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 system 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 microg/dL but no greater than 39 microg/dL was considered. The surveillance system identified all individuals who had been tested for blood lead. Adults with BLLs > or =30 microg/dL were interviewed. Companies where lead exposures occurred were identified and enforcement inspections performed there. Companies were grouped into four categories: one or more employees with BLL > or =50 microg/dL; one or more employees with highest BLL of 40-49 microg/dL; one or more employees with highest BLL of 30-39 microg/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 the three blood lead groups and with a control group of no lead-using companies. A cost-benefit analysis was performed. Citations and penalties did not differ among the three blood lead groups but were markedly increased compared with the lead using but no blood lead group. Violations of specific lead standard components were similar among the three blood lead groups. Blood lead companies had increased citations and penalties as compared with nonusing lead control companies. No significant decrease in blood leads was seen postinspection. Total cost to identify lead-exposed workers at problem work sites was $125 ($53-$459) per lead-exposed worker. Followup of companies identified through the surveillance system was an effective method to target workplace inspections. It is recommended that routine inspection be instituted for all companies in which an employee is reported to have a blood lead of 30 microg/dL or greater.