Evaluation of the effectiveness of following up laboratory reports of elevated blood leads in adults

The usefulness of a statewide laboratory-based blood lead surveillance syst em to initiate workplace enforcement inspections was studied. In particular , the effectiveness of inspection of companies in which at least one worker had a blood lead level (BLL) 30-39 mug/dL but no greater than 39 mug/dL wa s considered. The surveillance system identified all individuals who had be en tested for blood lead. Adults with BLLs greater than or equal to 30 mug/ dL were interviewed. Companies where lead exposures occurred were identifie d and enforcement inspections performed there. Companies were grouped into four categories: one or more employees with BLL greater than or equal to 50 mug/dL; one or more employees with highest BLL of 40-49 mug/dL; one or mor e employees with highest BLL of 30-39 mug/dL; and companies that used lead but from which no blood lead reports were received. The number of citations and amounts of penalties, and BLLs before and after, were compared among t he three blood lead groups and with a control group of no lead-using compan ies. A cost-benefit analysis was performed. Citations and penalties did not differ among the three blood lead groups but were markedly increased compa red with the lead using but no blood lead group. Violations of specific lea d standard components were similar among the three blood lead groups. Blood lead companies had increased citations and penalties as compared with nonu sing lead control companies. No significant decrease in blood leads was see n postinspection. Total cost to identify lead-exposed workers at problem wo rk sites was $125 ($53-$459) per lead-exposed worker. Followup of companies identified through the surveillance system was an effective method to targ et workplace inspections. It is recommended that routine inspection be inst ituted for all companies in which an employee is reported to have a blood l ead of 30 mug/dL or greater.