Occupational Health : Lead Medicals

Exposure to lead can cause two main symptoms

• Kidney damage
• Nerve and brain damage

At Risk Professions
Professions where workers may come into contact with lead include:

• Lead battery manufacturing
• Smelting, refining, alloying, casting
• Work with metallic containing alloys
• Painting of buildings and vehicles
• Manufacturing of organic and inorganic chemicals
• Scrap industry
• Demolition
• Glass making
• Manufacture of  pigments and colours
• Shipbuilding, repairing, breaking

Medical Surveillance

The objective of a medical surveillance 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

The medical surveillance will include the following:

• Pre-employment and pre-placement medical examinations
• Periodic medical examinations
• Clinical tests
• Health education
• Record keeping

Medical Examinations

An employee should have a medical before they commence in a job where they will experience significant exposure to lead. It is recommended that the medical takes place no later than fourteen working days, after first exposure. 

 The medical examination will include the following key areas:

• History (medical and occupational)
• Physical Examination
• Biological  Monitoring
• Frequency of Surveillance

History
The initial medical and occupational history will 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 will 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 will 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

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

Frequency of surveillance
The intervals between periodic assessments should not exceed 12 months. Where there has been significant exposure to metallic lead and its compounds, blood levels should be measured every 3 months.

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