Epidemiologic Notes and Reports Lead Poisoning Among Sandblasting Workers -- Galveston, Texas, March 1994

In the United States, an estimated 95% of elevated blood lead levels (BLLs) in adults are attributable to occupational exposure (1). This report summarizes the findings of an investigation by the Galveston County (Texas) Health District (GCHD) of occupational lead poisoning associated with sandblasting during February-March 1994.

On April 26, 1994, GCHD was notified by an emergency department physician of a 32-year-old man with a BLL of 111 ug/dL. On April 8, the patient had presented to the emergency department with onset of symptoms on March 15 including abdominal pain, vomiting, weight loss, constipation, headache, memory loss, tinnitus, metallic taste in mouth, stuttering, arthralgias, and discoloration of the gums. Acute lead poisoning was suspected, and a blood sample was obtained. The patient reported that, during February 15-March 30, he and seven other workers had sandblasted interior surfaces of a 100-year-old, five-story building in Galveston and that large quantities of dust had been created during the sandblasting process.

Follow-up investigation by GCHD revealed that when one of the other workers -- a 39-year-old man -- had developed similar symptoms and was hospitalized on March 28, his BLL was 245 ug/dL. Although this elevated result was recorded in his chart, lead poisoning was not diagnosed or treated, and his blood lead results were not reported to the Texas Department of Health (TDH) as required by Texas law. * The other six workers were located and evaluated during late April and early May. One of these workers (a 39-year-old man) had worked at the site for only 1 week; his BLL was 15 ug/dL. BLLs for the other five workers (age range: 34-43 years) ranged from 47 to 92 ug/dL. ** Only one worker (BLL of 83 ug/dL) reported a previous occupational history with potential for lead exposure; he had worked as a boilermaker for 17 years. All eight workers were referred for further evaluation and treatment.

Lead content in paint and sandblasting residue collected from the worksite on May 4 was 1900 ug/g and 25,000 ug/g, respectively; content in dust obtained from wipe samples of the floor and the interior surface of a window pane was 75,000 and 145,000 ug/ft2, respectively. ***

GCHD notified TDH and the Occupational Safety and Health Administration (OSHA) about these exposures. OSHA subsequently issued citations for violation of regulations at the worksite and levied fines on both the contractor and the building owner. In particular, employer-initiated monitoring of the worksite for airborne lead had not been conducted as required by law (3). Instead, workers had been instructed by the employer to keep the windows closed and had not been provided with adequate training; respirators or other protective equipment; or proper facilities for washing, changing clothes, and eating. The employer denied responsibility for the workplace hazards and refused to provide any medical or disability benefits for the exposed workers. The Texas Workers' Compensation Commission also conducted an investigation that culminated in the disbursement of benefits to the workers. Reported by: C Chambers, MPH, R Morris, MD, Galveston County Health District, Galveston; D Salzman, MPH, T Willis, P Schnitzer, PhD, J Brender, PhD, DM Perrotta, PhD, Environmental Epidemiologist, Bureau of Epidemiology, Texas Dept of Health. Div of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, CDC.

Editorial Note

Editorial Note: The incident described in this report underscores the continuing risks for adult lead poisoning in the United States, particularly among workers in construction trades (4). In addition, the findings of the GCHD investigation indicate the need for increased education of employers, employees, and health-care providers regarding lead exposure and poisoning. In this incident, the employer was unaware of, or disregarded, the hazard associated with sandblasting older buildings that are likely to have surfaces coated with lead-containing paint; the employees also may not have recognized the immediate potential for workplace-related lead exposure. Finally, although this problem was eventually recognized by a health-care provider who then notified local health authorities, the opportunity for earlier intervention was missed because of delays in identification of lead toxicity and reporting of elevated BLLs.

One of the national health objectives for the year 2000 is to eliminate occupational exposures that result in BLLs greater than 25 ug/dL (objective 10.8) (5). The prevention of occupational lead poisoning requires increased awareness by both employers and employees of the sources of lead exposure in the workplace and the methods for reducing worker exposure and requires an increased level of suspicion and compliance with reporting requirements by health-care providers.

References

1. CDC. Elevated blood lead levels in adults -- United States, second quarter, 1992. MMWR 1992; 41:715-6.

2. U.S. Environmental Protection Agency. Guidance on residential lead-based paint, lead- contaminated dust, and lead-contaminated soil. {Memorandum from Lynn Goldman, Assistant Administrator}. Washington, DC: US Environmental Protection Agency, Office of Prevention, Pesticides, and Toxic Substances, July 14, 1994.

3. Occupational Safety and Health Administration, US Department of Labor. Lead exposure in construction: interim final rule. Federal Register 1993;58:26590-649. (29 CFR 1926).

4. CDC. Lead poisoning in bridge demolition workers -- Georgia, 1992. MMWR 1993;42:389-90.

5. Public Health Service. Healthy people 2000: national health promotion and disease prevention objectives -- full report, with commentary. Washington, DC: US Department of Health and Human Services, 1991; DHHS publication no. (PHS)91-50212.

* Texas Health and Safety Code, chapter 84, section 99.1, 1985, mandates that BLLs greater than or equal to 40 ug/dL in adults be reported to TDH. 

** These workers were not tested until 5-6 weeks after their exposure ended. 

*** For comparison, U.S. Environmental Protection Agency-recommended acceptable levels after residential lead abatement are 100 ug/ft2 for uncarpeted floors and 500 ug/ft2 for window sills (2). The extremely high levels measured in these wipe samples represent an occupational hazard and also pose a potential environmental exposure hazard.

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