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Dust control is often recommended to prevent children's exposure to residential lead hazards, but the effect of these controls on children's blood lead concentrations is uncertain. We conducted a systematic review of randomized, controlled trials of low-cost, lead hazard control interventions to determine the effect of lead hazard control on children's blood lead concentration. Four trials met the inclusion criteria. We examined mean blood lead concentration and elevated blood lead concentrations (> or = 10 microg/dL, > or = 15 microg/dL, and > or = 20 microg/dL) and found no significant differences in mean change in blood lead concentration for children by random group assignment (children assigned to the intervention group compared with those assigned to the control group). We found no significant difference between the intervention and control groups in the percentage of children with blood lead > or = 10 microg/dL, 29% versus 32% [odds ratio (OR), 0.85; 95% confidence interval (CI), 0.56-1.3], but there was a significant difference in the percentage of children with blood lead > or = 15 microg/dL between the intervention and control groups, 6% versus 14% (OR, 0.40; 95% CI, 0.21-0.80) and in the percentage of children with blood lead > or = 20 microg/dL between the intervention and control groups, 2% versus 6% (OR, 0.29; 95% CI, 0.10-0.85). We conclude that although low-cost, interior lead hazard control was associated with 50% or greater reduction in the proportion of children who had blood lead concentrations exceeding 15 microg/dL and > or = 20 microg/dL, there was no substantial effect on mean blood lead concentration.

A home is intimately tied to the health and wellbeing of its residents, and Americans spend some 70% of their time at home. Evidence in a new, groundbreaking U.S. Department of Energy (DOE) report, Home R X : The Health Benefits of Home Performance, shows that home performance upgrades can improve the quality of a home's indoor environment by reducing the prevalence of harmful indoor air pollutants and contaminants. Until recently, however, no systematic review of this evidence had been conducted, limiting full understanding of the link between home performance and health.

The U.S. Department of Housing and Urban Development's (HUD's) Guidelines for the Evaluation and Control of Lead-Based Paint Hazards in Housing strongly recommend that after lead hazard control interventions all walls, ceilings, floors, and other horizontal surfaces be cleaned using a three-step process to reduce lead-contaminated dust and debris. The three steps are: an initial vacuuming using a machine equipped with a high-efficiency particulate air (HEPA) filter (HEPA vacuum), wet wash with a lead cleaner, and a final HEPA vacuum. This study evaluated the effectiveness of two cleaning protocols: (1) the HUD-recommended three-step procedure, and (2) an abbreviated two-step cleaning procedure that omits the final HEPA vacuum. Cleaning procedures were evaluated in 27 dwelling units that had undergone significant lead hazard control interventions likely to produce lead dust. Dust lead samples were collected on floors and in window sills and troughs prior to the lead control hazard intervention, after the wet wash step of the cleaning procedure, and after completion of the second HEPA vacuuming. The results of the study demonstrate that dust lead surface loading on smooth and cleanable surfaces following the three-step and two-step cleaning procedures can achieve 1995 federal guidance dust clearance levels and levels substantially lower. Although the dust lead clearance rates before and after the second HEPA vacuum were the same, the time saved by omitting the second HEPA is small relative to the other elements of the cleaning process.