HEAD LICE MANAGEMENT IN SCHOOL in School... · HEAD LICE MANAGEMENT IN SCHOOL SETTINGS Shirley Gordon,

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HEAD LICE MANAGEMENT IN HEAD LICE MANAGEMENT IN SCHOOL SETTINGSSCHOOL SETTINGS

Shirley Gordon, PhD, RNChristine E. Lynn College of Nursing

Florida Atlantic University

February 7, 2009FASN Conference

Shirley Gordon, 2009

The Head louse is an Ancient Parasite That:

Needs to feed on human blood every 2-3 hours [1mg per feeding]

Is easily transmitted through head to head contact

Is present on 1% to 3% of the worlds general population at any given time (Roberts, 2002)

Primary weapons used against the parasite areneuro toxic pesticidesLeading pesticide originally developed as an agent for bio chemical warfare

Costs

Direct: $90 million each year in the US

Cost of treatment products -

Average 5 self treatments before seeking help

Indirect Costs

Indirect:

Lost school days = lost school funding

California

10% children with lice/4 days =

$3.2 million

NY -

$20-$40/day/child = $25-$35 million

Nationwide $10-$40 per day per child/ 33.5 Million children in grades K-8 = $280 - $325 million in lost funding

Lost work days $2,720/wages per family per active infestation

Now Imagine:

Your child has head liceYour entire family has head liceAnd despite repeated treatment attempts [sometimes over a period of years] you cant get rid of it

Objectives:

Review current research related to head liceIdentify family centered lice treatment and prevention strategies Increase ability to recognize lice, eggs and nits

Head Lice (Pediculosis Capitis)Common among children ages 2 to 12 years old

Widespread throughout the United States and the world

6-12 million cases a year in the US (CDC)

Elementary schools may reach 25% infestation. (Roberts, 2002)

Photo: 2001-03, Johns Hopkins University School of Medicine: Dermatlas

http://dermatlas.med.jhmi.edu/derm/

Head Lice:Head Lice:

Size of sesame seed (adult)Wingless - Do not jump or flyAre human parasites host specificDo not live more than 24 hrs off their human host. Do not infest homes/schoolsAre highly stigmatized

PresenterPresentation NotesAdapts Color:Red or black lice are found on dark hair and skinGray-white lice on light hair and complexions

La Valle, A. (1999) Head lice: The truth, the myths, the update. School Nurse News, 17 (4). 34.( This was a presentation at the NASN Conference 1999) Hansen, R. C. & colleagues from Working Group on the Treatment of Resistant Pediculosis. (2000, August). Guidelines for the treatment of resistant pediculosis. Contemporary Pediatrics, (Suppl.), 6.

Life Cycle:Life Cycle:Lifespan approximately 30 days

Females lay up to 5-10 nits (eggs) per day (150-400 in a lifespan)

Nits hatch within 7-10 days and release nymphs (immature louse)

Nymphs reach adult reproductive stage in 8 or 9 days

PresenterPresentation Notes

La Valle, A. (1999) Head lice: The truth, the myths, the update. School Nurse News, 17 (4). 34.( This was a presentation at the NASN Conference 1999)

Nits (Eggs)Nits (Eggs)

Nits, tiny teardrop shaped eggsAttached to one side of the hair shaft with water proof, glue-like substanceLaid 1/4 inch from the scalp. (In warmer climates, viable nits can be found as much as 6 inches or more from the scalp)

PresenterPresentation NotesNits are often found:Nape of the neckBehind the ears

Hansen, R. C. & colleagues from Working Group on the Treatment of Resistant Pediculosis. (2000, August). Guidelines for the treatment of resistant pediculosis. Contemporary Pediatrics, (Suppl.), 6.

Active Infestation

Presence of at least one live louse

or Live lice & viable nits

Screen the entire familyTreat only active cases

Transmission:Transmission:

Direct head to head contactTheoretically, may be shared through fomits such as hats, combs, and towels, etc. (thought to play a minor role in transmission)

PresenterPresentation NotesDirect:Head to head contact with an infested person: During an embrace Close friend SiblingIndirectly:Through sharing personal items which come in contact with the head such as: hats combs and brushes head bands and scrunchies towels Brainerd, E. (1998). From eradication to resistance: Five continuing concerns about pediculosis. Journal of School Health, 68 (4), 146-150.

