Falls Church City Public Schools/Fairfax County Health Department HEAD LICE (Pediculosis) GUIDELINES 9/09

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1 STUDENT SECTION Regulation 9.62 /Fairfax County Health Department HEAD LICE (Pediculosis) GUIDELINES 9/09 Outbreaks of head lice are common among children in schools and daycare, affecting all social and economic groups. Because there is no evidence that head lice transmit disease, pediculosis is considered a nuisance rather than a health hazard. Head lice are not spread to humans from pets. Head lice are spread either by direct contact with a person who has head lice or indirectly by contact with personal belongings of an infested person. Specific guidelines are in place to address pediculosis in the school setting. Current research does not support exclusion policies for nits. { National Association of School Nurses Position Statement: Pediculosis in the School Community, July 2004; Harvard School of Public Health: Head Lice Information, 2007; Virginia Department of Health, 1998.} Exclusion policies can result in: increased absences from school which can have a negative impact on academic success and lost work time for parents; issues surrounding discrimination; over-treatment for head lice leading to resistance to commonly used medication; and a decreased tendency for parents to report cases identified at home. FCHD and the FCCPS do not support excluding students with nits. Screening and Treatment The first line of therapy is the use of a Food and Drug Administration (FDA) approved, over-thecounter (OTC) product which are primarily pyrethrins or permethrin based agents. FCCPS requires parents to return the Lice Treatment Verification Form indicating that the infested student was treated with an FDA approved product. Treatment includes application of the pediculocide, the daily manual removal of nits and a second treatment with a pediculocide 8-10 days after the initial treatment. In some cases prescription medication may be ordered by the private medical doctor and should be used as directed.

2 Alternative products such as olive oil, mayonnaise, margarine, vinegar, petroleum jelly, compounds that claim to dissolve the glue on the nits, tea tree oil and other natural products, and household chemicals (kerosene, gasoline, paint thinner, turpentine) have not been evaluated scientifically and are therefore not an acceptable alternative for treatment of head lice. They should not be used. A student may be referred to the SHA by a parent or staff for possible lice infestation. Screening should be done discreetly so as not to embarrass the student. Check student in a well lit area. Have the student look down so warm areas at the base of the hairline at the neck, or around the ears can be inspected easily. Areas at the crown of the head where layers of hair are kept warm are also areas where lice might be evident. Equipment for this procedure includes: tongue blades, wooden applicator sticks or pediculosis sticks and disposable gloves. 1. Put on disposable gloves. 2. Using one or two tongue blades/sticks, part the hair and look for crawling lice (difficult to see because of size) and nits. 3. For hair-styles that may make screening difficult, DO NOT disturb the hair, and notify the parent/guardian so that the screening can be done at home. Religious head covers are not to be disturbed or removed. Notify the parent or guardian so that screening can be done at home. 4. Students with nits only may return to class. The parent of these students will be contacted to discuss treatment and nit removal. 5. Students with live lice will remain in the clinic until he/she is picked-up by the parent/guardian. Student s siblings will be screened; the SHA will notify other FCCPS clinics where siblings attend. 6. Discuss the lice treatment (see approved FDA list) and verification of treatment with the parent. Provide the parent with a copy of the Lice letter in the Handbook for School Health Risks. This letter outlines cleaning the environment and treating infected individuals. Questions about alternative head lice treatments should be referred to the PHN. 7. Each confirmed case will be recorded by the SHA on the Pediculi Follow-Up Work Sheet. 8. The student with a confirmed case of head lice will be readmitted to school only after the initial treatment and the Lice Verification Form have been completed. Rescreening the student is not required prior to re-entry to school.

