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Registered medical practitioners (RMP) undertaking health monitoring are required to have an understanding of the potential adverse health effects of inorganic lead and to use their clinical knowledge to advise on health monitoring for workers in the workplace.
Occupational exposure to inorganic lead occurs in a wide range of industrial, manufacturing, construction and mining activities which produce lead dust or fumes.
Lead is present in significant quantities as a contaminant in the processing and smelting of mineral ores and hence in mining wastes. Lead is used as an additive in fire assay laboratories and gold processing. Inorganic lead itself is mined as lead sulphide (galena) or lead carbonate resulting in exposures from mining, processing, transportation and storage.
Lead was historically used in fuel and paint, resulting in environmental contamination of soil. It is present in solder, metal alloys, radiators, old paintwork, detonators, explosives, bullets, batteries and lead shielding from radiation.
Lead-risk industries include lead soldering, radiator repair, lead alloys, fire assay laboratories, foundries (melting, casting, machining), lead battery manufacture or its breaking and dismantling, the welding, cutting or cleaning surfaces coated with lead or paint containing more than 1% lead, and its removal by abrasive blasting and high pressure water jet or machining.
Non-occupational exposure can be significant from activities such as melting lead sinkers (fishing), home renovations, lead paint removal, lead-lighting hobbies, use of cosmetics (kohl), lead glazed food containers and glassware.
Inorganic lead enters the body through inhalation and ingestion. About 10% of ingested lead is absorbed in the gut. Between 50-80% of inhaled lead is absorbed through the lungs. Lead is excreted predominantly by the kidneys (70%).
Lead is distributed in three compartments in the body:
Ninety per cent of the total body lead is stored in bone. Lead is released from bone in osteoporosis and pregnancy and fractures will also raise the level of lead in blood.
Lead inhibits enzymes (including ALA dehydratase and ferrochelatase) which are involved in the synthesis of haem, an essential component of haemoglobin in red blood cells. Lead shortens the lifespan of red blood cells. Anaemia develops when the lifespan has been reduced from 120 days to 30 days. Affected red cells are more fragile and their removal from circulation stimulates bone marrow production resulting in stippled red cells.
Lead crosses the blood-brain barrier and placenta. Lead can be transferred from the mother to the infant through breast milk.
Lead is a cumulative toxic substance.
In adults with chronic low level exposure, there may be effects on the body’s digestive, cardiovascular, renal, reproductive and neurological functions. Chronic exposure to levels above 20 µg/dL can cause subclinical effects on cognitive function and adverse effects on sperm quality. However, symptoms may be absent or mild until blood levels are significantly elevated. Mood changes, anaemia, abdominal colic and constipation may be more apparent when blood lead levels exceed 60 µg/dL.
Exposure to high levels of lead dust or fumes cause anaemia, peripheral neuropathy, and damage to kidney and brain (encephalopathy). However, severe health effects are now extremely rare in Australia.
Young children (under five years) are more vulnerable. They absorb 3 times more lead than adults from ingestion. They are more prone to encephalopathy at a lower blood lead level as their brains are rapidly developing. Blood lead levels greater than 10 µg/dL may potentially be harmful with reports of impact on IQ, and behavioural disturbance. Ingested lead is absorbed at a higher rate in children. Hence, personal hygiene of the worker is vital to avoid contamination of the home environment.
|Blood lead level (µg/dL)||Signs and/or symptoms may include:|
|10-20||Increased blood pressure, abnormal renal function|
|20-40||Reduced renal function, reduced nerve conduction and abnormal postural balance|
|60||Neurobehavioural affects - tiredness, moodiness, headache and vague aches|
|70-90||Encephalopathy in children (headache, vomiting, ataxia, seizures, paralysis, stupor, coma)|
|100||Abdominal colic, peripheral nerve palsies, muscle wasting and encephalopathy|
|150||Encephalopathy in adults|
Non-occupational exposure levels
The average background blood lead level among Australians is less than 5 µg/dL (NHMRC, 2015; NHMRC, 2016). Levels above 5 µg/dL are considered to be consistent with exposure above the background level e.g. from work activities, hobbies or home renovations.
Baseline health monitoring is required prior to commencement of lead risk work, then at one month after the worker commences work. Thereafter, the frequency of testing is determined by the blood lead levels as outlined in the tables below.
Important considerations in the assessment of risk and the potential for elevated blood lead levels are:
Monitoring blood lead levels enables early intervention by the medical practitioner. Early intervention includes:
Workplaces should provide amenities for hot water for hand washing and showering. Personal hygiene must be strictly monitored (washing face and hands before eating; no smoking, eating or drinking in lead work area; laundry provisions, showering and changing into clean clothes before leaving work). It is essential that workers do not bring lead dust home from work.
The removal level of females of reproductive capacity is 10 µg/dL.
The removal level for males and females (not of reproductive capacity) is 30 µg/dL.
Pregnant and breast-feeding women should be removed from lead-risk work.
|Blood Lead Level (BLL)||Actions|
|Less than 10 µg/dL||Re-test six monthly.|
|10 to below 20 µg/dL||
|20 to below 30 µg/dL||
|30 µg/dL or greater||
|Blood lead level||Actions|
|Less than 5 µg/dL||
|5 to below 10 µg/dL||
|10 µg/dL or greater||
The registered medical practitioner has an important role in educating and reinforcing good personal hygiene and safe work practices through the following:
The registered medical practitioner removes the worker from lead-risk work when the removal threshold is exceeded or when the blood lead level is close to approaching the removal threshold.
The registered medical practitioner arranges the removal of the worker from lead work immediately by notifying the regulator, PCBU and worker, and arranges a medical examination of the employee within seven days of the removal.
The frequency of blood lead level testing is at the discretion of the registered medical practitioner. The worker must not return to lead work until:
The registered medical practitioner:
For mining operations The employer submits the biological monitoring results to Mines Safety via SRS.
The registered medical practitioner (RMP) has a duty to notify health monitoring results to the regulator. The RMP forwards the completed Health Monitoring Notification Form- Lead along with the pathology laboratory report, to email@example.com.