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California Code of Regulations (Last Updated: August 6, 2014) |
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Title 8. Industrial Relations |
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Division 1. Department of Industrial Relations |
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Chapter 4. Division of Industrial Safety |
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Subchapter 7. General Industry Safety Orders |
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Group 16. Control of Hazardous Substances |
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Article 109. Hazardous Substances and Processes |
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Appendix C. |
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Medical Surveillance Guidelines Introduction The occupational health standard for lead was promulgated to protect workers exposed to lead which, as defined by the standard, includes metallic lead, all inorganic lead compounds and organic lead soaps but excludes all other organic lead compounds. The term “inorganic lead” used throughout this appendix is meant to be synonymous with the definition of lead set forth in the standard. Under this final standard in effect as of September 8, 1979, occupational exposure to inorganic lead is to be limited to 50μg/m3 (micrograms per cubic meter) based on an 8-hour time-weighted average (TWA). This level of exposure must be achieved through a combination of engineering, work practice, and administrative controls (in periods of time ranging from 1 to 10 years) in primary lead smelting, secondary lead smelting, electronics, gray iron foundries, ink manufacture, paints and coatings manufacture, can manufacture, and printing. In these industries, respirators may be used to meet the 50μg/m3 exposure limit pending the implementation of the prescribed controls. For all other industries, there is no prescribed period during which compliance with the PEL must be achieved by controls other than respiratory protection. The standard also provides for a program of biological monitoring and medical surveillance for all employees exposed to levels of inorganic lead above the action level of 30μg/m3 (TWA) for more than 30 days per year. The purpose of this document is to outline the medical surveillance provisions of the standard for inorganic lead and to provide further information to the physician regarding the examination and evaluation of workers exposed to inorganic lead. Section I provides a detailed description of the monitoring procedure including the required frequency of blood testing for exposed workers, provisions for medical removal protection (MRP), and notification and recordkeeping requirements of the employer. Discussions of respirator use, respirator monitoring, and chelation therapy are also included. Section II discusses the toxic effects and clinical manifestations of lead poisoning and effects of lead intoxication on enzymatic pathways in heme synthesis. The adverse effects on both male and female reproductive capacity and on the fetus are also discussed. Section III outlines the recommended medical evaluation of the worker exposed to inorganic lead including details of the medical history, physical examination, and recommended laboratory tests, which are based on the toxic effects of lead as discussed in Section II. Section IV provides detailed information concerning the laboratory tests available for the monitoring of exposed workers. Also discussed are the relative value of each test and the limitations and precautions which are necessary in the interpretation of laboratory results. I. Medical surveillance and monitoring requirements for workers exposed to inorganic lead. Under the occupational health standard for inorganic lead, a program of biological monitoring and medical surveillance is to be made available to all employees exposed to lead above the action level of 30μg/m3 TWA for more than 30 days each year. This program consists of periodic blood sampling and medical evaluation to be performed on a schedule which is defined by previous laboratory results, worker complaints or concerns, and the clinical assessment of the examining physician. Under this program, the blood lead level of all employees who are exposed to lead above the action level of 30μg/m3 is to be determined at least every six months. The frequency is increased to every two months for employees whose last blood lead level was between 40μg/100g whole blood and the level requiring employee medical removal to be discussed below. For employees who are removed from exposure to lead due to an elevated blood lead, a new blood lead level must be measured monthly. A zinc protoporphyrin (ZPP) measurement is required on each occasion that a blood lead level measurement is made. An annual medical examination and consultation performed under the guidelines discussed in Section III is to be made available to each employee for whom a blood test conducted at any time during the preceding 12 months indicated a blood lead level at or above 40μg/100 g. Also, an examination is to be given to all employees prior to their assignment to an area in which airborne lead concentrations reach or exceed the action level. In addition, a medical examination must be provided as soon as possible after notification by an employee that the employee has developed signs or symptoms commonly associated with lead intoxication, that the employee desires medical advice regarding lead exposure and the ability to procreate a healthy child, or that the employee has demonstrated difficulty in breathing during a respirator fitting test or during respirator use. An examination is also to be made available to each employee removed from exposure to lead due to a risk of sustaining material impairment to health, or otherwise limited or specially protected pursuant to medical recommendations. Results of biological monitoring or the recommendations of an examining physician may necessitate removal of an employee from further lead exposure pursuant to the standard's medical removal protection (MRP) program. The objective of the MRP program is to provide temporary medical removal to workers either with substantially elevated blood lead levels or otherwise at risk of sustaining material health impairment from continued substantial exposure to lead. The guidelines which are summarized in the following table were created under the standard for the temporary removal of an exposed employee and his or her subsequent return to work in an exposure area.
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