Lead Poisoning Prevention Guidance for Health Care Providers

This information is for health care professionals. The Healthy Homes Lead Poisoning Prevention Program works with you to ensure that all 1- and 2-year-old children are tested for lead. Vermont law requires that all children are tested for lead at 12 months and 24 months. As of September 1, 2020, health care professionals must provide a copy of What Your Child’s Lead Test Means to all parents or caregivers of children being tested for lead, regardless of the test results.

Vermont has lowered its definition of an elevated blood lead result from 5 µg/dL to any reported level. Research highlights that there is no safe level of lead and levels at and below 5 µg/dL still impair development. Therefore, any level of lead in the blood is considered elevated.

Reporting Requirements

All blood lead results on Vermont residents are required by state law to be reported to the Vermont Department of Health. Most analytical laboratories report directly to the Health Department.

If you have a LeadCare II analyzer, you are required by state law to report all blood lead results on Vermont residents to the Health Department. Please call the Healthy Homes Lead Poisoning Prevention Program at 802-863-7220 or 800-439-8550 (toll-free in Vermont) for more information and procedures on how to report results.

Tips to improve testing rates at your practice

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 the Healthy Homes Program 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).

Criteria for Testing Asymptomatic Children

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

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 within three to six months, regardless of initial test result.
Other at-risk populations: International adoptees, immigrants, children of migrant workers, children in foster care, and children diagnosed with pica or special health needs that increase hand-to-mouth behavior.

Review the Pediatric Blood Lead Testing and Case Management Guidelines

When to test if a child of any age has symptoms

Blood lead testing should be considered part of a diagnostic work-up of any child, regardless of age, with any of the following:

Ingestion of an object that may contain lead
Signs or symptoms consistent with lead poisoning
Living in an older home undergoing renovations
Living 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)

How to collect and analyze capillary samples

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.

When to confirm with a venous test

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 on the table below.

If Capillary Blood Lead Level is:	Confirm with Venous Test Within:	The health department will:
No detected lead (DL)	Confirmation not needed
Any DL – 3.4 µg/dL	Within 6 months (capillary sample or venous)	Send a letter to the family recommending another blood lead test within 6 months
3.5 – 9 µg/dL	Within 3 months	Send a letter to the family recommending a venous blood test within 3 months
10 – 19 µg/dL	Within 1 month	Send a letter to the family recommending a venous blood test within 2 weeks to 1 month
20 – 44 µg/dL	Within 2 weeks	Send a letter to the family recommending a venous blood test within 2 weeks
45 – 59 µg/dL	48 hours	Call the family recommending a venous test as soon as possible
60+ µg/dL	Immediately as an emergency test	Call the family recommending an immediate venous test

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.

When to follow up with a venous retest

If venous blood level is:	Do a follow-up venous test within:	Late follow-up within (when blood lead level is declining):
Not detected (Detection limit varies across laboratories from <1 μg/dL to 3.3 μg/dL.)	Venous retest is not required
Any detected lead - 3.4 µg/dL	6 - 9 months
3.5 - 9 µg/dL	3 months	6 - 9 months
10 - 19 µg/dL	1 - 3 months	3 - 6 months
45+ µg/dL	Initiate chelation and retest in 7 - 21 days	As clinically indicated

When to test pregnant or breastfeeding people and adults

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

Resources and Patient Information

Accessing results through Patient Profile

Note: You will see changes to the Registry login process over the next few weeks, including a transition to new login credentials. Be sure to check your email regularly and visit this page for updates.

New Users: Please sign the Provider Confidentiality Agreement and fax to 802-863-7483 or email to [email protected].

Patient Profile, commonly called the Immunization Registry, is an application that is a confidential, web-based system that provides a way to collect and share data related to immunizations as well as results for 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 the ages of 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