Head lice (pediculus capitis) are small parasitic insects that live mainly on the scalp and neck hairs of their human host. Head lice survive by blood-feeding and cannot survive for more than a day or so at room temperature without ready access to a person’s blood. A nymphal louse hatches from its egg after about 8 days of development and begins to feed, grow and develop until it attains the adult stage about 9 – 12 days after hatching. A female louse may deposit more than 100 eggs at the rate of about 6 eggs daily. An infested person usually has fewer than 12 live lice in the hair but may have hundreds of eggs in various stages of development.
The primary transmission of head lice from one person to another is by direct contact with the head of an infested person. They may in some cases be transmitted by indirect contact or by combs, hairbrushes, clothing, hats and bedding. Lice do not hop or fly. In-school transmission of head lice is rare.
Animals do not carry lice that spread to humans, and human lice do not live on animals.
Obtain history. Pertinent information might be obtained with the following questions:
a. Does anyone else in the family have lice?
b. How long has the student been infested with lice and how many times has the student already been treated?
c. Who are the student’s siblings, household contacts, and closest friends?
d. Do any of the student’s closest friends or siblings have lice?
Current status. Determine if the student has any itching. If so, where and how long has it been occurring? Assess the knowledge, attitudes and beliefs of the family to determine the level of education needed. If the parent already knows about lice, determine what they may have already done to treat it. Assess the student’s emotional response to lice.
Inspect all areas of the scalp covered by hair using wood applicators or a fine-toothed comb. Discard or sterilize your tools between each student in hot (almost boiling) water for 15 minutes. Carefully differentiate dandruff, hair spray and hair casts. Inspect the head for excoriations from itching or secondary infections.
The school nurse is the key professional to provide education and anticipatory guidance to the school community regarding best practice guidance in the management of pediculosis.
The school nurse’s goals are to facilitate an accurate assessment of the situation, to prevent overexposure to potentially hazardous chemicals, to minimize absences, and to prevent stigmatization.
It is of utmost importance that the student’s privacy be protected as well as the family’s right to confidentiality. For this reason, staff are notified on a need-to-know basis only—see “Staff guide to Student Health Concerns”.
If live lice are found during your examination of the scalp and hair, contact the parent or guardian. The student may remain at school until the end of the school day or go home sooner as per parent preference.
Exclude students with an active infestation:
CHILDCARE: Children should be excluded until 24 hours after treatment has begun.
SCHOOLS: No exclusion.
Offer to show the parent live lice and/or nits to assist in the parent’s success in eradication of the infestation. Staff may also offer to check the heads of parents/guardians.
Reassure the parent and student that head lice is a common childhood problem. Recommend they buy a pediculicide of their choice or consult their healthcare provider for recommendations. Instruct them to follow the directions on the label very carefully. Warn against over-treating.
Supply the parent with a copy of the school district “Head Lice: Guidelines for Treatment” and review it with the parent and student, if appropriate.
Inform them that the student will need to be rechecked after treatment and before reentry for live insects and/or nits and again in 7-10 days.
Check siblings and household contacts in the district. Call other buildings if necessary.
Encourage parent to notify friends and other close contacts of the student.
Our district has a “no live lice” policy. If only nits are found, notify the parent and encourage removal.
Whole classroom or whole school checks are neither advisable nor effective in preventing head lice in students and are therefore to be discouraged.
Any letters to parents or families should focus on educating the whole school community about pediculosis and decreasing social anxiety and stigma and should not create an environment that leads to over identification of or fear of infestation. Use of the school newsletter to educate about head lice on a regular basis (once or twice a year in grade schools) is advised, as opposed to special letters of notification when cases are found, as these tend to increase anxiety and suspicion.
Head lice infestations are most commonly seen between the ages of 3 to 11. For this reason, nursing discretion is applied at the secondary level with regard to education and responses to individual cases.
Individual cases of head lice are not reportable to the Health Department, though they are available for consultation if needed.
Document all nursing assessments and interventions.
General environmental controls:
Students clothing and personal items should be stored separately (hooks, cubbie holes, etc.) and not piled.
Teach children not to share personal items (i.e. hats and combs).
Launder clothing and bedding in hot water (130F) for a minimum of 20 minutes and dried on the hot setting, OR dry clean. This should be done for items in the facility and at the home.
Items that cannot be cleaned should be placed in a plastic bag for 2 weeks.
Carpet and furniture can be vacuumed or gently ironed (not sprayed with insecticide).
Combs and brushes should be soaked in disinfectant solution (1/4 cup bleach to 1 gallon of water), lice- killing solution for 10 minutes or in hot (almost boiling) water for at least 15 minutes.
Prior to re-entry into school, check scalp and hair again for nits and live lice. If only nits are found, encourage parent to continue nit removal process at home until gone but allow re-entry. Recheck student again in 7-10 days.
If live lice are found, student must remain out of school until treated and no live insects are found. Referral to a healthcare provider is indicated if parent reports treatment has already occurred, yet insects continue to exist.
CDC Head Lice Infestation Fact Sheet. Available at: http://www.cdc.gov/ncidod/dpd/parasites/lice/factsht_head_lice.htm. Accessed March 14, 2006, February 19, 2007, and February 24, 2007.
Head Lice (Pediculosis). Infectious Disease in Child Care and School Settings: Guidelines for School Nurses and Other Personnel. Available at: http://www.colorado.gov/cs/Satellite/CDPHE-DCEED/CBON/1251607755294 Accessed December 4, 2012.
NASN. Pediculosis Management in the School Setting. Available at: http://www.nasn.org/PolicyAdvocacy/postionPapersandReports/NASNStatements.htm. Accessed December 3, 2012.
New Mexico School Health Manual. Available at: http://www.nmschoolhealthmanual.org. Accessed February 25, 2007.
Pollack R PhD. Head Lice Information. Harvard School of Public Health. Available at: http://www.hsph.harvard.edu/headlice.html. Accessed March 10, 2006, February 3, 1007, and February 24, 2007.
Schmitt, BD. Pediatric Telephone Protocols. Edition. 2000.