Appendix 1 - Medical Surveillance of Lead-Exposed Workers

• Issued: September 2004
• Content last reviewed: April 2011

Where construction workers are exposed to airborne lead, measures and procedures to control their exposure should be implemented. This guide has outlined (in Section 4) the types of controls that should be in place for various work activities. But to ensure that these controls are effective they should be periodically evaluated. One way of doing this is by establishing a medical surveillance program. A medical surveillance program refers to the systematic collection, analysis, and evaluation of health data in the workplace to identify cases, patterns, or trends suggesting an adverse effect on workers' health. It is highly recommended that employers establish and maintain a medical surveillance program in their workplace.

The essential features of a lead medical surveillance program are outlined below.

Medical Surveillance Program

Purpose

The objective of a medical surveillance program is to protect the health of workers by:

• ensuring their fitness for exposure to lead
• evaluating their absorption of lead
• enabling remedial action to be taken when necessary
• providing health education.

Program

The medical surveillance program should include the following:

• pre-employment and pre-placement medical examinations
• periodic medical examinations
• clinical tests
• health education
• record keeping.

Medical Examinations

The medical examination should include the following:

History

The initial medical and occupational history should include enquiries about the worker's previous exposure to lead (both occupational and non-occupational), personal habits (smoking and hygiene), and history of present or past gastrointestinal, hemopoietic, renal, reproductive, endocrine, or nervous disorders.

At subsequent examinations, the history should be updated to include:

• information on the frequency and duration of exposure to lead since the previous examination;
• the occurrence of signs and symptoms that may be an early indication of lead intoxication, e.g., abdominal pain, constipation, vomiting, asthenia, paraesthesia and psychological change.

Physical Examination

Medical surveillance should include a general physical examination. Particular attention should be directed to those systems that may be affected by lead. Personal hygiene should also be noted.

Biological Monitoring

Biological monitoring refers to the collection and assessment of bodily fluids or tissue, to evaluate occupational exposure to chemical hazards. The concentration of lead in a worker's blood is a good indicator of lead absorption by that individual. It does not indicate the total body burden of lead, but it is useful in the assessment of a worker's fitness for continued exposure to lead. As such, determining the blood lead levels in lead-exposed workers is highly recommended.

The concentration of lead in the blood can be used to determine:

• When a worker should be removed from lead exposure;
• When an enquiry regarding work practices and personal hygiene should be made;
• When further test(s) should be made; and,
• When a worker may be permitted to return to work.

The determination of whether a worker is fit, fit with limitations or unfit for exposure to lead should only be made by a physician. In addition, a physician should determine the required frequency for biological monitoring on an individual basis.

If symptoms or signs of lead intoxication are present the worker should be removed from lead exposure regardless of blood lead level.

In addition, it is recommended that a pre-placement blood-lead test be taken to establish a baseline for each worker that is exposed to lead.

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