Common Symptoms:Common Symptoms:Many children (50%) experience no symptoms.Symptoms take several weeks to developWhen symptoms occur, the most common are:

Scratching -

Sleeplessness

Red, hive-like bumps on the head.

Rash on back of neck

PresenterPresentation NotesChildren have sleeplessness because:Lice are more active at night.

Secondary bacterial infections such as, impetigo and swollen lymph glands, can occur when: Symptoms go undetected and untreatedThey are not common

Hansen, R. C. & colleagues from Working Group on the Treatment of Resistant Pediculosis. (2000, August). Guidelines for the treatment of resistant pediculosis. Contemporary Pediatrics, (Suppl.), 6. Estrada, J. S., & Morris, R. I. (2000). Pediculosis in a school population. The Journal of School Nursing, 16 (3), 34.

Head Lice are a Community Head Lice are a Community Problem:Problem:

Only 1 in 10 transmissions occur at school.

Common Outbreak Times:Common Outbreak Times:

Start of the School Year

After Winter Vacation

After Spring Break

Whenever children are in the community for extended periods of time

PresenterPresentation Notes

Socoloff, F. (1994). Identification and management of pediculosis. Nurse Practitioner, 19 (8) 62-63. Clore, E. R., and Longyear, L. A. (1990). Comprehensive pediculosis screening programs for elementary schools. Journal of School Health, 60 (5), 212-214.

Factors Contributing to Absenteeism

Exclusion PoliciesMisdiagnosis of Active Head LiceFailure to Treat / Treatment FailureFatiguePersistent head Lice

Exclusion Policies

No Nit Live Lice Only Non Exclusion Florida School nurses reported that the number of days children were excluded from the 2002-2003 school year for head lice ranged from 0 to 100 days (Gordon, 2004)School Districts vary on the number of days children receive an excused absence for lice

Conversion From Nits to Live Lice

In a CDC study:

1700 Atlanta children screened

91 had evidence of nits or lice (5%)

Only 28% (476) had active infestation

50 (10.5%) children diagnosed with nits (no live lice present) were followed for 2 weeks

18% (9) went on to develop live lice

5 or more nits close to the scalp

predictor

of

conversion to live lice

Williams, Reichert , McKenzie, Hightower, & Blake, 2001

Misdiagnosis of Active Infestation

Active Infestation: Live lice & viable nits

In a research study in which participants were asked to gather samples from identified head lice cases:

555 samples were sent in

57.5% of samples showed evidence of lice & eggs

teachers samples / 50% active

relatives / 47.1% active

nurses / 31.7% active

physicians / 11% active

Pollack,

Kiszewski,

Spielman, (2000)

Failure to Treat / Treatment Failure

Children may be excluded from school because caregivers:

Fail to treat their childs head lice

Misuse products leading to treatment failure

Do not complete follow-up

Lice and Nit removal

Experience resistant lice

Overuse products

Do not screen & treat other family members / contacts [contact tracing]

Treatment Approaches: Pesticides

Prescription:LindaneMalathion

OTC:Pyrethroids

Barrier

Dimeticone

Showing great promise

Creates a physical barrier around the louse

Does not act on the nervous system

Contraindications

On children under 6 months: medical supervisionPreparations with an alcohol base should not be used on children under 5Pyrethroid based products are contraindicated in persons with allergy to chrysanthemum flowersPreparations with an alcohol base should not be used on persons with scalp dermatitis or asthma.

Well ventilated rooms, away from heat sources like: open flames, stoves, cigarettes, hair dryers

Alternative Treatments

Mechanical removalHerbal and essential oils

Tea tree oil and lavender oil can be toxic in concentrates

Limited empirical evidence to determine effectiveness

Importance of Contact Tracing ( 9 out 10 family members in 4 homes )

Referral case6 yo Female

Uncle 59 Mother/Fatherbrother (10) brother (8)Aunt (no lice)

cousin (4) / cousin (7)

Grandmother 89

FatigueLice are more active at nightChildren with head lice report disrupted sleep patterns resulting in:

Irritability

Diminished ability to concentrate

Poor school performance

Sleepiness in class

Children sent to health room for falling asleep in class should be checked for head lice

Persistent Head Lice CasesA small number of children develop persistent cases: Diagnosis of live lice 3X in 6 weeks that are not amenable to treatment (Gordon, 2002, 2007)Children with persistent lice may be placed at risk:

educationally due to excessive absences from school

physically from unsafe treatment strategies

Emotionally from stigma & fea