MARY SHARON LOPEZ, RN CERTIFED SCHOOL NURSE PEDICULOSIS MARY SHARON LOPEZ, RN CERTIFED SCHOOL NURSE

TYPES HEAD LICE PEDICULUS CAPITUS BODY LICE PEDICULUS HUMANUS PUBIC LICE PTHIRUS PUBIS

DESCRIPTION PARASITIC INSECT FEEDS ON HAIR’S BLOOD SUPPLY AND EXCRETES A SUBSTANCE THAT PREVENTS BLOOD FROM CLOTTING DOES NOT TRANSMIT A PATHOGEN SIZE OF A SESAME SEED 6 LEGS WITH HOOK-LIKE CLAWS THAT ARE SUITABLE FOR GRIPPING HAIR SHAFT HABITAT REMAINS NEAR SCALP IN ORDER TO MAINTAIN BODY TEMPERATURE MOVES BY CRAWLING

LIFE CYCLE EGGS (NITS) Laid by adult female Cemented at the base of the hair shaft near scalp 0.8mm by 0.3mm in size Oval Yellow to white 6-9 days to hatch The closer to the scalp, the more likely to survive Not all nits are viable – only those deposited by an inseminated female will hatch

LIFE CYCLE Nymph hatches to the size of a pinhead Molts three times before becoming an adult Reaches adulthood about 9 - 12 days after hatching

ADULT LOUSE Females are larger than males Females may lay up to 8 nits per day Can live up to 30 days on a person’s head Without blood to feed on, a louse will die within 1 to 2 days off the host

INFESTATION HOW AND WHY? Lice have evolved along with the human race Very common and distributed world-wide Preschool and elementary-aged children are infested most often Females are infested more than males Reliable statistics of incidence are not available Most common transmission is head to head contact Infrequently, transmission occurs from shared hats, combs, and hair accessories, as well as from infested bedding or upholstered furniture

SYMPTOMS/DIAGNOSIS Itching of head – may or may not occur due to the saliva of the louse as it bites the scalp. Tickling sensation of something moving in the hair Diagnosis is made by observing nits, nymphs, or adults

INSPECTION PROCEDURE Part hair in sections, tie off, check for nits close to scalp Use a fine tooth comb to comb through each section, one section at a time Use a methodical approach to your inspection – start on one side and work your way around the scalp from your starting point Behind ears, crown, and nape of neck are common areas where nits are found Live insects move rapidly away from hair movement and light

EQUIPMENT NEEDED STRONG, BRIGHT LIGHT MAGNIFYING GLASS IS HELPFUL METAL OR PLASTIC NIT COMB (FINE TOOTHED COMB) PATIENCE AND PERSEVERANCE!

TREATMENT OF PERSON CONSULT PEDIATRICIAN/PHARMACIST ABOUT A PEDICULOCIDAL SHAMPOO USE SHAMPOO ACCORDING TO PACKAGE DIRECTIONS DO NOT REWASH WITH REGULAR SHAMPOO OR USE A CONDITIONER AFTER PEDICULOCIDE HAS BEEN USED FOR 1-2 DAYS RETREAT ACCORDING TO PACKAGE DIRECTIONS IN 7-10 DAYS MANUALLY REMOVE NITS WITH BRIGHT LIGHT AND FINE TOOTH NIT COMB AFTER SHAMPOOING INSPECT HAIR DAILY, AND REMOVE NITS AS THEY ARE FOUND

TREATMENT OF HOME Wash bedding and articles of clothing that have been worn within the past two days. Wash in HOT water and dry on the HOT cycle for at least 20 minutes. Both nits and adults are killed in 10-20 minutes at 125 F. If items can’t be washed by machine washing, dry cleaning will kill them. Vacuum all surfaces that are upholstered. Don’t forget your car interior! Place stuffed animals that child has had contact with in a sealed plastic bag for two weeks. Combs, brushes, etc. can be disinfested by soaking them in one of the pediculicidal shampoos for one hour or in a pan of boiling water for 5-10 minutes

DURATION/REINFESTATION WHEN WILL IT END???????????? IT WAS GONE, NOW IT’S BACK!!!!!!!!!!!!! ARE THEY RESISTANT TO THE MEDICATION IN THE SHAMPOO???? IT IS IMPORTANT TO USE A COMBINATION OF VISUAL INSPECTION, MANUAL NIT-PICKING, AND PEDICULICIDAL SHAMPOO CONTINUE VISUAL INSPECTIONS LONG AFTER YOU SUSPECT THE LICE HAVE BEEN ELIMINATED!!

RESISTANCE TO TREATMENT May be related to one or more of the following: Misdiagnosis Not following treatment instructions fully Medication is not working – consult pediatrician if you have had to retreat three times Reinfestation

HERBAL/NATURAL REMEDIES Neither the CDC or the AAP can verify the effectiveness of these remedies

PROPHYLAXIS Inspect your child’s head daily, whether you have received a notice from school or not! Advise your child not to share hair grooming items or accessories Advise your child not to play with the hair of friends or schoolmates Avoid sharing sports helmets Avoid sleepovers

RANDOLPH PROCEDURE Teachers and parents/guardians should report any noticeable head scratching and/or skin irritations of neck and forehead to school nurse. If live lice or nits are identified, contact the parent/guardian and inspect siblings. Exclude student from school, recommend physician follow-up, begin treatment, and provide identification letter. Elementary level – Inspect class and send notification letter to classmates/grade level Childcare providers will be notified and copied on all correspondence pertaining to incidence of pediculosis. Upon return to school, student must report to the health office for re-inspection. Students must have no evidence of live lice and must be “nit-free” to remain in school. Students must report to the health office two weeks later for a re-check.

PROCEDURE FOR INCIDENCE OF PEDICULOSIS Student Reports to Nurse Inspect Hair Do Nothing Live Lice/NITS Elementary Secondary Contact parent/guardian and inspect sibling(s) Check entire class, recommend physician follow-up, exclude from school, and begin treatment Re-inspect student(s) (student must be “nit free”) Provide letter home to class/grade level & to identified student Return to school and recheck in 2 weeks STOP Exclude from school, recommend physician follow-up, and begin treatment Provide parent/guardian identification letter Re-inspect student No Yes PROCEDURE FOR INCIDENCE OF PEDICULOSIS SEC2-13-PEDICULOSISFLOWCHART

RESOURCES Pediatrician / School Nurse Public Health Nurse www.cdc.gov www.hsph.harvard/edu www.aap.org