WELLNESS AND HEALTH SERVICES PROCEDURE Bloomington Independent School District Lice Management Procedure Based on the recommendations of the Texas Department of State Health Services, Bloomington ISD is adopting this updated procedure for the prevention and management of lice. The DSHS recommendations are in agreement with the Centers for Disease Control (CDC), the American Academy of Pediatrics (AAP), and the National Association of School Nurses (NASN). While head lice are inconvenient, they are not a health hazard and are not responsible for the spread of any disease. The presence of lice and/or nits should not disrupt the educational process. Lice control takes teamwork among the school nurse, teachers, parents, and guardians. Parents/guardians of younger children should monitor their child, checking the child’s hair for lice or nits, on a regular basis. PURPOSE: To describe the procedure for management of pediculosis infestation at school and recommendations to parents for home treatment. Prevent infestation of other children or staff members. Maintain school attendance as well as minimize the disruption of the learning process to the greatest extent possible. Preserve the privacy and confidentiality of staff and students. DEFINITIONS: Head lice: small parasitic insects that live on the scalp and neck of the human host. Louse: singular of lice. Nymph: young, recently hatched louse. Active infestation: finding a live louse or nymph on the scalp. Pediculosis: an active infestation of head lice. Nit: an egg of a female louse, attached to hair shaft. Non-viable nit: an egg found on a hair shaft FARTHER than 1/4th an inch from the scalp. Viable nit: an egg found on a hair shaft CLOSER than 1/4th an inch from the scalp. Considered to be unhatched. Ovacide: chemical which kills lice eggs/nits. Pediculicide: chemical which kills nymph stage and adult lice. DATE ADOPTED: 2/2013 1 of 5 WELLNESS AND HEALTH SERVICES PROCEDURE BACKGROUND INFORMATION: Infestation by head lice, also known as pediculosis capitis, is a common problem that crosses all geographic and socioeconomic boundaries in this country. Lice depend on their host for food (blood) and warmth. Lice are found specifically on the scalp because this area is warm and dark. Lice cannot live very long when separated from this source of food and warmth. Lice do not jump, hop, or fly. Females lay 6-10 eggs per day that are incrusted in pearly white egg-cases called nits. Viable nits are generally found within ¼ inch from the scalp where they are fixed firmly to the hair shaft with a glue-like substance. Nits are difficult to remove and do not simply fall off of the hair. Nits are most frequently attached to the hair at the nape of the neck and behind the ears. After 5-10 days, the nits hatch to produce juvenile lice called nymphs. The nymphs mature fully and are able to lay eggs in about two weeks. The entire cycle takes about 21 days. An Adult Female Louse (Enlarged view) SYMPTOMS OF AN INFESTATION: Pruritis (itching) is the most common symptom of a lice infestation. Pruritis is caused by a local reaction to the saliva that the louse injects while feeding. Additional symptoms include: a tickling feeling or a sensation of something moving in the hair irritability and sleeplessness sores on the head caused by scratching a rash on the scalp or the back of the neck DATE ADOPTED: 2/2013 2 of 5 WELLNESS AND HEALTH SERVICES PROCEDURE PREVENTION OF LICE INFESTATIONS: In order to prevent lice infestations, the following measures will be implemented within the classroom: Children’s personal items (combs, brushes, hair bows, hats, and scarves) will not be shared Coats, sweaters, and backpacks will be stored separately Carpet will be vacuumed daily No sharing of cloth or upholstered pillows or mats Play items will be cleaned after each child’s use Teachers will be aware of students exhibiting symptoms of an infestation and will refer them to the school nurse for appropriate screening SCREENINGS: Routine screenings, class-wide, and/or campus-wide screenings are not productive and result in a potential loss of privacy as well as decreased instructional time. Therefore, Bloomington ISD will not perform these types of screenings. Screenings will be performed on an individual basis with an emphasis on maintaining student privacy. Students exhibiting symptoms of a lice infestation will be referred to the school nurse for a screening. These symptoms include: Frequent scratching of the head and/or back of the neck Student complaints of itching Pink or red marks on the back of the neck Unexplainable sores and/or scabs on the scalp or back of the neck Any small form, approximately the size of a sesame seed, crawling in the hair Visible nits (small white to yellow spot attached to the hair that doesn’t fall off) A parent may request that his or her child be screened. Screenings will be performed by the school nurse or other school employee who is knowledgeable of the Lice Management Procedure and trained in the screening procedure. Parent permission is not required to screen a student for possible pediculosis. SCREENING PROCEDURE: 1. Wash hands. 2. Screening sticks, the wooden end of cotton tipped applicators, or gloves will be used to separate the hair and expose the scalp. Separate sticks or gloves will be used for each child. 3. The back of the head and around the ears should be checked thoroughly. If the hair is longer in the front, the front should be checked as well. DATE ADOPTED: 2/2013 3 of 5 WELLNESS AND HEALTH SERVICES PROCEDURE 4. The hair should be separated into small sections while looking for nits and live lice. Nits will not move when the strand of hair is flicked. Dandruff, lint, and other debris will move when the hair is flicked. 5. Dispose of sticks or gloves. 6. Wash hands. 7. Return the child to class. SCREENING RESULTS: Follow the “Lice Screening Guidelines” flow chart (Exhibit A). If the student has live lice (an active infestation) the “Lice Treatment Guidelines” form (Exhibit B) will be sent home with the student along with a letter to the parent or guardian. (Exhibit C) Students with live lice and nits will not be excluded from school. Children with live head lice will remain in class, but be discouraged from close direct head contact with others. Every effort will be made to prevent spreading the lice while maintaining the dignity of the affected student. EXCEPTION: If a parent or guardian refuses to comply with treatment guidelines, a student may be excluded from school at the discretion of the campus administrator. An excluded student may return to school as soon as the student is treated according to the “Lice Treatment Guidelines.” Students with nits will not be excluded from school. The CDC sites the following reasons for this practice: Nits are cemented to the hair shafts and unlikely to be transferred successfully to another person. Many nits are more than ¼ inch from the scalp. Such nits are usually not viable and unlikely to hatch to become crawling lice, or may in fact be empty shells, also known as casings. The burden of unnecessary absenteeism to the students, families, and community far outweighs the risks associated with nits. The parent or guardian of a student with nits will be sent a letter with appropriate information. (Exhibit D) EDUCATION: The school nurse is the key health professional to provide education and guidance to the school community regarding best practice and management of pediculosis. DATE ADOPTED: 2/2013 4 of 5 WELLNESS AND HEALTH SERVICES PROCEDURE Information regarding lice, nits, treatment guidelines, and lice fact sheets will be posted on the Bloomington ISD School Health Web page. This information will include the Texas Department of State Health Services’ publication “Everything You Need to Know about Lice.” (Exhibit E) School nurses and campus employees will be educated on the current lice management procedures. The district nurse and campus nurses will be available to answer parent questions as needed. See the following forms and information related to Lice Management: Exhibit A: Exhibit B: Exhibit C: Exhibit D: Exhibit E: Lice Screening Guidelines- 1 page Treatment Guidelines for Lice and Nits- 2 pages Parent Letter/Lice- 2 pages Parent Letter/Nits- 2 pages Everything You Need To Know About Head Lice- 17 pages DATE ADOPTED: 2/2013 REVIEWED: 5 of 5