Transcript Document

Louisiana Childhood
Lead Poisoning
Prevention Program
Child Care Health Consultant Video Conference
November 13, 2008
Presented by LACLPPP Staff
Ann Bludsaw, GSW, Case Manager
Colleen Clarke, BS, Program Coordinator
Ngoc Huynh, M.D., MPH, Surveillance Epidemiologist
Caroland Randall,BA, M.A.O.M, Environmental Coordinator
OBJECTIVES
1.
2.
3.
4.
5.
6.
7.
Define Childhood lead poisoning.
Recognize sources of lead poisoning.
Discuss the components of the comprehensive Childhood Lead Poisoning
Prevention Program.
Describe the components of the Louisiana Childhood Lead
Poisoning Prevention Program.
Determine lead screening requirements.
Determine case management requirements.
Discuss lead inspection requirements.
What is lead poisoning?
Lead is
especially
dangerous for
young children.
They:
• are still developing
• absorb it more easily
• are more likely
to put things in
their mouths
Lead affects the
brain and nerves.
This may cause:
• learning problems
• physical problems
More effects of lead
• stunted growth
• behavior problems
• other issues
Effects of
high lead levels
• damage to the
nervous system,
including the brain
• convulsions
or coma
• death
Sources of Lead
•
•
•
•
LEAD PAINT
DUST AND SOIL
WATER
PARENTAL OCCUPATIONS OR
HOBBIES
• HOME REMEDIES
• FOOD
• OTHER
Lead-based paint
and lead dust are
the leading sources.
• chipped or
flaking paint
• dust from
deteriorating paint
• dust from
renovations
Lead may be
in water.
It can come from:
• lead plumbing
fixtures in
your home
• lead in
the water
supply system
Hobbies may be
a source of lead.
• stained-glass or
pottery making
• fishing
• refinishing
furniture
Lead may
be in food.
It can come from:
• soil or water
• dust on
hands or
preparation surfaces
• leaded crystal
• lead-soldered cans
• some glazed pottery
Comprehensive Approach to
Childhood Lead Poisoning
• Assess children’s exposure to lead
• Develop policies for childhood lead poisoning
prevention
– Primary Prevention
– Secondary Prevention
• Assure performance of activities to prevent childhood
lead poisoning
• Monitoring (surveillance)
- Monitoring children’s BLL’s
- Monitoring for risk for lead elevation
Head Start Requirements
• It is a Medicaid EPSTD requirement that a lead
screening blood test be performed to determine a lead
toxicity level for all Medicaid-eligible children.
- A “risk assessment” (i.e. a paper and pencil
questionnaire or parent interview) does not meet this
requirement.
If parents are unable to provide written documentation
that their child received a lead screening test at ages, 12
and 24 months, then CMS requires that the children
receive a lead screening blood test between the ages of
36 and 72 months.
Management
• The most important step is identification
of source and separation of child from the
source
• Rapidity of response depends on the level
– Medical evaluation
– Environment evaluation for sources.
• Decrease risk factors – nutrition, anemia
Primary Objectives of Case
Management
• Reduce the child’s blood lead level (BLL) below
the level of concern 10µg/dL
• Give the highest priority to children with both
the highest BLLs and those less than 2 years of
age.
Client Identification and Outreach
for Case Management
• Lead poisoning risk assessment (screening
questionnaire) – assess level of poisoning threat
on all children beginning at six months of age
and each medical screen through age six years.
• Blood lead screening – begin with any “yes”
answers on risk assessment, then screen yearly
as high risk. If low risk screen at one and two
years of age.
• Counsel parents on lead poisoning prevention at
each visit.
Reporting Requirements
• Physicians are required to report blood lead levels that are
15 ug/dL or greater immediately to LACLPPP
• Physicians are required to submit Environmental Lead
Investigation Form immediately to LACLPPP with Blood
lead levels that are 15 ug’dL-19 ug.dl after 2 venous tests or
> 20 ug/dL
• Follow CDC Summary Chart Lead Poisoning Management
to determine when a child needs to repeat a blood lead level
test, when to make a referral, or when an environmental
inspection is needed.
Required Reporting Information
• Complete LACLPPP Lead Case Reporting form,
then fax to 504-219-4452
• Complete the Request for Environmental Lead
Investigation form if needed, then fax to
504-219-4452
• Forms can be obtained from OPH website –
http://www.genetics.dhh.la.gov
Follow-Up
•
•
•
•
Monitoring of blood lead level
Continued assessment for symptoms
Attention to nutrition and iron status
Environmental follow-up to ensure hazard
reduction
• Contact provider to ensure child is in care,
provide health education materials to
family/guardian and physicians as needed
Environmental Case Management
defined
• Following - up on eligible children
• Coordinating environmental investigations
• Notifying parents, medical providers and
property owners of investigation results
• Coordinating remediation and/or abatement
strategies
Environmental Investigations/
Environmental Risk Assessments
• Visual Inspection
• An Extensive
Questionnaire
• Dust, soil and paint
sampling (if chipping)
• Investigation Report
– Results & Analysis
– Hazard Control Plan
• Cost Estimates of Hazard
Controls
Most Common Sources of Lead
Poisoning
Identified Lead Sources
No Source
8%
Dust
17%
Miniblinds
14%
Soil
18%
Dust
Soil
Paint
Miniblinds
No Source
Paint
43%
Sources of childhood lead poisoning identified and recorded through lead
inspections & risk assessments (1999 – 2003) through the Office of Public Health
Louisiana Childhood Lead
Poisoning Prevention Program
3101 W. Napoleon Avenue
Metairie, LA 70001
504 – 219-4413
800 – 242 – 3112
www.genetics.dhh.louisiana.gov