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Lead Poisoning in Bridge Demolition Workers -- Georgia, 1992
Bridge demolition and maintenance are leading causes of lead poisoning among workers in the United States (1-5). In June 1992, a local health department in Georgia detected elevated blood lead levels (BLLs) in four demolition workers. This report summarizes the investigation of these cases.
In February 1992, a temporary-service company was subcontracted by a steel corporation to cut apart steel beams that had been removed from a local bridge. Four men were hired; one worker, aged 54 years, began work in late February; two, aged 36 and 28 years, in March; and one, aged 24 years, in early April. All four were immigrants from Mexico; only two spoke English. The work was performed outdoors, without protective equipment or training, using oxy-acetylene flame-cutting torches.
In April, all four workers reported light-headedness and shortness of breath from the metal fumes, requiring frequent fresh-air breaks during the day. In early May, all four workers developed a variety of symptoms including headache, dizziness, fatigue, sleep disturbance, confusion, forgetfulness, arthralgia, and abdominal pain. Paper masks were provided to the workers in late May by the steel company; however, because these became blocked within hours by the accumulation of dust, the workers discarded them. The severity of symptoms intensified through June, with nausea, vomiting, constipation, weakness, shortness of breath, loss of balance, and nervousness. The 36-year-old worker left employment for 3 weeks (from mid-June through early July) because of his symptoms.
As part of an annual risk-management assessment by the steel company's insurance carrier, personal air sampling was conducted April 30 for one of the four workers; this specimen measured an airborne lead concentration of 525 ug/m3, more than 10 times the Occupational Safety and Health Administration (OSHA) permissible exposure limit (PEL) of 50 ug/m3 for general industry *. In early June, the steel company suggested BLL examinations of the workers; their BLLs, measured at the local health department, were 93, 90, 59, and 66 ug/dL for the 54-, 28-, 24-, and 36-year-old men, respectively. The workers' employment was terminated in late June on receipt of the test results by the company.
In follow-up to the BLL results, in mid-June the health department investigated each worker's household, using a standard protocol of visual inspection and portable radiographic fluorescence readings of window sills, walls, and trim; no environmental sources of lead exposure were identified. BLLs were obtained from three children who resided in the homes; all had levels less than 10 ug/dL, which is below the CDC BLL of concern for children (6).
The health department recommended that the workers promptly seek medical evaluation and care; however, because they had no medical insurance and both the subcontractor and the steel company declined to assume the costs of treatment, the workers initially delayed seeking medical treatment. They subsequently contacted an attorney, who initiated worker's compensation proceedings and arranged for a local hospital to admit them for treatment. Each worker received three 5-day chelation treatments with intravenous calcium disodium ethylenediamine tetraacetic acid approximately 15 days apart. All four reported improvement but continued to experience memory deficits, arthralgias, headaches, dizziness, and/or sleep disturbances.
The health department also recommended that the workers request an OSHA inspection of the worksite. Findings from the inspection of the steel company on July 15 resulted in citations for violations of the medical removal protection and worker training provisions of OSHA's lead standard *. OSHA inspectors also investigated work conditions at the bridge from which the beams were removed; the demolition company was cited for excessive lead exposures (based on the construction industry PEL of 200 ug/m3 **), failure to provide personal protective equipment, and failure to monitor workplace conditions.
On December 14, 1992, the workers were evaluated at a university-based occupational medicine clinic. Physical examinations of three workers were normal; the 54-year-old worker was markedly depressed with evidence of neurologic abnormalities, including a strongly positive Romberg test and marked dysnomia. BLL measurements were 27, 25, 13, and 16 ug/dL for the 54-, 28-, 24-, and 36-year-old workers, respectively. No further treatment was recommended, but follow-up BLL monitoring was planned.
Reported by: H Frumkin, MD, F Gerr, MD, F Castaċeda, MD, A Leal, MD, Environmental and Occupational Medicine Program and School of Public Health, Emory Univ, Atlanta. S Brown, Chatham County Health Dept, Savannah, Georgia. LR Santiago, Savannah Area Office, Occupational Safety and Health Administration, US Department of Labor. Div of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, CDC.
Editorial Note: An estimated 90,000 bridges in the United States are coated with lead-containing paints (7). Because of maintenance and reconstruction requirements, lead exposure is a continuing occupational health hazard for construction and demolition workers. Previous cases of lead poisoning associated with similar work have been characterized by extremely high BLLs in affected workers, which developed after brief exposures and, in some instances, were unresponsive to chelation therapy.
The findings in this report are consistent with other studies that indicate that minority groups are disproportionately exposed to lead and other occupational hazards (8,9). In addition, the hazardous process described in this report (flame-cutting or burning of paint-coated steel beams) had been subcontracted to a smaller company by a larger, well-established firm. Such subcontracting is common in the construction industry but often concentrates hazards among workers with limited access to appropriate training, personal protective equipment, and other safety and health measures.
Construction workers are subject to highly variable exposures, and high worker-turnover rates in the construction workforce may pose special hazards for construction workers. Effective June 3, 1993, a new interim final OSHA standard on "Lead Exposure in Construction" extends to workers in the construction trades the basic health and safety provisions of the OSHA lead standard for general industry, such as requirements for medical monitoring and medical removal protection (10).
The response of the health department to the lead exposure in these workers was prompt and effective. However, the limitations of the interventions available and the persistence of the workers' symptoms underscore the need for primary prevention -- including portable local ventilation, personal protective equipment, personal hygiene measures, and worker training -- during bridge renovation and related demolition work.
References1.Fischbein A, Goldberg R, Haymes N, et al. Health effects of low-level lead exposure among iron workers repairing an elevated railway in New York City. Mt Sinai J Med 1978;45:698-712. 2.Landrigan PJ, Baker EL, Himmelstein JS, et al. Exposure to lead from the Mystic River Bridge: the dilemma of deleading. N Engl J Med 1982;306:673-6. 3.Pollack CA, Ibels LS. Lead intoxication in Sydney Harbor bridge workers. Aust N Z J Med 1988;18:46-52. 4.Marino PE, Franzblau A, Lilis R, Landrigan PJ. Acute lead poisoning in construction workers: the failure of current protective standards. Arch Environ Health 1989;44:140-5. 5.CDC. Lead poisoning in bridge demolition workers -- Massachusetts. MMWR 1989;38:687-8,693-4. 6.CDC. Preventing lead poisoning in young children: a statement by the Centers for Disease Control, October 1991. Atlanta: US Department of Health and Human Services, Public Health Service, 1991. 7.Katauskus T. R&D special report: DOT coats rusting bridges with layers of problems. R&D Magazine (May) 1990:42-8. 8.Robinson JC. Exposure to occupational hazards among Hispanics, blacks, and non-Hispanic whites in California. Am J Public Health 1989;79:629-30. 9.Friedman-Jimenez G. Occupational disease among minority workers: a common and preventable public health problem. American Association of Occupational Health Nurses Journal 1989;37:64-70. 10.US Department of Labor, Occupational Safety and Health Administration. Lead exposure in construction; interim final rule. Federal Register 1993;58:26590-649. (29 CFR section 1926).
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