Salt Lake County, Utah

It is important that all children are tested for lead poisoning at their 1- and 2- year-old well-child checks. However, only 1.3% of children younger than 6 years of age were being tested for lead in Utah in 2019. Over 30% of homes in Salt Lake County were constructed before the 1978 ban on lead in residential paint. Further, the CDC updated its blood lead reference value (BLRV) from 5 μg/dL to 3.5 μg/dL in October 2021. More children younger than age 6 years are expected to have blood lead levels (BLLs) at or above this action level and will require care management for lead exposure. Healthcare providers in Salt Lake County need education about lead poisoning prevention to increase the number of children who are tested for lead poisoning.

Since October 2021, the Salt Lake County Health Department (SLCoHD) has provided education about lead poisoning prevention to physicians and staff members in seven county clinics. In collaboration with the Utah Lead Coalition, SLCoHD updated several clinical resources such as a lead exposure questionnaire, parents’ guide to lead poisoning, and lead testing and treatment guidelines to reflect CDC’s updated BLRV. In January 2022, SLCoHD provided these updated clinical resources and further information about the change in the BLRV to over 40 clinics in Salt Lake County. SLCoHD has also worked with the Utah Lead Coalition to update their website to include the most up-to-date information about lead poisoning prevention.

To increase the number of children tested for lead poisoning at their 1- and 2-year-old well-child checks, SLCoHD invited more than 40 individual clinics to participate in a lead poisoning prevention quality improvement project to serve children younger than age 6. For participating clinics, SLCoHD provided point of care machines (LeadCare II Analyzers¹), education to physicians and staff members, and help with creating and implementing policies and workflows to increase lead testing. The project also ensures that children who have a BLL ≥ 3.5 μg/dL are connected to valuable resources such as the Lead Safe Housing Program and SLCoHD Home Visiting Program.

The three clinics initiating continuous quality improvement projects in 2022 and who submitted complete follow-up data have shown a 260% increase in capillary blood tests (443 baseline vs 1,152 post-intervention) and a 405% increase in venous testing (39 baseline vs 158 post-intervention). SLCoHD has invited other clinics within the county to participate in the project and will continue to form new clinical partnerships.

According to the Utah Department of Health, approximately 3% of children ≤6 years of age have been tested for blood lead levels (BLL) in Utah. Additionally, according to Intermountain Health, only 20% of Medicaid accountable care organization patients are currently tested compared to the national average of approximately 70%.

The Salt Lake County Lead Safe Housing Program partnered with the Utah Lead Coalition, Utah Physicians for a Healthy Environment (UPHE), and a private practice pediatrician to develop a Lead Exposure Resource Guide for physicians working with families at risk for lead exposure. The Resource Guide included the following streamlined, straightforward guidance:

• A personalized letter from physician peer,
• A childhood lead risk questionnaire,
• A quick guide for lead testing and treatment,
• A parent handout for children with elevated BLLs; and,
• An informational flyer to connect at-risk families with Salt Lake County’s free lead remediation program.

UPHE helmed the project and collaborated with partners on content, design, and printing. The packet was printed and mailed to 1,169 pediatricians, pediatric sub-specialties, and general care practitioners in the Salt Lake Valley. UPHE staff members made follow-up calls and emails to ensure receipt of packets, answer any questions, and further emphasize the importance of blood lead level testing.

Routine blood lead testing and reporting has become a more common practice among physicians in Salt Lake County. Testing and reporting of blood lead levels for children under 5 years increased substantially from 2015 to 2019, with 1,500 children tested in 2015 and over 19,000 children tested in 2019. Two of the largest pediatric providers in the county began testing children routinely with similar efforts spreading to smaller family practice offices in the county. Additionally, one of the largest pediatric providers in the county, the University of Utah, partnered with the county health department on several projects to increase blood lead testing for children and provide financial incentives to some offices.