Best Practice Guidance for the Management and Treatment of Head Lice

Transcription

1 Best Practice Guidance for the Management and Treatment of Head Lice Author Service and Clinical Lead Liz Grogan Infection Prevention and Control Nurse Specialist Leeds Community Healthcare NHS Trust (LCH) Infection Prevention and Control Team David Hall Infection Prevention and Control Lead Applies to LCH Clinical Services Document Version Version1 Document Status Final Date approved by service April 2013 Date issued April 2013 Review date April 2015 Service Document Number BPG1 Best Practice Guidelines for the Management and Treatment of Head Lice

2 Introduction There is a need for a consistent, integrated, rational approach to the prevention and control of head lice infection in the UK Stafford Report Head lice infections are commonest in children aged 3 to 11 years but head lice also affect people outside of the school age range. Head lice are a community problem and are not restricted to children as many people think. Adult head lice (Pediculus humanus capitis) are quick moving, flesh coloured insects about one millimetre in length, which darken after feeding. They can only be caught by direct, still and prolonged head to head contact. Contact is likely to be from other household contacts or best friends rather than casual social contacts. Lice cannot swim, fly, hop or jump and can be found on all types of hair, both clean and dirty. The lice feed on human blood by biting into the scalp. No report of a blood borne infection (such as hepatitis or HIV) being spread by head lice has ever been recorded. Lice stay close to the scalp enjoying the warmth required to hatch their eggs. The live eggs which are very small, dull and flesh coloured adhere to hair shafts just above the roots of the hair. They can be seen by the naked eye more easily in bright light. By the time the hair has grown one centimetre the content of the egg has either hatched or died. The incubation period is 6-10 days when the young louse (nymph) emerges. Old egg shells, the nits, are found away from the scalp, are white and shiny and more easily seen then the eggs and are harmless. The presence of nits does not necessarily mean there is an active live infection on that head. Head lice symptoms The main symptom from head lice is itching, and consequently head lice infection does not constitute a serious public health problem in this country. However head lice generate considerable anxiety among parents and within schools, which is often due to myths and to unjustified stigma. Inappropriate blame may be attached to schools or to individuals. Health professionals have an important role in reducing the anxiety surrounding head lice infection, and in changing false perceptions of head lice infection. Life Cycle of a head louse The head louse feeds only on human blood, approximately 5 times per day. Females outnumber males in the ratio 4-1 and lay 6 to 8 eggs daily. Best Practice Guidelines for the Management and Treatment of Head Lice 2

3 Eggs are firmly glued to strands of hair, close to the scalp preferring a temperature of C, which is favourable to incubation. The incubation period is 6-10 days and within 10 days of hatching, the louse becomes an adult and begins to mate. Live eggs are skin coloured, whereas dead eggs are white and remain glued to hair. Responsibilities All staff employed by Leeds Community Healthcare NHS Trust must work in concordance with the Leeds Safeguarding Multi-agency Policies and Procedures and local guidelines in relation to any safeguarding concerns they have for children or adults with whom they are in contact. The primary responsibility for the identification, treatment and prevention of head lice in a family has to lie with the parents / guardian. Parents however must not be expected to diagnose current infection, or to distinguish it from successfully treated previous infection or other conditions if they are not adequately instructed and supported by a range of professionals. All health professionals involved in the control of head lice infections including health visitors, school nurses, head teachers and community pharmacists amongst others should ensure that they are able to identify a louse at all stages of its development. Preventative measures Grooming Good hair care in terms of personal and social education and hygiene, and grooming should be encouraged. Females with long hair are advised to tie their hair back and males are recommended to keep their hair short. Regular combing however can not be recommended as a primary method of treatment for head louse infections. There is little evidence and efficacy supporting this practice (Stafford Report, 2012). Best Practice Guidelines for the Management and Treatment of Head Lice 3

4 Repellents Products that claim to repel lice are not recommended, as they do not deal with the control of lice in the population and do not treat existing infections. Alternative Therapies Many products are now available on the market. Advice from the Insect Research Centre is that these products should not be recommended as a method of treatment and/or prevention of head lice as: There is no scientific evidence to support its effectiveness against head lice Misuse in the application of such oils can easily occur and there have been reports of children acquiring superficial burns as a result of oils not being correctly diluted Some of the oils used in head lice preparations may aggravate medical conditions, for example eucalyptus oil should be avoided by people who suffer from epilepsy and asthma. To date no such warnings have appeared on these preparations It is the physical act of combing that actually removes lice from the hair is a long winded approach and can often be distressing for the child Resources and Equipment Head lice detection combs are required, which should have rigid teeth no further than 0.3mm apart, each tooth having preferably at least one flat surface. Detection Comb Appropriate personal protective equipment and hand hygiene facilities are required at all times. Leeds Community Healthcare NHS Trust staff must work in accordance with LCH Standard Infection Control Precautions Policy. Best Practice Guidelines for the Management and Treatment of Head Lice 4

