Head Lice Protocol

Head Lice Protocol:
Caroline County Public Schools will maintain a Head Lice Protocol in accordance with recommendations from the National Association of School Nurses (NASN) and the American Academy of Pediatrics (AAP).

General Information:
Head lice, also known as Pediculus humanus capitis, are tiny insects that live on the human scalp; they feed on human blood to survive; therefore, they are not found on, nor can be transmitted from, wild or domestic animals. In the United States, head lice infestation is seen more commonly amongpreschool and elementary school-aged children. Head lice are not a health hazard or a sign of poor hygiene; they are not responsible for the spreadof any disease.Historically, diagnosis of head lice infestations and the easy availability ofover-the-counter (OTC) pediculicides fortreatment essentially removed the physician from the treatmentprocess. However, the potential for misdiagnosis coupled with the improper use of pediculicides has raised concerns about unsafe useof these products, specifically when no lice are present orwhen these OTC products are used excessively. Because lice infestationis benign, treatments must be safe so that theadverse effects of the treatment are not worse than the infestation (American Academy of Pediatrics (AAP), 2010).

Adult head lice are about the size of a sesameseed and can adapt to match the color of the hair.The female lives up to 3 to 4 weeks and can layup to 10 eggs per day. These tiny eggs are firmly attached tothe base of the hair shaft approximately 4 mm from thescalp with a glue-like substance produced by the louse. Empty egg casings (nits) are easier to see;they appear white against darker hair. The eggs (viable nits) typically hatch in 8 to 9 days (even up to 14 days depending on the climate temperature). Once hatched, a nymph leaves theshell casing and passes through a total of 3 nymph stages (instars)during the next 9 to 12 days and then reaches the adult stage (AAP, 2010).

Signs/Symptoms
Head lice do not transmit any disease agent.When infestations are symptomatic, itching of the scalp and back of the neck is the primary symptom caused by an allergic reaction to the louse saliva. Rarely,scratching may cause skin infection, and may need to see a provider.

Transmission
Lice cannot hop or fly; they crawl. Lice are generally transferred from one individual to another through direct head-to-head contact. While indirect spread throughcontact with personal belongings of an infested individual (combs,brushes, hats) is much less likely, it may occur. Licefound on combs are likely to be injured or dead; a healthylouse is not likely to leave a healthy head unless there isa heavy infestation.

Treatment
Parents should understand that the most important components of head lice control are a single treatment of an over-the-counter (OTC) permethrin (pediculicide), then reapplication if live lice are found seven to ten days later. Because none ofthe pediculicides are 100% ovicidal, manual removal of nits(especially the ones within 1 cm of the scalp) after treatmentis necessary to assure all viable nits are removed. Nit combing should also be performed. Nit removal can bedifficult and tedious. Fine-toothed “nit combs” make the process easier.Just washing the hair will not remove nits.

All household membersshould be checked for head lice: those with live lice ornits within 1 cm of the scalp should be treated. In addition,the AAP (2010) recommends treatment of family members who share a bed with theperson with infestation, even if no live lice are found.

Lice can become a costly and time-consuming problem. The BEST use of time is in removing the nits (lice eggs) from the hair. Research shows that approximately 30% of nits are still alive after lice treatment because no product is 100% effective against lice.

Head Screenings:
Schools may conduct head lice screenings at any time to detect head lice cases and to educate parents of proper treatment. Any student entering Caroline County Public Schools after treatment will need to be re-screened by the nurse or principal’s designee for presence of live lice before being admitted to the classroom. Any student with suspicion of head lice, such as intense head scratching, shall be screened for head lice. If live lice are found, the school nurse should ascertain from the child/parent if there are any other siblings in CCPS. The school nurse should then contact the school nurse(s) at the other school(s) to advise them to check siblings as well. Parents/Guardians are encouraged to be screened to assure proper family treatment and compliance.

Protocol:
1. To ensure privacy, student assessments will be completed only if a child is referred by a staff member due to signs and symptoms of a lice infestation–OR- at the request of that child’s parents.
2. Individual head screening shall be performed under a good light source with the use of applicator sticks. The hair will be separated and inspected at least at back and sides but preferably throughout head, focusing on the thickest part of hair. The re-screening process will be very thorough including the entire scalp.
3. Classroom screenings will not be conducted unless 3 or more students are presenting with signs and symptoms of infestation from that classroom (AAP, 2010). *Only applies to elementary schools. Middle school/high school will only check symptomatic students*
4. To maintain privacy and confidentiality, lice alert letters will be sent home to parents if their child is in a particular classroom that has 3 or more students with lice (AAP, 2010)
5. Principals will implement school wide measures to prevent lice. Examples include: individualized head phones for each student, separation of coats in classrooms, no longer sharing “penny’s” in PE, educating students and staff about how lice spreads and encouraging behaviors that lessen the chance of sharing lice (not hugging, not sharing hats/combs, etc)

Presence of Live Head Lice:
Any student or staff member having active head lice infestation, will be excluded from school and from the school bus.
Protocol:
1. Students will be excluded from school and the school bus at the time an infestation is discovered. An infestation will be defined as live lice.
2. Parent will be contacted to pick up the student.
3. Parents will be given educational information about appropriate treatment. The parent or guardian will receive written education on the treatment of head lice as provided by the school. Verbal education will be provided as requested and needed. Caroline County Public Schools will provide additional education on awareness and removal of head lice as needed and upon request.
4. A parent must accompany the child to the clinic to have the student checked for lice upon returning to school after treatment. If the child still has live lice, the parent will be asked to take the child back home for lice removal.

Documentation:
1. Each school will record the date of a child’s positive lice detection, date of return, and results of head check. The documentation will remain on file in the clinic.

Head Lice Protocol (Print PDF Version of this document)