Physician's Handbook on Childhood Lead Poisoning Prevention

Chapter Nine

Environmental Management

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Summary

  • Those counties with full service health departments perform environmental investigations of children with CONFIRMED blood lead levels equal to or greater than 20 μg/dL. For counties without full service health departments, the investigations are performed by the State Department of Health. The New York City Health Department conducts investigations within New York City.
  • Investigations normally involve observation of the dwelling unit, interview of the occupants and testing of suspect sources of exposure and education about temporary measures to minimize exposure. When a hazard is identified, the dwelling owner is required to remove or abate the hazard within a specified period of time. Both, the parent/guardian and dwelling owner receive investigation results and are advised to temporarily relocate children or the family if abatement of the hazard may result in increased lead exposure.
  • State or local environmental health staff monitor and verify that hazard abatement is performed. If a hazard remains uncorrected, the case is referred for an enforcement proceeding.

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The Environmental Investigation

Environmental health staff from county health departments or State Department of Health district offices conduct environmental investigations when a child with a confirmed blood lead level of 20 μg/dL or greater is identified. The environmental investigation includes:

  • when necessary, taking emergency measures to reduce lead exposure;
  • investigating the dwelling and other areas of regular occupancy, conducting field measurements of lead in paint and collecting environmental samples as appropriate;
  • analyzing samples and providing results to the owner and the occupants;
  • serving notice of a lead hazard when one exists and outlining a schedule of corrective actions;
  • notifying the person responsible for the child's medical management of the findings;
  • educating parents/guardians about the sources, effect and prevention of lead poisoning;
  • notifying public health nurses, medical providers, social service and housing authorities, as appropriate; and
  • evaluating the effectiveness of the interventions.

The State Department of Health has adopted the CDC timeframes for conducting environmental investigations and interventions:

Blood Lead Levels equal to or greater than 70 μg/dL. Environmental investigation and intervention must be started within 24-48 hours and should include the child's home and potential sites of exposure, such as a relative's home or a daycare center. The homes or other potential sites of exposure of these children must be remediated before they are allowed to return. When a child is hospitalized, the child must not be discharged into a leaded environment. Alternative housing should be provided as part of case management. The local health unit, in conjunction with the pediatric providers, are responsible for the child's discharge to a lead safe home with temporary relocation as needed.

Blood Lead Levels Between 45 and 69 μg/dL. Environmental investigation and intervention should begin within five working days and should include the same components as for children with higher blood lead levels. When a child is hospitalized, the child must not be discharged into a leaded environment. Alternative housing should be provided as part of case management.

Blood Lead Levels Between 20 and 44 μg/dL. Environmental investigation and intervention should begin within ten working days. Since many of these children will not be hospitalized and since allowing exposures to continue might result in further increases in blood lead levels, environmental interventions for these children should be conducted as quickly as possible. Children should not be present when environmental interventions are being performed. Therefore, temporary relocation of the child and family to a lead safe dwelling may be needed.

Blood Lead Levels Between 15 and 19 μg/dL. Environmental investigation and intervention for children at this level should be based upon local resources. Local health units must prioritize their investigations to evaluate the homes of children with higher levels first. If a lead hazard is found, the owner of the dwelling will be required to correct the hazard within 30 days. The local health unit will work with the owner to ensure appropriate corrective action is taken. If a lead hazard is found, the owner of the dwelling will be required to correct the hazard within a designated timeframe. The local health unit will work with the owner to ensure appropriate corrective action is taken.

Emergency Measures to Reduce Lead Exposure

When the source of lead is paint and paint-contaminated dust, parents/guardians can be instructed to temporarily mitigate a paint related hazard with these recommendations: limiting a child's access to lead; moving furniture to cover the lead hazard; using duct tape to cover hazardous areas; ensuring the paint is in a condition where it will not peel, chip or flake; wet mopping all floors and wet cleaning window sills and window wells at least daily. Cleaners high in phosphates appear to bind and remove lead more effectively than low phosphate detergents. However, most cleaning products in New York State contain no more than trace amounts of phosphorus, except those for dishwashers, food and beverage processing equipment and dairy equipment. Therefore, parents should be instructed to thoroughly clean surfaces, such as floors, window wells and window sills with a solution containing a heavy duty household cleaner.

Children's hands should be washed regularly, particularly before eating. Toys and pacifiers that are mouthed should be washed at least daily. Cribs and playpens should be moved away from chipping and peeling paint; barriers can be placed in front of areas where there is chipping; duct tape can be used on window sills with peeling or deteriorated paint, to make them less accessible. Dry sweeping of dust should be avoided, because it will stir up and spread the dust; wet mist the area first, then sweep.

