I. Purpose: To provide guidelines for managing Pediculosis in Queen Anne s County Public Schools while reducing the number of missed days by students.

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1 QUEEN ANNE S COUNTY DEPARTMENT OF HEALTH POLICY & PROCEDURE School Health Services PEDICULOSIS GUIDELINES I. Purpose: To provide guidelines for managing Pediculosis in Queen Anne s County Public Schools while reducing the number of missed days by students. II. Rationale: Lice are tiny parasites that live among human hairs and feed on blood. Pediculosis (head lice) is very common, particularly for children between the ages of 3 to 12 years. Lice are not dangerous and do not carry disease, but because they cause anxiety among parents and staff and are contagious, it is important to manage and control head lice in the school setting. According to COMAR 13.A , Maryland public schools are required to develop procedures for dealing with non-reportable communicable diseases such as Pediculosis. III. Guidelines: A. Assessment Information regarding Pediculosis will be available on the Queen Anne s County Public Schools website. The school nurse will examine any student who complains of scalp itching or who has been referred to the health room due to increased scratching of the scalp. The nurse will also screen a child who mentions that he or she or a family member had head lice. B. Treatment 1. If live lice are found, the student will be maintained in the health room and the parent/guardian contacted to retrieve the student from school. The nurse will provide education to the parent/guardian to include verbal and written information. The location and appearance of the lice on the student s head should be pointed out to the parent. This serves two purposes: 206 North Commerce Street Centreville, Maryland Fax: Joseph A. Ciotola, Jr., M.D., Health Officer

2 Page 2 of 6 Revision Date: July 2015 a. It clearly demonstrates that the student is infested, a fact which many parents are reluctant to accept if the child is merely sent home with a note; and, b. It shows parents what the lice look like so they will be able to examine other family members for evidence of infestation. 2. The student should be treated with a pediculocide such as Rid or Nix. Parents should be cautioned to follow directions on the package. Family members should also be checked and treated if necessary. 3. All bedding and clothing worn within hours should be washed in hot water and dried in a dryer if possible. Any items that cannot be washed or dry cleaned should be sealed in a plastic bag for two weeks. Mattresses, carpet, and furniture should be thoroughly vacuumed. 4. Hair items such as brushes, combs, hair bands, and barrettes should be soaked in alcohol or the lice shampoo for an hour. The parent or guardian should try to remove as many nits as possible. This is best done by grasping the nit between the thumb and forefinger and pulling it gently down the hair shaft. 5. A letter and checklist (see attachments) should be sent home with the child. The checklist should be completed by the parent/guardian and returned to the school nurse when the child returns to school. The parent/guardian should bring the child to school to be examined by the nurse before the child may return to class. 6. If a child is found to have head lice, any siblings or other close contacts (friends, etc.) in the school system should also be screened. If three or more students in a class are infested, a letter (see attachment) should be sent home to the parents of the children in the class informing them of the situation and advising them to monitor their children. The school nurse will use her nursing judgment as to whether to check and screen entire class. 7. Remind teachers to discourage direct contact (head to head) as much as possible. Carpeted areas in the classroom should be vacuumed daily. Educate teachers to avoid allowing children to share dress-up clothing, hats, coats, and other garments that may lead to spread of the Pediculosis. Outwear may be separated using plastic bags or other barriers.

3 Page 3 of 6 Revision Date: July If no live lice are found, but nits are present, the child should NOT be excluded from school. The American Academy of Pediatrics states that no-nit policies are detrimental, resulting in unnecessary loss of school days for students and inappropriate allocation of the school nurse s time (Sciscione & Krase-Parello, 2007). In addition, Pollack (as cited in Sciscione & Krase-Parello, 2007) states that there is no scientific evidence to support that no-nit policies reduce transmission of lice in schools. 9. The parent of a child found to have nits should be contacted (phone or letter) and encouraged to try to remove the nits as much as possible, especially any nits that are within ¼ from the scalp. The child s head should be re-inspected in 7 to 10 days by the nurse for live lice. If live lice are found, the preceding procedure should be followed. C. Re-Entry to School 1. The student may return to class if there are no live lice noted. The parent should be reminded to continue to examine the child several times per week, to remove nits seen, especially those close to the scalp, and to re-treat the child with Rid or Nix in approximately 7 days. 2. The school nurse should examine the student in 7 to 10 days to check for re-infestation. 3. Students should be able to return to school the day after they were excluded provided the parent or guardian has used the appropriate treatment. If the child is out more than 2 days following the exclusion, the nurse should call the home and assess the situation in order to assist in facilitating treatment if needed. D. Persistent Re-Infestation 1. It is possible that a child may have a repeat infestation of lice. However, if more than two infestations have occurred back to back, the nurse should re-educate the family regarding treatment and removal of nits. 2. Family members should be strongly encouraged to be screened. Stress the importance of frequent checks at home. 3. Consult or suggest the parent/guardian consult the child s provider for a stronger treatment. 4. Offer a referral to Multiple Points of Prevention.

4 Page 4 of 6 Revision Date: July Conduct a home visit (if consent provided by parent/guardian) to view the home and suggest modification. 6. If infestations persist after these measures, consult the Department of Health. E. General Unproven treatment such as oils, mayonnaise, or other similar products should not be advocated by the school nurse. Research has not proven these to be effective in the treatment of Pediculosis (NASN, 2004) and some products impede the effectiveness of the pediculocides. References American Academy of Pediatrics, Clinical Report, April 27, 2015, Updates Treatments for Head Lice. American Academy of Pediatrics, Clinical Report, Head Lice, 06/20/2016. National Association of School Nurses (2004). Position statement: Pediculosis in the school community, NASN, Retrieved November 10, 2008 from the NASN website. Sciscione, Patricia and Krause-Parello, Cheryl A. (2007). No-nit policies in schools: time for a change. The Journal of School Nursing, 23(1), Retrieved October 14, 2008, from ProQuest Health and Medical Complete database (Document ID: ). Joseph A. Ciotola, Jr., M.D. Health Officer Date Mary Ann Thompson, R.N., B.S.N. Director of Nursing & Clinical Programs Date

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