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Head Lice A New Look at an Old Problem A D303 Data Collection Study Conducted in 2007/2008
Head Lice
A New Look at an Old Problem
A D303 Data Collection Study
Conducted in 2007/2008
Head Lice Hysteria
Parents
Teachers
Administrators
Head Lice
Organizations
Common Misperceptions
Based on social stigma
Myths
Degree of difficulty to
eradicate
Common Misperceptions
Based on old research
Head lice transmits
typhus
Based on old management
"No Nit" policies
School-wide screenings
Common Misperceptions
Common Misperceptions
When parents of
elementary students are
asked what childhood
health issues concern
them most, head lice
ranks higher than much
more serious conditions.
Common Misperceptions
Lice are not known to transmit infectious agents
No evidence that nits correlate with any disease process
Bacterial infection due to scratching is the only known physical complication
What is Head Lice?
A small parasitic insect
that lives on the scalp and
neck hairs of a human
host.
Six legs
No wings
Cannot hop
Does not fly
What is Head Lice?
Requires human blood to grow, develop and lay eggs (nits)
Cannot survive more than a day without a blood meal
Cannot survive more than a day or so off the head at room temperature
What is Head Lice?
Does not discriminate
among socioeconomic
groups
Most commonly found in
children of preschool and
early elementary age
The Life Cycle of The Head Louse
Three Stages
1. Nit
2. Nymph
3. Adult
Nit Stage (louse egg)
Lice eggs are called nits
Oval shaped and usually
yellow to white
Attached to the hair with a
quick hardening glue that
the female louse extracts
from her body
Nit Stage (louse egg)
Takes 7-10 days to develop
and hatch
Hatched or dead eggs
remain firmly attached to
the hair, but will never
again produce another
louse
Nymph Stage
Immature stage of a louse
Very difficult to see and moves quickly
Looks like an adult, only smaller
Unable to reproduce
Matures into an adult 8-12 days after hatching
Must feed on human blood to survive and grow
Adult Louse Stage
Size of a sesame seed
Tan to grayish in color
Difficult to see - moves quickly
Feeds 1 to 4 times a day
Fewer than a dozen active lice on the head at any time
Females live up to 30 days and lay about 6 eggs a day
Dies within a day when off the head
Identification of Head Lice
Students with head lice are usually asymptomatic
Some experience itching from bites or irritation from sores caused by bites
Some experience redness behind ears or back of neck
Identification of Head Lice
Nits are difficult to identify
without magnification and
are often confused with
artifacts in the hair
Nits are often identified
before finding a live louse
Identification of Head Lice
Nits are deposited on the hair shaft about 1mm from the scalp
Eggs more than 1/4 of an inch away from the scalp are nearly always hatched, and do not by themselves indicate an active infestation
Identification of Head Lice
A louse can be difficult to site as they move quickly away from light
They can be found anywhere in the hair but are easiest to locate on the scalp, behind the ears and near the neckline at the back of the neck
Treatment of Head Lice
Ensure that a correct identification has been made
Treatment is recommended only for individuals found with live lice or viable eggs
Nits further than ¼ inch from head, are probably hatched and no longer viable
Treatment of Head Lice
Parents should consult with a
pharmacist or health care
provider regarding treatment
options
OTC Pediculocides
Mechanical Removal
Prescription Pediculocides
Alternative Treatments
Treatment of Head Lice
OTC pediculocidal shampoos
Permethrin products (Nix)
Pyrethrin products (RID, Pronto)
Directions must be followed carefully
Most effective in combination with combing
May repeat if live lice are found after 7-10 days
Treatment of Head Lice
Misuse of Treatment
Using agents ineffectively
causing resistance
Using agents as
preventative
Using agents for other
scalp infections
Treatment of Head Lice
Mechanical Removal of
lice and nits
Comb daily until no
live lice or viable nits
are discovered
Recheck in 2-3 weeks
after you think they are
gone
Treatment of Head Lice
If live lice persist after 2 OTC treatments consult with your HCP regarding prescription pediculocidal shampoos
Lindane (Kwell)
Malathion (Ovide)
A malathion product, is by far the most effective product on the market to kill lice
Treatment of Head Lice
Alternative Treatments
Examples: Petroleum
jelly, margarine,
mayonnaise, herbal
oils, olive oil, and
enzyme-based products
No conclusive
evidence these are
effective or safe
Treatment of Head Lice
Emerging new treatments
on the horizon
5% lice asphyxiator
lotion
NatrOVA
Incidence of Head Lice
Harvard School of Public Health found
41% of samples sent from parents, schools and health providers did not contain lice or nits
Of the 59% containing lice or nits, only half were viable
Less than 1/3 of samples collected were active cases of head lice
Incidence of Head Lice
In a 2001 CDC/DPH
Study of Georgian
students
Only 9 of 50 children
with nits alone (18%)
converted to live lice
Only 1/3 of those with
nits ¼ inch from the
scalp developed active
head lice
Incidence of Head Lice
Data collected in D303 Schools totaling 13, 694 students showed:
36 known cases of head lice reported - less than 0.03%
33 known cases were reported in the Elementary Schools
13,694
36
Total students Students with head lice
Incidence of Head Lice
Three classrooms had more than one case of head lice
Two of these classrooms had an outside common source of transmission
Impact of Head Lice
In D303 schools that year
21 school days missed by
students with head lice
42 hours spent in classrooms
screening students
Only 2 students were
identified in screening
sweeps
What We Conclude…
The majority of transmissions occur outside the school setting – 96%
The majority of infestations are isolated, occurring from outside sources – 80%
The incidence of transmission within a classroom is extremely low – 0.3%
Screening is not effective for identification – 6%
What We Conclude…
There is NO convincing
data demonstrating that
exclusion policies and
“No Nit” policies are
effective in reducing the
transmission of head lice
What We Conclude…
Our policies, protocols and
practice must be based on
scientific evidence and
research, not fear and
hysteria.