3 9. The SHA will follow-up with the parent in 8 10 days after the 1st treatment to remind the parent about the second treatment and that the verification of treatment form is required for 2nd treatment. 10. The SHA will contact the parent 8-10 days after the 2nd treatment to determine if there is evidence of live lice and will consult with the PHN if the parent reports the presence of live lice. Treatment failure may be attributed to: inappropriate use of the over the counter product, failure of the over the counter product to kill the lice, resistance to the pediculicide or reinfestation from another source. If treatment failure occurs, refer the child to their pediatrician and assess the need for close contact inspection. Further Investigations SHA will discuss with PHN the following situations: Additional cases discovered in the classroom/school and the potential need for close contact investigation. Possible treatment failures. Inadequate treatment of student and/or environment. The Fairfax County Health Department will provide guidance to assist with situations in which public health involvement is necessary. Additional resources: Centers for Disease Control and Prevention Harvard School of Public Health

4 RESPONSIBILITIES OF THE SCHOOL HEALTH AIDE (SHA) AND THE PUBLIC HEALTH NURSE PREVENTION OF HEAD LICE School Health Aide: Screens student with suspected head lice infestation. Contacts parent/guardian to discuss findings and required treatment as needed. Provides Lice Treatment Verification form to parent/guardian and collects completed form from parent after each treatment. Tracks cases and informs the Public Health Nurse (PHN), as needed. Inspects class contacts after consultation with the PHN. Consults with PHN regarding use of product containing non-fda approved ingredients for treatment of head lice. Supports FCCPS/FCHD Head Lice Guidelines to address pediculosis in the school setting. Public Health Nurse: Provides training for School Health Aide (SHA) and validates SHA s screening skills. Consults with school staff and/or parent/guardian regarding lice. Provides health education for students and school staff. Monitors trends and investigates outbreaks, as indicated. Recommends the direct inspection of close contacts or others who may have been exposed, as appropriate. Provides guidance to SHA and Principal on extent of contact screening. Supports FCCPS/FCHD Head Lice Guidelines to address pediculosis in the school setting.

5 RESPONSIBILITIES OF THE SCHOOL ADMINISTRATION AND STAFF PREVENTION OF HEAD LICE Principal: At the beginning of each school year sends the Lice Brochure to all parents and guardians. Recommends parents and guardians inspect their children s heads on a routine basis for head lice. Provides opportunities for PHN to educate school staff and parents regarding lice. Consults with public health nurse when a live lice infestation has been identified. Supports FCCPS/FCHD Head Lice Guidelines to address pediculosis in the school setting. School Staff: Limits classroom/school activities that may result in head to head contact. Discourages students from sharing combs, brushes, hair apparel, plush toys, headphones, pillows, and clothing (especially costumes). Wipes headphones between use with a damp paper towel. Instructs students to hang outer garments, such as coats, so that they are not touching, if possible. Consults with public health nurse when a live lice infestation has been identified. Supports FCCPS/FCHD Head Lice Guidelines to address pediculois in the school setting.

6 RESPONSIBILITIES OF THE PARENTS OR GUARDIANS: HEAD LICE If your child has live lice: Inform the public health nurse or school health aide at your child s school. Check the hair of everyone in the household. Consult your pediatrician or public health nurse for treatment information. Treatment with a FDA approved anti-pediculosis product should be given to those people who have live lice except children under 2 years of age and women who are pregnant or breastfeeding. See brochure for description of lice. After the initial treatment, complete a Lice Treatment Verification Form which can be obtained from the school clinic. Return the form to your child s school health room before the child returns to school. Clean clothing, bedding, and soft toys using hot water, hot dryers (for at least 20 minutes), or by dry cleaning. Items that cannot be washed should be sealed in a plastic bag for 2 weeks. Vacuum carpeting, upholstery and car seats. Disinfect combs and brushes and then wash in hot water daily. Disinfecting is done by soaking them in lice shampoo for 4 minutes or boiling them in water for 10 minutes. Retreat your child eight to ten days after initial treatment and return the second Lice Treatment Verification Form to the school health room. Check your child s hair daily and manually remove nits for the 2 weeks following the initial treatment. Continue to check your child s head weekly for 4 weeks. Consult with your doctor, school nurse, or local health department for more information.

7 FDA APPROVED ANTI-PEDICULOSIS PRODUCTS 9/09 I. Lindane-generic Bio-Well G-Well Hexit Kwell PMS Lindane Scabene Thionex II. Malathion-generic Ovide III. Permethrin-generic Acticin Elimite Lice Crème Rinse Nix Nix Cream Rinse IV. Pyrethrims/Piperonyl Butoxide (base)-generic A-200 Pyrinyl II Blue Gel Pyrinyl Plus Clear Lice Elimination Rid Licetrol Tisit Licide Tisit Blue Pronto Triple X Pyrin-x Tegrin LT Pyrinyl