Parents/guardians should be advised not to attempt abatement themselves. Improper abatement will most likely increase dust lead levels in the home and create additional, more severe exposure for the child. Children and pregnant women should not be in house when abatement takes place.

Before selecting a method see Containment and Safe Work Practices.


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Analysis of Abatement Methods

Encapsulation

Encapsulation refers to the coating and sealing of surfaces with durable coating formulated to be elastic, long-lasting and resistant to cracking, peeling, algae and fungus so as to prevent deteriorating lead-based paint from becoming part of the house dust or accessible to children.

ADVANTAGES
  • Application is quick and easy.
  • Abatement contractors require little training on safe application.
  • Minimal hazardous waste is generated.
  • A limited amount of capital equipment is required.
  • Worker protection requirements are minimal (respirators required during surface preparation).
  • Can be carried out both on interior and exterior surfaces of the dwelling.
  • No additional finish work is required.
  • Can be applied to almost any material with proper surface preparation.
  • A wide variety of products are currently available on the market.
  • When surfaces are properly prepared, generates the lowest levels of airborne dust lead during abatement.
  • Least expensive of all methods of lead-based paint abatement for most surfaces.
DISADVANTAGES
  • Cannot be used on friction surfaces (eg., window tracks, door jambs).
  • Does not permanently remove the lead, only covers the hazard.
  • Cannot be applied during adverse weather conditions.
  • Long-term effectiveness is unknown.
  • Bonding to lead-based paint surface is sometimes poor.
  • Further product testing is required.
  • Quality of products varies, especially with respect to long-term durability.

Replacement

Replacement entails removing structural substrates such as windows, doors and trim that have lead painted surfaces and installing new or de-leaded substrates free of lead hazards.

ADVANTAGES
  • A new, clean substrate results.
  • Completely abates the lead hazard.
  • Can be used on almost all substrates.
  • Generally improves the quality of a unit.
  • Does not create significant hazardous waste.
  • Most promising of the removal methods.
  • Relatively little airborne dust lead is generated.
DISADVANTAGES
  • Should not be used where architectural significance will be altered.
  • Requires skilled workers.
  • More costly than encapsulation for all substrates except for doors.

Enclosure

Enclosure is the resurfacing or covering of surfaces. It also includes sealing or caulking with durable materials mechanically affixed so as to prevent or control chalking or flaking of lead-based paint from becoming part of house dust or accessible to children.

ADVANTAGES
  • When installed properly, this method is a very effective alternative to removing the lead-based paint.
  • May enhance overall appearance of the housing unit.
  • Generates very little hazardous waste.
  • Materials are readily available.
  • Does not create large amounts of dust lead during abatement.
  • Provides additional thermal insulation on exterior surfaces.
  • Works well on large, flat surfaces such as ceilings and walls.
  • Worker protection requirements are minimal.
  • Is uniformly more expensive than encapsulation, may be more durable than encapsulation.
DISADVANTAGES
  • Can only be used on large, flat substrates.
  • Lead is not removed.
  • Requires basic carpentry skills. Sealing is critical and must be carefully examined.
  • May be difficult to install in older units or over masonry surfaces.
  • There is a potential for buckling and bowing if not properly installed.
  • Can be difficult to install in some instances due to surface irregularities and poor existing substrate integrity.

Removal

Chemical removal entails removal of lead based paint using chemical paint strippers.

ADVANTAGES
  • Effective on a wide variety of substrate types.
  • Lead is removed permanently.
  • Application is not difficult and training is moderate.
  • Various products are readily available.
  • Leaves the substrate visually clean when used properly.
  • Only feasible removal method for exterior walls.
DISADVANTAGES
  • Labor intensive and requires time for compounds to react.
  • Very messy. Care must be taken to contain the caustic stripper.
  • Worker protection is especially important.
  • Waste generated is considered hazardous.
  • Large potential for damage to surrounding substrates.
  • If not used properly, may require several applications to be completely effective.
  • Can damage substrate if not used properly by experienced personnel.
  • Highest failure rates on initial sample clearance tests.
  • Clean-up is extensive.
  • Requires a moderate range of temperature.
  • Creates significant amounts of lead dust with respect to most other lead abatement methods.
  • Cost is consistently higher than the costs of removing lead based paint by hand-scraping or replacement methods.

