2. Six legged, no winged insects They live close to the scalp They feed from blood from the head They spread through head to head contact They vary in size from a full stop – about 3-4mm long Female louse lays eggs when she is about 10 days old she will lay about 50-150 eggs during her lifespan Lice are the insects, young lice called nymphs are transparent until after their first blood Meal Lice lay eggs close to the scalp which makes them difficult to detect Nits are the empty shells that stick to the hair shaft

3. Detection of head lice 1. CHECK Parents once a week check your childs head Wet hair, condition, leave conditioner in, use head lice comb If lice are detected treatment is advised Diagnosis can only be made when live louse are found

4. Treatments: Four principle treatments 1.Pesticides two types in the BNF Malathion – (derbac) Lice can develop high resistance to chemicals Favourable safety record Not recommended if child has eczema/asthma Can cause skin irritation Not to be used on broken skin Eradication rate 33% (Thornton and Ross 2010) Permethrin – lyclear not recommended in BNF current preparation too diluted to be effective (BNFC 2011-2012)

5. 2. Non pesticides: Dimeticone (Hedrin) Coat the outside of the louse causing interference with water balance it to die, research suggests that because this is a physical process the lice cannot build resistance. (BNF 2011; NPF 2011) Less effective against eggs and needs to be repeated after 7 days (BNF 2011) Eradication rate 97% Avoids resistance (Thornton and Ross 2010)

6. 3. Wet combing/bug busting 38% – 57% effective at eradicating lice Labour intensive, relies on commitment of both parent and child – therefore cannot be relied upon to tackle at community level (Schweiger 2012) No chemicals involved therefore preferred by Some parents

7. 4. Alternative remedies Electronic devices not suitable for general use Herbal/essential oils Eucalyptus oil/tea tree oils/lavender oil limited evidence to assess their effectiveness some oils can be toxic Some products claim to act as repellents not recommended (Schweiger 2012)

8. What is the best product? Systematic review of RCTs, Case studies and Cohort studies comparing the above treatment methods found that in all cases Dimeticone was significantly more effective at the eradication of head lice compared to malathion (Burgess et al 2007; Schweizer 2012) Burgess et al (2007) was a small sample for a RCT, total random sample of 73 children with head lice 25 cures and 5 reinfections (Dimeticone) 9 cures and 1 reinfection (malathion)

9. Which To Choose? Age – not licensed for under 6 months Contra-indications – asthma, skin problems Resistance – what has been tried previously why is it not working Avoiding resistance Parent preference

10. Apply sufficient lotion evenly over DRY hair ensuring that the scalp is fully covered Allow the hair to dry naturally. Leave on the hair for at least 8 hours or overnight. Wash the hair with normal shampoo, rinse thoroughly with water and dry. Duration of treatment It is important that Hedrin® Lotion is applied again after seven days to deal with any lice which may hatch in that time. Failure to repeat the treatment may result in the return of a louse infestation Thornton and Ross (2010) Hedrin 4% lotion – 50mls (£2.98) 150mls (£6.92)

11. Hedrin once – liquid gel (100ml (£8.00) 250ml (£17.35) SHAKE THE BOTTLE WELL BEFORE EACH USE. Apply sufficient gel evenly over DRY hair, to ensure that the scalp and hair are fully covered and the hair is SATURATED. Work into the hair with the fingers or an ordinary comb spreading the gel thoroughly and evenly from the roots to tips. Leave on the hair for at least 15 minutes (or longer if more convenient). Apply shampoo directly to the entire surface of the hair without first wetting it, shampoo thoroughly then rinse with water. Repeat the process, then apply conditioner, rinse and dry. (Thornton and Ross 2010)

12. Hedrin Once spray gel 100ml (£9.00) 60ml (£5.00) The spray comes ready assembled. Before use remove the coloured safety clip from under the spray nozzle. This may be retained or disposed of safely. Holding the spray approximately 10cm from the hair carefully spray sufficient solution evenly over DRY HAIR to ensure that the scalp and hair are fully covered and the hair is saturated. Leave on the hair for at least 15 minutes or longer Wash the hair with normal shampoo, do not wet hair first, rinse thoroughly with water and dry. (Thornton & Ross 2010)

13. Apply straight onto dry hair, following the instructions on the pack. Shake the bottle well before use then rub or comb the lotion into the hair until it’s covered from root to tip. Leave on for at least 8 hours or overnight Rinse or shampoo it out, you’ll find it comes out really easily. Repeat after 7 days (Thornton and Ross 2011) Hedrin treat & Go mousse 100mls (£10.00)

14. Hedrin Once spray gel 100ml (£9.00) 60ml (£5.00) The spray comes ready assembled. Before use remove the coloured safety clip from under the spray nozzle. This may be retained or disposed of safely. Holding the spray approximately 10cm from the hair carefully spray sufficient solution evenly over DRY HAIR to ensure that the scalp and hair are fully covered and the hair is saturated. Leave on the hair for at least 15 minutes or longer Wash the hair with normal shampoo, do not wet hair first, rinse thoroughly with water and dry. (Thornton & Ross 2010)

15. References: BNF (2011) BNF for children the essential resource for clinical use of medicines in children. London. BMJ Burges, I. Lee P. Matlock, G. (2007) Randomised controlled, assessor blind trial comparing 4% Dimeticone lotion with 0.5% malathion liquid for head lice infestation. Plosone (11) pp 1121-1127 NPF (2011) Nurse prescribers formulary for community practitioners. London. BMJ. Schweiger, M. (2012) Head lice – Evidence based guidelines based on the Stafford Report 2012 update. Public health medicine controlled group. Thornton and Ross (2010) New best practice guidelines for tackling head lice. [online] available from:http://www.checktreatcomplete.co.uk/about-this- module/about-hedrin.php [Accessed 9/3/2012]http://www.checktreatcomplete.co.uk/about-this- module/about-hedrin.php

16. PRACTICE STANDARDS Licence as a prescriber (only prescribe from relevant formulary) Accountability Assessment Need (must be genuine clinical need) Consent (information sharing) Communication Record keeping Prescribing and administration (kept separate) Prescribing and dispensing (kept separate) Evidence based prescribing Delegation Gifts and benefits

17. NMC STANDARDS OF PROFICIENCY FOR NURSE PRESCRIBERS Assess client’s clinical condition Undertake thorough history (including medications) Decide on appropriate management of condition (?prescribe) Identify appropriate products if medication required Advise client on effects and risks Write prescription (with client consent) Monitor response to medication and lifestyle advice