National Recommendations for
School Policy
The American Academy of Pediatrics states: “No Nit” policies are detrimental causing:
Lost time in the classroom
Inappropriate allocation of the school nurse’s time for screening
A response that is out of proportion to the medical significance
National Recommendations for
School Policy
The American Academy
of Pediatrics states:
No healthy child be
excluded from or allowed to
miss school because of head
lice
"No Nit" policies for
returning to school be
discouraged
National Recommendations for
School Policy
The National Association of School Nurses state :
“No Nit policies disrupt the education process and should not be viewed as an essential strategy in the management of head lice.”
A Better Management Practice
Educate parents to:
Know the facts
Recognize symptoms
Inspect Regularly
Decrease transmission
Treat effectively
A Better Management Practice
Educate Teachers and Students to:
Avoid direct head to head
contact
Hang coats separately
Store hats & scarves in coat
sleeves
Eliminate sharing personal items
Avoid lying on carpets, pillows
or stuffed toys
A Better Management Practice
Role of the School Nurse
Create an atmosphere of open communication
Protect the privacy, dignity & confidentiality of students
Develop evidence-based treatment plans
Develop evidence-based educational programs for staff & parents
Why NOT a No-Nit Policy?
Causes children to miss
school needlessly
Misidentification of non-
viable nits is common
Encourages dangerous
overuse of pesticides
Why NOT an Exclusion Policy?
Students with head lice are healthy and do not impose a health risk
An active infestation has already been present for 4 weeks at minimum by identification
Students do not impose a high risk of transmission
A Better Perspective!
Children with head lice are
healthy children who
should be treated and
remain in school to learn.
Developed for CUSD303
by The Health Services Department
Some of the materials are used by permission from:
Marjorie Cole, RN, MSN
Department of Health and Senior Services
School Health Program
References Canyon, D., Speare, R., Muller, R. (2002). Spatial and kinetic factors for the transfer of Head lice
(pediculus capitis) between hairs. Journal of Investigative dermatology.119. 629-631.
Centers for Disease Control (2001). Fact sheet: treating head lice. Retrieved April 21, 2005 from:
http://www.cdc.gov/ncidod/dpd/parasites/headlice/factsht_head_lice_treating.htm
Department of Health and Senior Services; School Health Program (2007) Managing Head Lice in the
School Setting. [Power Point] Cole, M.: Author Used by permission of author.
Donnelly, E., Lipkin, J., Clore, E., Atschuler, D. (1991). Pediculosis prevention and Control strategies
of community health and school nurses: a descriptive study. Journal of community health nursing. (8)2.
85-95.
References Frankowski, B.L, Weiner, L.B., (2002). American Academy of Pediatrics: Head Lice. Pediatrics,
110 (3). 638-643.
Herbert, A.A., (2008, July). Issues in Emerging Therapies in the Treatment of Head Lice. Paper
presented at the 40th Annual NASN Conference, Alburquerque, New Mexico. Retrieved October 20,
2008 from http://www./nasn.org/
Kentucky school boards association. (November, 2004). DPP Survey: Impact of
Nits/Lice identification of school attendance. Unpublished raw data.
Kentucky Department of Education (2004). Equity resources for schools and districts. Retrieved
October 20, 2004 from: http://www.education.ky.gov/cgi-
bin/MsmGo.exe?_grab_id=20591960&EXTRA_ARG=&host_id=1&pa
References
Melnyk, B. (2005). Creating a vision: motivating a change to evidence-based practice in individuals
and organizations. In B. Melnyk & E. Fineout-overholt (Eds.),
Evidence-based practice in nursing & healthcare, a guide to best practice (pp.443- 455).
Lippincott Williams & Wilkins, PA:Philadelphia.
Mumcuoglu, K. (1991). Head lice in drawings of kindergarten children. Israeli Journal of psychiatry
related science. (28) 1. 25-32.
National Association of school nurses (2004). Position statement: pediculosis in the school
community. Retrieved October 20, 2004 from: http://www.nasn.org/positions/2004pediculosis.htm
References National Pediculosis Association [n.d]. The no nit policy: A healthy standard for children and their
families. Retrieved April 21, 2005 from: http://www.headlice.org/downloads/nonitpolicy.htm
Olowokure, B., Jenkinson, H., Beaumont, M., Duggal, H. (2003). The knowledge of healthcare
professionals with regard to the treatment and prevention of Head lice. International journal of
environmental health research. 13. 11-15.
Pollack, R. 2000. Harvard School of public health: head lice information. Retrieved January 12,
2001 from: http://www.hsph.harvard.edu/headlice.html
