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James R. Ginder, MS,NREMT,PI,CHES,NCEE Health Education Specialist Hamilton County Health Department www.hamiltoncounty.in.gov Reviewed By: Kelly Mullen, R.N., BSN Nursing Supervisor Hamilton Southeastern Schools ---PAGE BREAK--- The Learner Will Be Able To.. • Identify the various stages of head lice • Recall three signs and of head lice • Describe two ways head lice are transmitted • List two treatment opportunities ---PAGE BREAK--- Public Health Problem.. Lice Are Not A Public Health Problem While Head Lice Are A Nuisance, They DO NOT Spread Disease Source: Centers For Disease Control & Dr. Richard Pollack Harvard School Of Public Health ---PAGE BREAK--- Public Health Problem.. • The greatest harm associated with head lice results from the well‐intentioned but misguided use of caustic or toxic substances to eliminate the lice. (Pollack) ---PAGE BREAK--- What Are Head Lice? • Head lice (Pediculus capitis) are small insects that can live on the scalp and neck hair of a human host • Approximately 6 to 12 million children are infected with head lice per year (CDC) • Head lice are not a health hazard or a sign of uncleanliness and are NOT responsible for the spread of ANY diseases • All groups of people can develop head lice ---PAGE BREAK--- Head Lice Information.. • In the United States, infestation with head lice is most common among preschool children attending child care, elementary schoolchildren, and the household members of infested children • One should expect about one infested child in a school group of 100 children in the kindergarten through 4th grades (Pollack) • African Americans have fewer cases of head lice due to oval‐shaped hair shafts which are harder for lice to grasp ---PAGE BREAK--- Head Lice Information.. • Lice seem to prefer red or brown hair over blonde or black hair • Lice development has no connection with the length of hair or the frequency of brushing or shampooing ---PAGE BREAK--- Nits/Eggs.. • Nits are lice eggs laid by the adult female head louse at the base of the hair shaft nearest the scalp. • Nits are firmly attached to the hair shaft and are oval‐shaped and very small (about the size of a knot in thread) and hard to see • Nits often appear yellow or white although live nits sometimes appear to be the same color as the hair of the infested person • Nits are often confused with dandruff, scabs, or hair spray droplets ---PAGE BREAK--- Nits/Eggs.. • Nits usually take about 8‐9 days to hatch • Eggs that are likely to hatch are usually located no more than ¼ inch from the base of the hair shaft • After hatching, the remaining shell looks white or clear and continues to be firmly attached to the hair shaft • This is the stage when it's easiest to spot them, as the hair is growing longer and the egg shell is moving further away from the scalp ---PAGE BREAK--- • A is an immature louse that hatches from the nit • A looks like an adult head louse, but is smaller • To live, a must feed on blood • mature into adults about 9‐12 days after hatching from the nit Adult ---PAGE BREAK--- Adult.. • The fully grown and developed adult louse is about the size of a sesame seed, has six legs, and is tan to grayish‐ white in color • Adult head lice may look darker in persons with dark hair than in persons with light hair • To survive, adult head lice must feed on blood • An adult head louse can live about 30 days on a person's head but will die within one or two days if it falls off a person • Adult female head lice are usually larger than males and can lay about six eggs each day ---PAGE BREAK--- Head Lice Transmission.. • Head lice move by crawling; they cannot hop or fly • Head lice are spread by direct contact with the hair of an infested person • Anyone who comes in head‐to‐head contact with someone who already has head lice is at greatest risk • Sharing clothing, bed linens, combs, brushes, and hats can also help pass them along • Personal hygiene or cleanliness in the home or school has nothing to do with getting head lice ---PAGE BREAK--- Where Are Head Lice Found? • Head lice and head lice nits are found almost exclusively on the scalp, particularly around and behind the ears and near the neckline at the back of the head • Head lice or nits sometimes are found on the eyelashes or eyebrows but this is uncommon • Head lice hold to hair with hook‐like claws at the end of each of their six legs. • Nits are cemented firmly to the hair shaft and can be difficult to remove even after the hatch and empty casings remain. ---PAGE BREAK--- What Are They • Tickling feeling of something moving in the hair • Itching, caused by an allergic reaction to the bites of the head louse • Irritability and difficulty sleeping; head lice are most active in the dark • Sores on the head caused by scratching. • These sores can sometimes become infected with bacteria found on the person's skin ---PAGE BREAK--- Diagnosis Of Head Lice.. • The