues
• Don’t limit visits to environmental and/or
nursing issues. Communication is the key
to the best outcome for the child
Owner/tenant notification
• Owner – NOV certified letter with DCA approved
•
•
•
•
contractors, readings, dust wipe sample results
and copies of Chapter XIII (NJAC 8:51) and DCA
NJAC Chapter 5:17 with 10 days to reply
Provide info on DCA funding sources
EPA regulation regarding notification for sale
Code enforcement is notified to hold co
Tenant – notified inspection completed, lead
found, areas, advise hand wash, dietary,
cleaning
Contractor Meeting/Phone Call
• Review inspection report with the
contractor
• Scope of work submitted for review
– I’ll do the best I can
– I’ll try
– Paint with encapsulate
– If SOW is approved letter to owner,
contractor and local construction official
This is where it falls apart
• Expensive
– Current funding
sources
• Landlord wants to
•
•
evict
Owner occupied
Foreclosures
– Dealing with banks
Expensive
• DCA abatement funding
• Relocation Fund – DCA
• Local and county affordable housing funds
Owner doesn’t respond
• 10 days after
receipt of letter
• Issue summons
– Chapter XIII –
8:51-6.2
(exterior) and
8:51-6.3
(interior)
Eviction
• Can not evict as
an abatement
method
Owner Occupied
• Allowed to do work themselves
• Increased risk of exposure to themselves
and the child
• Long time frame – drag on
• Chapter XIII – 8:51-7.1 – health dept
responsible for abatement
Foreclosures
• Bank not foreclosing
•
•
due to lead
Tied up in court for
long periods
Important to put a
hold on the CO
Other sources
• Causative factors –
•
•
water leak
Lead Recall Book
Imported cosmetics,
candy, pottery,
cooking utensils,
furniture etc
– Chapter XIII (NJAC
8:51 4.2 9d and 8:51
6.5)
Occupations/Hobbies
• Removing the source
– Recent poisoning – lead workers with the car
seats
– Right to Know
– OSHA for workers
– All else fails Criminal Code 2c – Endangering
the Welfare of a Child
Partners
•
•
•
•
•
•
•
•
•
•
Model Cities – local ordinances
Code Enforcement
Building Department
Neighborhood Perseveration/ Historical Preservation
DCA
EPA
Law Enforcement
Consumer Affairs (State and local)
Prosecutors/Judges
Public Advocate
Where do we go from here?
– Right now working in
reactive way –
– Future- Intervene and
prevent lead exposure
– Primary prevention –
CDC, HUD and
NJDHSS moving to
Healthy Homes
Questions?