Missouri Code of State Regulations › Title 19 - DEPARTMENT OF HEALTH AND SENIOR SERVICES › Division 20 - Division of Community and Public Health › Chapter 8 - Lead Program › Section 19 CSR 20-8.030 - Lead Poisoning Assessment, Testing, Follow-Up, and Reporting

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule sets forth the criteria for
				  determining high-risk areas for lead poisoning in Missouri; describes who is to
				  perform blood lead testing, testing requirements in high-risk and non-high-risk
				  areas; type of and when to use each type of blood test; follow-up steps for
				  elevated blood lead levels; requirements for child care facility directors in
				  high-risk areas; and reporting requirements for lead poisoning case follow-up
				  activities.
(1) Definitions.
(A) Adult is any person eighteen years of age
				or older (>=18).
(B) ATSDR
				refers to the federal agency called the Agency for Toxic Substances and Disease
				Registry.
(C) Blood lead testing
				refers to the process of obtaining a blood sample, either by capillary or
				venous sample, and the analysis for lead content of the sample.
(D) Case Management refers to the
				collaborative process that assesses, plans, implements, coordinates, monitors
				and evaluates options and services to meet the health needs of an individual
				with lead poisoning to effectively reduce their lead level by using
				communication and available resources to promote quality, cost effective
				outcomes.
(E) CDC refers to the
				federal agency named the Centers for Disease Control and Prevention.
(F) Chelation is a physician-supervised
				medication treatment specifically meant to gradually remove lead from the
				body.
(G) Child (children), refers
				to a(all) child(ren) less than eighteen years of age (<18).
(H) Childhood Blood Lead Testing and
				Follow-Up Guidelines refers to the time intervals at which confirmatory venous
				blood lead testing should be performed, the time intervals at which retesting
				of children should take place and the follow-up actions that should be
				undertaken based on the results of blood lead test results.
(I) Clearance testing refers to
				post-abatement clearance procedures that must be performed following abatement
				work at an elevated blood lead level (EBL) child's residence and are found in
				the Lead Abatement Work Practice Standards
				19 CSR
				30-70.630.
(J) Confirmatory blood lead test is a test
				for blood lead levels performed by venous blood sample.
(K) Department refers to the Missouri
				Department of Health and Senior Services (DHSS).
(L) Director refers to the Director of the
				Missouri Department of Health and Senior Services.
(M) Elevated blood lead (EBL) refers to a
				venous blood lead test result as defined by the Centers for Disease Control and
				Prevention. It is the minimum level at which specific medical and public health
				actions shall be followed to reduce the blood lead level to protect the health
				of the individual and prevent further harmful effects. The term is used
				interchangeably with the terms "lead poisoning" and "level of
				concern."
(N) EBL environmental
				risk assessment refers to an on-site investigation of the residence or other
				sites where a child having elevated blood lead levels as set forth in the
				current "MDHSS Lead Manual" spends more than ten (10) hours a week, in order to
				determine the existence, nature, severity and location of lead hazards that are
				most likely the source of the elevated blood level in the child, and the report
				by the person conducting the risk assessment explaining the results of the
				investigation and options for reducing lead hazards. A trained person holding a
				valid Lead Risk Assessor License from the Missouri Bureau of Lead Licensing
				must perform an EBL environmental risk assessment.
(O) Follow-up blood lead testing refers to a
				blood lead test performed by venous sample either as confirmation of an
				elevated blood lead test result or those to be performed at intervals following
				a confirmed elevated blood lead test result. The intervals are described in the
				Childhood Blood Lead Testing and Follow-Up Guidelines and found in the current
				"MDHSS Lead Manual."
(P) Geographic
				area refers to any area that is easily identified by established or recognized
				boundaries and designated by the department for purposes of establishing
				high-risk or non-high-risk areas for lead poisoning.
(Q) Lead poisoning refers to any level of
				lead in the blood, but is most frequently used as the level at which specific
				health effects may occur, initiating specific health care and prevention steps.
				See Elevated Blood Lead.
(R) Lead
				poisoning case management refers to the collaborative process that assesses,
				plans, implements, coordinates, monitors and evaluates options and services to
				meet the health needs of an individual with lead poisoning to effectively
				reduce their lead level by using communication and available resources to
				promote quality, cost effective outcomes.
(S) Level of concern refers to the lead level
				in the blood at which specific health effects may occur and therefore specific
				health care and prevention steps should be initiated. The term is
				interchangeable with the terms "elevated blood lead (EBL)" and "lead
				poisoning."
(T) Minimum sample size
				refers to a quantity determined by a statistical formula, that incorporates
				acceptable sample error, desired confidence level and the size of the
				population universe of the population or area in question. The resulting sample
				size number, if confidence level and sampling error factor are selected
				appropriately, will provide very close results to reality in a population of
				samples, to allow confidence in a random sample selection representative of the
				real population. The formula used is:
n = (pq)/[(E/Z)2 + (pq)/N]
Definitions
Value
n = sample size
the calculated value
p = attribute %
0.12 (% children tested)
q = 1 - p
0.88
E= sampling error
0.03 (3%)
Z = numeric value of STD confidence level
1.96 (95%)
N= size of universe
Area specific
						  population
(U)
				Missouri Department of Health and Senior Services (MDHSS) current "Lead Manual"
				is incorporated by reference in this rule, and refers to a department document
				that outlines procedures and guidelines for testing of the population and
				follow-up steps when a child has been identified with an elevated blood lead
				level.
(V) Patient lead information
				questionnaire refers to a series of questions that have been selected by the
				department in collaboration with the Department of Social Services, Division of
				Medical Services to determine whether there is a high risk for lead poisoning
				and are based on knowledge of the commonly known hazards that expose persons to
				lead poisoning.
(W) Reliable data
				refers to the data for a geographic area that meets the standards necessary for
				determining accurate testing percentages which are: at least a minimum sample
				size tested annually for three (3) consecutive years and at least ninety-five
				percent (95%) of EBL and ninety percent (90%) of non-EBL with residential
				identification.
(X) Treatment
				refers to medical or health intervention procedures required in order to follow
				an identified elevated case of lead poisoning for the purposes of lowering and
				maintaining the blood lead level at or lower than the level of concern for an
				individual. The procedures and techniques may include but may not be limited
				to: case management, follow-up blood testing, medical management including
				chelation therapy, visits to the home by the nurse, education for improved
				health behavior (hygiene, improved cleaning techniques and improved nutrition),
				and social service intervention.