diagnosis of a head lice infestation is best made by finding a live or adult louse on the scalp or hair of a person • Because and adult lice are very small, move quickly, and avoid light, they can be difficult to find • Use of a magnifying lens and a fine‐ toothed comb may be helpful to find live lice • If crawling lice are not seen, finding nits firmly attached within a ¼ inch of base of the hair shafts strongly suggests, but does not confirm, that a person is infested and should be treated. ---PAGE BREAK--- Diagnosis Of Head Lice.. • Nits that are attached more than ¼ inch from the base of the hair shaft are almost always dead or already hatched • Nits are often confused with other things found in the hair such as dandruff, hair spray droplets, and dirt particles • If no live or adult lice are seen, and the only nits found are more than ¼‐ inch from the scalp, the infestation is probably old and no longer active and does not need to be treated Dandruff ---PAGE BREAK--- Treatment Of Head Lice… • Treatment for head lice is recommended for persons diagnosed with an active infestation • All household members and other close contacts should be checked two‐three days; those persons with evidence of an active infestation should be treated • Retreatment of head lice usually is recommended ---PAGE BREAK--- Examples Of Treatments.. • Insecticides • Mechanical Removal • Enzyme Treatments • Antibiotics • Suffocation Agents • Heat/Cold Treatments • Haircut BeforeANY treatment contact a pharmacist or your healthcare provider ---PAGE BREAK--- At Home… • Hats, scarves, pillow cases, bedding, clothing, and towels worn or used by the infested person in the 2‐day period just before treatment is started can be machine washed and dried using the hot water and hot air cycles because lice and eggs are killed by exposure for 5 minutes to temperatures greater than 53.5°C (128.3°F) • Items that cannot be laundered may be dry‐cleaned or sealed in a plastic bag for two weeks ---PAGE BREAK--- At Home • Items such as hats, grooming aids, and towels that come in contact with the hair of an infested person SHOULD NOT be shared • Vacuuming furniture and floors can remove an infested person's hairs that might have viable nits attached • Pets can NOT transmit lice and SHOULD NOT be treated ---PAGE BREAK--- National Association Of School Nurses.. • It is the position of the National Association of School Nurses that the management of pediculosis should NOT disrupt the education process • Children found with live head lice should remain in class, but be discouraged from close direct head contact with others • The school nurse should contact the parents to discuss treating the child at the conclusion of the school day • Classroom‐wide or school‐wide screening is not merited Source: NASN ---PAGE BREAK--- Prevention.. • AVOID head‐to‐head contact during play at school and at home • DO NOT share clothing, such as hats, scarves, coats, sports uniforms and hair ribbons • DO NOT share infested combs, brushes or towels • DO NOT lie on beds, couches, pillows, carpets or stuffed animals that have been in contact with an infected person • Talk with your child about not sharing clothing with anyone ---PAGE BREAK--- Lice And Schools.. • No‐nit policies developed by school systems were established in response to the stigma and unclear transmission of lice • The National Association of School Nurses (NASN) states that children who have been treated for lice SHOULD NOT be excluded from school because of the existence of residual nits (NASN) • According to the American Academy of Pediatrics, no‐nit policies in schools are a detrimental cause of lost time in the classroom ---PAGE BREAK--- Lice And Schools.. • Children with an active head lice infestation are likely to have had the infestation for at lease a month by the time it is discovered • A child with active head lice have NO immediate risk to others and SHOULD be allowed to remain in school for the day. • Lice transmission in school is LOW, due to close head‐to‐head contact which is LOW and generally does not happen in the school setting ---PAGE BREAK--- Lice And Schools.. • Case of head lice be brought to the school’s attention, the school nurse will MAINTAIN confidentiality of the student’s identity (FERPA) • Screening entire classrooms is an unjustified response (Pollack) • Parents of students found to have LIVE lice should be contacted by the school nurse and advised of treatment options • Children SHOULD NOT be sent home for head lice ---PAGE BREAK--- Lice And Schools.. • NO notification needs to be sent home to classmates parents • Insecticides in the school are not warranted and provide unnecessary chemical exposure ---PAGE BREAK--- Questions.. ---PAGE BREAK--- Source.. • Centers For Disease Control and Prevention • HeadLice.org • Kids Health • Mayo Clinic • Medline Plus • National Association Of School Nurses • Pollack, Richard., Harvard School Of Public Health