Head lice are spread most commonly by direct head-to-head (hair-to-hair) contact and much less frequently by sharing clothing or belongings onto which lice or nits may have crawled or fallen. The risk of getting infested by a louse that has fallen onto a carpet or furniture is very small. Head lice survive less than 2 days if they fall off a person and cannot feed; nits cannot hatch and usually die within a week if they are not kept at the same temperature as that found close to the human scalp.
The following are steps which can be taken to help prevent and control the spread of head lice:
Avoid head-to-head (hair-to-hair) contact during play and other activities at home, school, and elsewhere (sports activities, playground, slumber parties, camp).
Do not share clothing such as hats, scarves, coats, sports uniforms, hair ribbons, or barrettes.
Do not share combs, brushes, or towels. Disinfest combs and brushes used by an infested person by soaking them in very hot water (at least 130°F) for 5-10 minutes.
Do not lie on beds, couches, pillows, carpets, or stuffed animals that have recently been in contact with an infested person.
Machine wash clothing, bed linens, and other items that an infested person wore or used during the 2 days before treatment using the hot water (130°F) laundry cycle, and then dry the items using the high heat drying cycle.
Clothing and items that are not washable can be dry-cleaned or sealed in a plastic bag and stored for 2 weeks.
Vacuum the carpets and furniture, particularly where the infested person sat or lay.
Do not use fumigant sprays or fogs; they are not necessary to control head lice and can be toxic if inhaled or absorbed through the skin.
Check all persons in the household. Examine the scalp and hair, especially around the nape of the neck and behind the ears, for lice and nits (eggs).Nits are attached to the hair shaft about ¼” from the scalp; they may be gray/brownish in color, oval-shaped, and they are very small. They are sometimes mistaken for dandruff.
Ask your health care provider what remedy he/she recommends for treatment of head lice. Follow the directions of over-the-counter and prescription treatments carefully. Many products suggest re-treating the person after 7-10 days.
Procedure for Screening/Exclusion of Infested Students
The goal of the school nurse with respect to pediculosis is to contain transmission, provide appropriate health information for treatment and prevention, and minimize school absence.
Any student suspected of having an active case of pediculosis will be referred to the school nurse. The nurse will check the child and if lice or potentially viable nits are found, the student will be referred to the parent/guardian for appropriate care. The nurse will recommend that the parent/guardian seek professional advice concerning treatment. She or he will also educate the parent/guardian about additional measures which should be taken to help prevent the spread of lice to other members of the family and to help prevent the reinfestation of the student.
The school nurse will check any siblings of the student in the school and/or notify the school nurses of siblings in other schools. The respective school nurses will check the siblings for evidence of pediculosis.
The school nurse may take the following steps:
Notify the principal.
Notify the school nurses of siblings.
Screen the entire class for pediculosis, if deemed necessary. Depending on the severity and extent of the problem, the school nurse may consider screening a “team” or grade.
A class may be screened in the classroom or the health room using window light or artificial lighting.Any student suspected of having pediculosis should be carefully rescreened before a definitive determination is made.
Using hands or tongue blades, the nurse makes parts in the student’s hair, paying particular attention to the nape of the neck and behind the ears.Tongue blades should be discarded or hands should be washed after checking each student.
The nurse should invite the teacher to be screened when doing a class check.
The Center for Disease Control reports that “current evidence does not support the efficacy and cost-effectiveness of classroom or school-wide screening for head lice to reduce the number of lice infestations among school children.”
With this in mind, it would only be in the most extreme circumstances that extensive pediculosis screening would be done. The school nurse will consider the circumstances of each unique situation to determine the need and extent of further screening. These factors include the scope of infestation and the amount of new infestation following the initial outbreak.
Measures that may be taken in school to manage pediculosis transmission include:
Having students put their hats in the sleeves of their coats
Avoiding activities involving any exchange of clothing or headgear
Avoiding activities involving close head-to-head contact
Storing students’ outerwear in plastic bags when problems persist
Cleaning audiometer head equipment between each use during hearing screening
Depending on the extent of the infestation in a particular class, a letter may be sent home advising the parents/guardians of the pediculosis problem. The purpose of this notification would be to inform and educate. Information regarding preventative measures and treatment approaches will be shared. Parents/guardians should report any new cases of lice found on their children to the school nurse.
When a student returns to school after treatment for pediculosis, he/she must first report to the school nurse. The nurse will screen the child in the health office and determine if appropriate treatment measures were taken. Since the American Academy of Pediatrics and the National Association of School Nurses discourage the use of “no nit” policies for readmission to school, the nurse will consider several factors to make a determination about readmission including, but not limited to, the treatment used and the proximity of nits to the scalp. If conditions are found to be satisfactory, the nurse will clear the child for admission to class. Depending upon the severity and frequency of the infestation, the nurse may want to make periodic checks after a student’s readmission to ensure complete eradication of lice.