Comparison of home lead dust reduction techniques on hard surfaces: the New Jersey assessment of cleaning techniques trial.

High efficiency particulate air filter (HEPA) vacuums, which collect particles > 0.3 micro m, and trisodium phosphate (TSP), a detergent claimed to selectively remove lead, have been included in the HUD Guidelines for the Evaluation and Control of Lead Based Paint Hazards in Housing without systematic validation of their effectiveness. At the time the study was initiated, both HEPA vacuums and TSP were relatively expensive, they were not readily found in urban retail centers, and there were environmental concerns about the use and disposal of high-phosphate detergents. A randomized, controlled trial was conducted in urban high-risk homes in northern New Jersey to determine whether a more readily available and less expensive low-phosphate, non-TSP detergent and non-HEPA vacuum could perform as well as TSP and a HEPA vacuum in a cleaning protocol. Homes were randomized to one of three cleaning methods: TSP/HEPA vacuum, TSP/non-HEPA vacuum, or non-TSP/non-HEPA vacuum. Change in log-transformed lead loading was used in mixed models to compare the efficacy of the three cleaning techniques separately for uncarpeted floors, window sills, and window troughs. After we adjusted for baseline lead loading, the non-HEPA vacuum produced larger reductions on hard floors [19%; 95% confidence interval (CI), 3-38%], but the HEPA vacuum produced larger reductions on window sills (22%; 95% CI, 11-32%) and larger reductions on window troughs (16%; 95% CI, -4 to 33%). The non-TSP produced larger reductions on window troughs (21%; 95% CI, -2 to 50%), but TSP produced larger reductions on hard floors (5%; 95% CI, -12 to 19%) and window sills (8%; 95% CI, -5 to 20%). TSP/HEPA produced larger reductions on window sills (28%; 95% CI, 18-37%) and larger reductions on window troughs (2%; 95% CI, -24 to 23%), whereas the non-TSP/non-HEPA method produced larger reductions on hard floors (13%; 95% CI, -5 to 34%). Because neither vacuum nor detergent produced consistent results across surface types, the use of low-phosphate detergents and non-HEPA vacuums in a temporary control measure is supported.

RCT Entities:   Population Interventions Outcomes