Lead Poisoning Prevention Guidance for Health Care Providers

These criteria are for testing asymptomatic children at well child visits and do not apply to children previously or currently have elevated lead levels:

• Test all children at 12 months and 24 months.
• Test all children ages 36 to 72 months who have not been previously tested.
• For refugees: test all children ages 6 months to 16 years old upon entry to the U.S. 
  • Perform a follow-up blood lead test on all refugee children ages 6 months to 6 years old within three to six months, regardless of initial test result.
• For other at-risk populations: test children who are international adoptees, immigrants, children of migrant workers, in foster care, and are diagnosed with pica or special health needs that increase hand-to-mouth behavior.

Find out how to collect and analyze capillary samples

Blood lead testing should be considered part of a diagnostic work-up of any child, regardless of age, if they:

• Ingested an object that may contain lead
• Have signs or symptoms consistent with lead poisoning
• Live in an older home undergoing renovations
• Live with someone who has a blood lead level of 5 µg/dL or greater
• Are an at-risk population (children who are international adoptees, immigrants, children of migrant workers, in foster care, and are diagnosed with pica or special health needs that increase hand-to-mouth behavior) 

Find out how to collect and analyze capillary samples

• Confirm capillary levels at or above 3.5 µg/dL with a venous test.
• Monitor capillary levels between the detection limit and 3.4 µg/dL over the next 6 months.

The higher the capillary test result, the more urgent the need for a confirmatory venous test. Please confirm as early as possible. See the guidelines in the table below.

The Health Department provides education and initiates case management for all venous confirmed lead levels.  

• For detected lead levels less than 3.5 µg/dL, we send a letter with educational materials.
• For venous lead levels 3.5 – 4.9 µg/dL, we provide education over the phone.
• For lead levels 5 µg/dL and higher, we offer an environmental inspection of the child’s home. 

*Detection limit varies across laboratories from <1 μg/dL to 3.3 μg/dL.

See the Clinical Treatment Guidelines for Venous Confirmed Blood Lead Levels for children ages 6 to 72 months.

Because evidence of lead exposure is often not apparent, it’s important to assess lead risks for pregnant and breastfeeding patients regardless of clinical signs. Use the Blood Lead Risk Assessment for Pregnant and Breastfeeding People to determine when to have them tested.

If adults are exhibiting symptoms of lead poisoning and have jobs or hobbies that increase their lead exposure risk), then consider having them tested.  

• Examples of jobs include manufacturing, construction, automotive repair, or mining
• Examples of hobbies include making stained glass, target shooting, casting bullets, making ceramics, furniture refinishing, or home renovations 

A high percentage of patients referred to a hospital lab do not follow through with a lead test. We recommend collecting and analyzing blood samples through one of these options:

• The Health Department Lab can mail free test kits to your practice with a 3- to 4-day turnaround for results. Order free blood lead testing supplies.
  • Remember to fill out the blood lead test requisition form when returning samples to the Lab.
• If you’re at a larger practice, consider a Lead Care II analyzer for point-of-care testing. These machines offer results within minutes.
• Have another clinic laboratory analyze capillary samples you collect in office.

Be sure to follow instructions for proper capillary sample collection. 

Each year, we send a report to you so that you can see how your practice’s testing rate compares to the state average. Contact us for your latest report.

We know that well child visits can be busy. Here are some tips for improving test rates at your practice:

1. Designate a lead screening champion

• Assign a staff member to run lead screening at your practice.
• Monitor and track the monthly percentage of patients overdue for lead testing to see trends and areas for improvement.

2. Use your Electronic Health Record (EHR)

• Set automatic reminders for lead testing at 12- and 24-month well child visits.
• Include alerts to follow up with patients who miss their 12- or 24-month well child visits.

3. Access and use the Patient Profile Lead Tab

• Have two designated staff members sign up for access.
• Use the Lead Tab to pull population-level reports on children who have not been tested.
• Continue to track and share monthly data.
• Run regular reports to find:
  • Patients who are coming in due for testing.
  • Patients who are overdue.
• Use reports to:
  • Offer lead testing during acute visits.
  • Reach out to patients ages 36 to 72 months who have never been tested.

4. Improve access to screening

• In-office screening: Use point-of-care (POC) testing to improve compliance.
  • Many patients referred to outside labs do not follow through with testing.
• Health Department Lab: Take advantage of free testing kits and mailing services.
  • Recommended for practices without POC testing capabilities.
• LeadCare II Analyzer: Consider purchasing a POC analyzer if you have a large practice.
  • Keep the Health Department Lab as a backup in case of recalls or downtime.
  • Make sure reporting happens regularly (weekly or bi-weekly). 

Patient Profile, commonly called the Immunization Registry, is a confidential, web-based system that collects and shares data related to immunizations, as well as results from childhood hearing, newborn metabolic, blood lead and developmental screening.

Access to the Blood Lead Program will allow you to view patient records or run reports:

• Individual Patient Record – provides a complete history of reported blood lead results for a patient
• Screening Tests Needed Report – lists patients in your practice who are due or overdue for their 12-month or 24-month lead tests, and patients between ages 36 and 72 months who have never had a lead test
• Venous Follow-Up Tests Needed – lists patients in your practice who need venous confirmation tests and those who are in case management

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If you are a new user, please sign the Provider Confidentiality Agreement and fax it to 802-863-7483 or email it to [email protected].

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