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Head Lice

Summary of Policy

1. This revision supercedes all previous policies.

2. The rotational treatment policy previously advised is unenforceable and no longer recommended.

3. Treatment (2 applications of lotions 7 days apart) should only be applied if live lice are detected.

4. All close contacts should be advised to check their hair but not to treat unless live lice are found.

5. If treatment fails and live lice persist a GP/Health Visitor/Pharmacist should be consulted for advice regarding alternative treatment. (N.B. nits are empty egg cases and will remain after the lice are dead.)

6. Treatment does not prevent re-infection.

7. Regular wet combing should be encouraged, both for diagnosis and for removal of nits and dead lice after treatment.

8. Grampian Health Board does not endorse alternative products (e.g. herbal treatments, louse repellants).

Prevention

  • Anti-lice treatments do NOT prevent infection.
  • Children should have a brush and comb and be taught to use them. Children and adults should brush or comb their hair twice a day. This may help prevent any infection becoming established.

Diagnosis

  • Parents should watch for early signs of infection (black dust on the pillow) and use a detector comb if ever they suspect head lice and whenever they are warned of a possible contact.
  • When washing the hair the sink plug should be inserted so that the water can be checked for any lice that may have been washed off.
  • Parents should use a detector comb on wet hair each week to check for lice. Combing may be helped by the presence of hair conditioner applied to the wet hair and combed through thoroughly. Wet combing may also remove newly hatched lice before they are sexually mature and able to lay eggs, thus reducing the extent of the infection.

Contact Tracing

Contact tracing is the family's responsibility. All close contacts should be informed. The aim is to warn everyone who may have caught the lice from the infected person and to detect the source of the infection - frequently a symptomless adult carrier.

Schools

Transmission of lice within the classroom is relatively rare. When it does occur, it is usually from a "best friend". At any one time, most schools will have a few children who have active infection with head lice (0% to 5%).

Schools are encouraged to follow the protocol on the management of head lice. Educational information should be provided to parents and children on a regular basis, preferably as part of a package dealing with other issues. The topic of head lice should be incorporated into the school health education curriculum at all ages.

If the school is informed of head lice by a parent, the school should NOT routinely send out an "alert letter" to other parents. This leads to an inflated perception of prevalence, to unnecessary, inappropriate, or ineffective action and to a great deal of unwarranted anxiety and distress. It also leads to the misuse and/or overuse of treatment.

However, there may be occasions when it becomes more beneficial to inform parents (e.g. repeated re-infection within a class) and the Head Teacher should follow the protocol in such cases. The School Nurse should be informed in confidence of all cases of head lice infection. If there is a persistent problem in a school then a combined approach involving School Nurse, Health Visitor, parents and school staff should be employed.

If a member of staff identifies an infected child, the child's parents should be informed and advised about treatment, contact tracing and detection combing (see Appendix 1). If a member of staff suspects that a child is infected, but requires confirmation, it may be necessary to contact the School Nurse for advice.

The child need not be excluded from school before the end of the school day (except in extreme circumstances) and should return to school after the first treatment has been applied. Only in rare cases should statutory measures need to be taken. (See section on legal issues).

PLAYGROUPS/NURSERIES

Transmission of lice within playgroups and nurseries is relatively rare. When it does occur, it is usually from a "best friend".
Playgroups/nurseries are encouraged to follow the protocol on the management of head lice. Educational information should be provided to parents and children on a regular basis, preferably as part of a package dealing with other issues and the topic of head lice should be incorporated into health education at all ages.

If the playgroup/nursery is informed of head lice by a parent, the staff should NOT routinely send out an "alert letter" to other parents. This leads to an inflated perception of prevalence, to unnecessary, inappropriate, or ineffective action

However, there may be occasions when it becomes more beneficial to inform parents and the Head of the playgroup/nursery should follow the protocol in such cases.

If there is a persistent problem in the playgroup/nursery then Health Visitors should be contacted for advice and support.

If a member of staff identifies an infected child, the child's parents should be informed and advised about treatment, contact tracing and detection combing (see Appendix 1). If a member of staff suspects that a child is infected but requires confirmation, it may be necessary to contact the Health Visitor for advice. The child need not be excluded from playgroup/nursery before the end of the day (except in extreme circumstances), and should return after the first treatment has been applied.