Head Lice
New Lice
Procedures
For Shoreline
School District
March 5, 2012
Linda Condit, RN, BSN
Lead Nurse
Procedures for Schools are changing
all over the country
School policies for dealing with lice are outdated,
based on myths and untruths rooted in
unfounded fears of rampant outbreaks.
The CDC, American Academy of Pediatrics, King
County Health Dept, and National Association of
School Nurses support updating policies to
reflect current evidence based science.
Objectives: After this presentation,
school staff will:
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Identify facts about head lice
Describe management of possible head lice
infestation in the classroom according to newly
designed Shoreline School District procedures
Learn that our old ways of dealing with lice were
exclusionary and placed unnecessary blame
Recognize that lice are almost always present in
schools in varying numbers
Observe that science and evidence-based
information on lice supports school districts in WA to
adopt new policies
Head Lice: Historical Perspective
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Lice likely co-evolved with people; claws are well
adapted to grasping the human hair shaft. They don’t
jump or fly.
Lice are ‘host specific’ parasites. Human lice don’t
live on dogs, cats or other animals.
Lice must feed off scalp, so they die within 24-48
hours of separation from human hosts; if they have
fallen off hair, they are at the end of the life cycle.
Over use of pesticides have resulted in lice resistant
to treatments.
Being “nit-picky” relates directly to careful and
complete removal of nits--- a helpful practice
Head Lice: What are they?
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A head louse is an insect that lives on the human
scalp and feeds on blood.
Head lice hatch from a small eggs (nits) that are
attached with a cement like substance to the shaft of
individual hairs.
Eggs hatch in about 10 days. Once hatched the head
louse matures in less than 2 weeks.
Female head lice may survive for as much as a
month (most seem to perish sooner). Those more
than about 2 weeks old increasingly become geriatric
and tend to produce fewer eggs and less viable eggs.
If nits are present, head lice have already been therebut may be long gone.
Head Lice: How bad are they?
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Head lice do not transmit disease.
Most louse infestations cause little, if any, direct
harm. Annoying itching is a child’s usual complaint.
The greatest harm associated with head lice is from
the well-intentioned, but misguided over use of
neuro-toxic substances to eliminate the lice.
Traditional pediculocides and alternative
formulations or methods are frequently over-applied
and successfully kill only some of the lice and nits.
Anyone with lice/nits is just unlucky, not unclean.
Lice don’t care about heads- they just need a warm
head to live on….. Clean or in need of a shampoo.
Head Lice: How do we get them?
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The most common means of transmission is
through physical/direct (head to head) contact!!
Indirect transmission is uncommon but may occur
via shared brushes, hats, and hair accessories or
pillows and sheets that have been in contact with an
infested person.
Rarely, through shared helmets –they don’t live on
helmets or coats alone.
Surprisingly, schools are not a common source of
transmission.
Homes, camps and sleepovers are the most
common sources.
Managing Presumed Head Louse
Infestations in Schools
When lice are present it is NOT necessary to:
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exclude or quarantine a person in the health office
notify classmates parents
bring insecticide treatments to the school
environment (sprays etc)
bag clothes, toys, etc.
vacuum, boil or launder all linens
restrict use of headphones, equipment (helmets)
report to CPS in absence of other indicators
initiate classroom or school wide screening
What staff need to know in
response
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Creating unnecessary panic in the school community
is a disservice to students.
We need to educate students, families, and
ourselves based on fact and not fear.
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Head lice should not interfere with students’
opportunities to learn and achieve in the classroom.
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Research proves education does help decrease cases!
Missing school puts a child at risk for failure.
Children with live lice most likely have had them for a
month or more, so immediate exclusion is not
necessary.
Shoreline School District
Procedure
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School employees will refer students with itchy
heads or questionable lice to the school nurse or
designee (trained by the nurse).
The school nurse or designee shall examine the
student. True cases will be determined by looking
closely through the hair and scalp for viable nits or
live lice.
If live (crawling) lice are found on the hair, the
parent/guardian will be notified by the end of the day
via phone, email, and/or a note sent home with the
student and appropriate treatment begun by parent.
Shoreline School
District Procedure
cont’d
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If nits only are found on the hair, the parent should comb
out the nits, as nit removal is recommended and parents
should re-inspect for live adult lice within 7-10 school
days. Old non-viable nits confuse the diagnosis.
In both cases the parent/guardian will be provided
information on the biology of head lice, methods to
eliminate infestation, and directions to examine
household contacts for lice and nits.
The students’ friends and contacts should be informed by
the parent, if appropriate, to encourage them to check,
treat and/or examine other students most likely to have
had direct head-to-head contact with the affected student.
Shoreline School District Procedure
cont’d
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Nurses can provide support for parent treatment of lice by
checking in with student and parent in the weeks after lice are
found.
Nurses may still occasionally exclude students with chronic
cases and help parents to comply with treatment and removal.
The nurse or designee shall provide in-service education to
staff.
Information about head lice shall be provided yearly to all
parents/guardians in the student handbook. Staff shall attempt
to maintain the privacy of students identified as having head
lice.
Students identified with lice are less likely to feel shame and
embarrassment when they are allowed to stay in school.
Resources
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NASN pediculosis position statement
http://www.nasn.org/Default.aspx?tabid=237
AAP policy on head lice
http://aappolicy.aappublications.org/cgi/reprint/pediat
rics;126/2/392
http://www.kingcounty.gov/healthservices/health/com
municable/diseases/headlice.aspx
http://www.cdc.gov/parasites/lice/head/schools.html