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  • HEAD LICE MANAGEMENT IN HEAD LICE MANAGEMENT IN SCHOOL SETTINGSSCHOOL SETTINGS

    Shirley Gordon, PhD, RN Christine E. Lynn College of Nursing

    Florida Atlantic University

    February 7, 2009 FASN 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 are neuro toxic pesticides Leading 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 lice Your entire family has head lice And despite repeated treatment attempts [sometimes over a period of years] you can’t get rid of it…

  • Objectives:

    Review current research related to head lice Identify 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 fly Are human parasites – host specific Do not live more than 24 hrs off their human host. Do not infest homes/schools Are highly stigmatized

    Presenter Presentation Notes Adapts Color: Red or black lice are found on dark hair and skin Gray-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

    Presenter Presentation 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 eggs Attached to one side of the hair shaft with water proof, glue-like substance Laid 1/4 inch from the scalp. (In warmer climates, viable nits can be found as much as 6 inches or more from the scalp)

    Presenter Presentation Notes Nits are often found: Nape of the neck Behind 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 family Treat only active cases

  • Transmission:Transmission:

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

    Presenter Presentation Notes Direct: Head to head contact with an infested person: During an embrace Close friend Sibling Indirectly: 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 develop When symptoms occur, the most common are: –

    Scratching -

    Sleeplessness

    Red, hive-like bumps on the head. –

    Rash on back of neck

    Presenter Presentation Notes Children 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 untreated They 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

    Presenter Presentation 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 Policies Misdiagnosis of Active Head Lice Failure to Treat / Treatment Failure Fatigue Persistent 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 child’s 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: Lindane Malathion

    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 supervision Preparations with an alcohol base should not be used on children under 5 Pyrethroid based products are contraindicated in persons with allergy to chrysanthemum flowers Preparations 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 removal Herbal and essential oils –

    Tea tree oil and lavender oil can be toxic in concentrates

    Limited empirical evidence to determine effectiveness