5 Best Practice Head Louse Treatment Head lice infections should be treated using lotion or liquid formulations. Shampoos are diluted too much in use to be effective. Preparation lotions have shown to be the most effective method of treatment. Hedrin 4% treatments or alternative for head louse infection must only be recommended or used when living, moving lice have been found on the head. Advise parent /guardian to administer (Leeds Area) 1st line treatment Hedrin 4% (Dimeticone) as per manufacturers instructions 2nd line treatment - If known allergy to Hedrin 4% use Derbac-M (Malathion) as per manufacturers instructions A contact time of 12 hours or over night treatment is recommended for lotions and liquids; a 2 hour application of treatment is not sufficient to kill eggs. Please note a course of treatment for head lice should always be 2 applications of the product at least 7 days apart to prevent lice emerging from the eggs that survive the first application. Metal Combing for removing head lice and nit cases As part of the treatment process families are recommended to use a metal comb for removing head lice and nit cases, in addition to preparation treatments. Best Practice Guidelines for the Management and Treatment of Head Lice 5

6 Frequently Asked Questions Q: What are head lice? A: The head louse, or Pediculus humanus capitis, is a parasitic insect that can be found on the head, eyebrows, and eyelashes of people. Head lice feed on human blood several time a day and live close to the human scalp. Head lice are not known to spread disease. Q: What are the signs and symptoms of head lice infestation? A: 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. Q: How do they pass from person to person? A: Direct contact is the route of transmission for head lice. Commonly head-to-head contact with a person who already has head lice. Q: Can head lice jump? A: No they can over transfer with direct head to head contact. Q: Can people catch head lice from their pets? A: Transmission from pets has not been identified. Q: How big are head lice? A: Head lice are 1-4 mm long (about the size of a sesame seed) and cling to the hair shaft with hook-like claws found on the legs. They cannot hop or fly. They move about by crawling Q: What are nits? A: During the life cycle of lice, the female louse lays eggs (oval and yellow white), called nits which can be found attached to the hair shaft. Nits attach to the hair shaft close to the scalp or body - nits, which resemble dandruff, are attached with a waterinsoluble, glue-like substance that makes them difficult to remove. After 6-10 days, the nits hatch as nymphs (immature lice) - nymphs become adults in 10 days. Q: How long do lice live for? A: Adult lice live for approximately 1 3 months on their human hosts Q: How do you diagnose head lice? A: Structured detection combing is helpful in diagnosis. It is more reliable than simple visual confirmation of the presence of active infestation. Q: Can head lice survive on clothing or in bedding? A: No. Head lice die if they are away from a human's head or body for more than 2 days. Best Practice Guidelines for the Management and Treatment of Head Lice 6

7 Q: Can head lice be spread by sharing sports helmets or headphones? A: Head lice are spread most commonly by direct contact with the hair of an infested person. Spread by contact with inanimate objects and personal belongings may occur but is very uncommon. Head lice feet are specially adapted for holding onto human hair. Head lice would have difficulty attaching firmly to smooth or slippery surfaces like plastic, metal, polished synthetic leathers, and other similar materials. Q: Can Secondary skin infections be caused by head lice infections? A: Head lice infections rarely cause physical symptoms other than itching of the scalp. Sensitization to lice saliva and faeces may result in localised irritation and erythema. Skin may become infected as a result of itching. If a secondary skin infection is identified please ensure the individual is referred to their GP for further management and guidance. Best Practice Guidelines for the Management and Treatment of Head Lice 7

8 Flowchart for Professionals on the Management and Treatment of Head Lice Best Practice Guidelines for the Management and Treatment of Head Lice 8

9 Top Tips for Healthcare Professionals Do Do adhere to the following principles of control: Definite diagnosis i.e. living, moving louse found by detection combing Listing and examination of contacts Simultaneous thorough and adequate treatment of all confirmed cases with one of the standard recommended lotions IMPORTANT Repeat the treatment after seven days Do follow the National British Formulary s recommendation of two applications of lotion (not shampoo) seven days apart. Do understand that the correct use of chemical lotions is the scientifically confirmed way to treat head louse infections. Do play an active part as a health professional in providing regular, accurate information about head lice to parents Don t Don t routinely refer patients to the Headstart Team unless it is an extreme case. Don t recommend treatment unless a louse has been clearly identified. Don t assume that reinfections or treatment failures are truly infections. Make sure that a louse is found or produced. Don t support the use of electronic combs, repellent sprays or chemical agents that are not specifically licensed for the treatment of head louse. Don t prescribe just one course of treatment; always provide enough lotion for two separate treatment applications seven days apart. Further Reading Head Lice: Evidence Based Guidelines based on the Stafford Report (2012). Cambridge: Public Health Medicine Environmental Group. LCH Leaflet Head Lice: What they are, how to spot them and how to treat them. (2012) BlD7%2BZPQr602SHeoKLfV3ZP0UXQBUFFTt4s9MyaxXGrbjhHyRWgOTzM%2BFvdQfW3kjXzollbZOes Y0xllog Polish Translated T9HKsTMqA63Fy8oeVRpwxZZTGOKEdhrNf%2FeFzeVxSxjSfipYKOgQftRHGe%2BHZB%2FhJclTvscq8 W0ZF3HylmhrK6D8opVveEBkBRMQ Best Practice Guidelines for the Management and Treatment of Head Lice 9