Purpose
To contain infestation of head lice among the school age population while maximizing students’ academic performance and minimizing absences due to unnecessary exclusion of students using nursing/medical best practices. The American Academy of Pediatrics and the National Association of School Nurses no longer endorse a “No Nit” policy in schools. Exclusion is not an effective tool in reducing the outbreaks (CDC, 2010; Frankowski & Boccini, 2010: Frankowski & Weiner, 2002). In cases that involve head lice, as in all school health issues, it is vital that the school nurse prevent stigmatizing and maintain the student’s privacy as well as the family’s right to confidentiality (Gordon, 2007).
Standard
The school nurse will examine the head of any child suspected of having a live lice infestation and notify the parent/guardian. Head lice are not a health hazard or a sign of uncleanliness and are not responsible for the spread of disease (Frankowski & Weiner, 2002). Positive lice are not a public health emergency. Lice cannot hop or fly; they crawl. Transmission in most cases occurs by direct contact with the head of another infested individual (Chunge, et al. 1991).
Children returning to school after treatment for head lice will be examined by the school nurse to verify absence of live lice prior to entering the classroom.
Presence of nits does not indicate active infestation and no evidence are found that the presence of nits correlates with any disease process (Scott, Gilmer, Johannessen, 2004). Other studies show that lice are not highly transferable in the school setting (Hootman, 2002) and no outbreaks of lice resulted when allowing children with nits to remain in class (Scott, Gilmer & Johannessen, 2004). Nurses will perform targeted pediculosis screenings for nits alone have not been proven to be effective and will only be performed based on multiple live lice infestations found in a single class (CDC, 2010; Frankowski & Weiner, 2002).
Procedure
Upon notification of suspected cases of head lice, the school nurse will examine the student.
ü An infestation will be determined by looking closely through the hair and scalp for viable nits or live lice. Lice and nits (dirty-white to grey colored eggs attached to the hair shaft) are visible to the naked eye. Nits which are farther than ¼ inch from the scalp are not considered viable because eggs are laid at the scalp and the life cycle is short, therefore, any remaining nits beyond ¼ inch (hair growth takes time) are either empty or dead.
ü The nurse will determine the severity of the infestation (live lice or just nits) and the parent/guardian will be notified via phone, email, and/or a note sent home with the student (see “Head Lice Screen Information for Parents”). If live lice are found, the student will be sent home. The parent/guardian will be provided with information on biology of head lice, methods to eliminate infestation, and directions to examine household contacts for lice and nits and that the student must check in first with the school nurse upon returning to school the next day.
ü If only nits are detected the student will remain in his/her classroom for the remainder of the school day.
ü The school nurse will perform a targeted screening of the students most likely to have had direct head to head contact with the affected student (especially recent sleepovers). Parents/guardians will be referred to their health care provider for follow up if there are positive findings, or lice are resistant to treatment. If 3 or 4 students in one class are affected, all classmates will be checked and at that time a class wide letter will be sent home (see “Notes from the Nurse”) classroom letter).
UPON STUDENTS RETURN TO SCHOOL
ü The school nurse will examine the student’s hair for presence of lice at the beginning of the school day. The student is required to be live lice free to return to school.
ü The student will remain in school if no presence of live lice. A student may remain in school if only nits are found.
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ADDITIONAL INFORMATION RELATING TO HEAD LICE:
ü Parents/guardians will be encouraged to verify treatment as soon as possible after notification. Parents/guardians will be encouraged to check their child’s head daily for at least 2-3 weeks after discovery. Removing nits EVERY day for 3 weeks is the most effective treatment (Refer to “Recommendations for Comb-Out Lice Treatment” as needed for parents/guardians).
ü Students will be discouraged from direct head to head contact with other students. The school nurse will provide in-service education to staff regarding how to handle nits and/or live lice in the classroom.
ü The most common means of transmission is through physical/direct (head to head) contact. Indirect transmission is uncommon but may occur from shared combs, brushes, hats, and hair accessories that have been in contact with an infested person. Schools are not a common source of transmission. Lice prefer clean hair because it is easier to attach to the hair shaft to lay their eggs.
ü Staff will maintain the privacy of students identified as being infected with head lice.
ü The school nurse is the key health 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 problem, contain infestation, provide appropriate health information for treatment and prevention, prevent overexposure to potentially hazardous chemicals, and minimize school absence.
RESOURCES
American Academy of Pediatrics, (2010), Policy statement: Clinical report head lice. Retrieved from http://aapolicy.aapublications.org/cgi/content/full/pediatrics;126/2/392.
American School Health Association. (2005). School policies in the management of Pediculosis. Retrieved from http://www.ashaweb.org/files/public/resolutions/pediculosis.pdf.
Centers for Disease Control and Prevention. (2010). Head lice information for schools. Retrieved from https://www.cdc.gov/parasites/lice/head/index/html.
Chunge, R.N., et al. (1991). A pilot study to investigate transmission of head lice. Canadian Journal of Public Health, 82, 207-208.
Frankowski, B.L., & Bocchini, J.A. (2010). Committee on School Health American Committee on Infectious Disease, Academy of Pediatrics. Clinical report: Head lice. Pediatrics, 126(2), 392-403.
Frankowski, B.L., & Weiner, L.B. (2002). Committee on School Health Committee on Infectious Disease, American Academy of Pediatrics. Clinical report: Head lice. Pediatrics, 126(2), 392-403).
Gordon, S., (2007). Shared Vulnerability: A theory of caring for children with persistent head lice. The Journal of School Nursing. 23 (5) 283-292. doi: 10.1177/10598405070230050701
Hootman, J. (2002). Quality Improvement Projects Related to Pediculosis Management. Journal of School Nursing. 18(2) 80-86.
Humphreys, Elizabeth et. Al. (2008). Outcomes of the California Ban on Pharmaceutical Lindane: Clinical and Ecological Impacts. Environmental Health Perspectives, 116(3), 297-302).
Massachusetts Department of Public Health. (2007). Pediculosis (Head Lice). The Comprehensive School Health Manual, (8), 56-58.
National Association of School Nurses. (2011). Position Statement: Pediculosis in the School Setting. Retrieved from http://www.nasn.org/default.aspx?tabid+237.
National Guideline Clearinghouse. (2008). Guidelines for the diagnosis and treatment of Pediculosis capitis (head lice) in children and adults. Retrieved from http://www.guideline.gov/summary/summary/aspx?doc_id+12784&nbr=00658=Pediculosis.
Pollack, R. (2009). Head lice information. Statement from the Harvard School of Public Health. Retrieved from http://www.hsph.harvard.edu.headlice.html.
Pollack, R.J. (2010). How many people are infested with head lice? Retrieved from: https://identify.us.com/head-lice/head-lice-FAQS/how-many-people-infested.html.
Pollack, R.J., Kiszewski A.E., Spielman A., (2000). Over diagnosis and consequent mismanagement of head louse infestations in North America. Pediatric Infectious Disease Journal. 2000 (8):689-93.
Williams, L.K., et al (2001). Lice, Nits, and School Policy, Pediatrics. 107 (5), 1011-1015.