HEAD LICE MANAGEMENT IN SCHOOL SETTINGSnursingnetwork-groupdata.s3. ... HEAD LICE MANAGEMENT IN SCHOOL

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