Hand-scraping, with or without the use of a heat gun includes the preparation of walls and other surfaces, such as window sills, door jambs and radiators for painting and staining or wallpapering. The best tool for this work is a scraper attached to a HEPA vacuum, which efficiently removes small dust particles generated during scraping. Also, continuously misting the surface to be sanded with water minimizes dust generation. This procedure may be best accomplished by two people, one misting, the other scraping.

Hand-scraping generates more airborne lead dust than any other abatement method. A heat gun may reduce dust generation but it can release lead fumes which can be inhaled. Respiratory protection is recommended whenever scraping is used.

ADVANTAGES
  • Experienced workers can be quick and effective.
  • Can be used on a variety of surfaces.
  • Lead-based paint is removed permanently.
  • Extensive training is not required.
  • Equipment is inexpensive and readily available.
  • Less expensive than replacing windows when only interior or exterior surfaces of the windows require abatement.
DISADVANTAGES
  • Very labor-intensive for those with little or no experience.
  • Creates large amounts of airborne lead dust, more than any other abatement method, and requires strict worker protection in almost all cases.
  • Paint residue is considered hazardous.
  • Should not be used on masonry surfaces or on cold metal surfaces.
  • Care must be taken to prevent overheating of the substrate that could cause a fire.
  • More expensive than replacement for most substrates except windows and about the same cost for replacement of baseboards, window sills and exterior door frames.

Containment and Safe Work Practices

Any method of removing lead paint creates poisonous dust and debris. Using a heat gun will also create lead fumes. It is important to remember that lead fumes and dust can be inhaled and readily absorbed from the lungs. The steps listed in this section are intended to keep lead dust, fumes and debris from spreading outside of the work area during lead abatement or renovations. These steps will also make clean-up of the work area much easier. A safe, complete job cannot be done without containing all lead within the work area.

Containment Steps
Before beginning to remove lead paint:
  • Remove all furniture and moveable items from the work area.
  • Clean and cover all permanent items, such as, radiators and refrigerators with plastic sheets. Seal the sheets with heavy duty tape.
  • Remove all carpeting from the work area. Carpeting which already has lead dust in it should be cleaned or replaced with new carpet after the project has been completed.
  • Cover all floors and other exposed surfaces with plastic sheets. Fasten all edges of the sheets securely.
  • If the work area is one room or a group of rooms, seal off the work area from the nonwork area with plastic. Cover all openings, including doors and air ducts for the heating and cooling systems.
While work is in progress:
  • Cover shoes with disposable booties every time before entering the work area; take the booties off when leaving the work area.
  • Wear disposable coveralls while on the job site to keep lead dust from collecting on regular clothes. Remove the coveralls when leaving the job site at the end of the work day and shower before returning home. Do not take lead dust home on work clothes.
  • Carefully inspect plastic sheets for tears every day before beginning work. Repair or recover areas as soon as a tear is noticed.

Clean-up

A careful and complete cleaning of the work area is necessary. Lead dust that remains on surfaces can get onto children's toys and hands. The following general steps should be followed to clean-up thoroughly after every abatement project:

  1. Wear plastic gloves to protect hands from strong detergents.
  2. Use a spray bottle to wet down all dust and debris with a fine mist of water. This will help control the dust during clean-up.
  3. Place large disposable items in heavy duty plastic bags (single 6 mil bags or double 4 mil) and tie the bags shut.
  4. Wrap all debris in plastic sheets used during the abatement. Place these sheets in plastic bags and tie them shut.
  5. HEPA vacuum all surfaces in the work area including woodwork, walls, windows, window wells and floors. Start at the ceiling and work down, cleaning the floors last.
  6. Wash all surfaces in the work area with strong commercial detergent solution (cleaners high in phosphates work particularly well), including the ceiling and areas that had been covered with plastic. Start with the ceiling and work down to the floors. Mix up a new detergent solution frequently so it remains relatively clean.
  7. After all surfaces have dried, HEPA vacuum a second time until no dust or residue can be seen.
  8. Discard all items used for cleaning (towels, sponges, rags, mopheads) in plastic bags.
  9. At this time, before repainting, contact the local health department to arrange for an inspection, if required.
  10. After repainting, clean the area again following steps 5, 6, 7 and 8 above.

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Bibliography

U.S. Department of Housing and Urban Development (HUD), 1991. The HUD Lead-Based Paint Abatement Demonstration (FHA). Prepared by Dewberry & Davis. Maryland Department of the Environment, June 1990. Lead Paint Hazard Fact Sheet 5: Containment of Lead Bearing Dust and Debris.

Maryland Department of the Environment, June 1990. Lead Paint Hazard Fact Sheet 5: Cleanup of Lead Bearing Dust.

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