Head Lice: a report for Consultants in Communicable Disease Control (CCDCs)

Head lice: notes and guidance for school nurses

(or other responsible school health officer)

General

• Please read the attached Statement carefully. It is your professional duty to ensure that you are fully informed and up to date with current scientific knowledge and practice.
• Health professionals should make sure that they are able to identify a louse at all stages of its development. It helps to have a magnifying glass to hand.
• Parents and staff should be made aware that head lice are only transmitted by direct, prolonged, head-to-head contact.

Specific

• Do not undertake routine head inspections as a screening procedure. Detection combing should be done by parents, but it is important that they are given proper information, advice and support by you. This should be in accordance with the Statement.
• Do especially always adhere to the following principles of control (see Appendix 5: have you got head lice? - notes for families, Appendix 6: how to treat head lice - notes for families, and Appendix 7: head lice; the truth and the myths - notes for families):

• definite diagnosis; a living, moving louse found by detection combing
• listing and examination of contacts by the family
• simultaneous thorough and adequate treatment of all cases
• repeat of the treatment after seven days

• Do make a professional assessment of reported cases of head louse infection of any child in the school. If the report is from the child’s parent, make sure that the parents are provided with information, advice and support. If the report is from a teacher, for example that the child is scratching continuously or that a moving louse has been seen on the head, it may be necessary to examine the child to establish a diagnosis. If your knowledge of the parents is good, it may be sufficient to make contact with them to ensure that they know how to undertake detection combing and what to do if there are head lice present.
• Do not diagnose head louse infection unless you yourself have found a living, moving louse, or you have physical evidence from the parents; ask them to stick one of the lice on a piece of paper with clear sticky tape and bring it in to you or one of their other health advisors.
• Do not recommend the head teacher to send out "alert letters" to other parents. In fact, encouragement should be given not to do so.
• Do yourself understand and teach your families and school staff that the correct use of insecticidal lotions is the scientifically confirmed way to treat head louse infections.
• Do not ever recommend treatment unless a louse has been clearly identified (as described above). If you do recommend treatment, ensure that it is done adequately for the case and infected contacts.
• Do make every effort to discourage unnecessary or inappropriate treatment with insecticides.
• Do not assume that "reinfections" or "treatment failures" are truly infections. Make sure that a louse is found or produced.
• Do not ever recommend retreatment without first of all establishing that living, moving lice are still present after two applications of lotion seven days apart and after a full professional assessment as to the ways in which the family may not have complied carefully with the first attempt.
• Do resist the temptation to agree with parents’ suggestions that a first course of treatment has failed, that "it must be a resistant strain", and a that further course of treatment should be given. This may be an easier approach in a busy schedule, but is not in the best interests of the family. There is no substitute for a proper professional assessment.
• Do be prepared to do a domiciliary visit if that is the most tactful and effective way of dealing with a family problem, especially for a "problem family". You have the professional skills and training to educate, persuade, inform, guide and support them.
• Do not recommend or support any mass action, including wet combing campaigns.
• Do not support the use of electronic combs, repellent sprays, or chemical agents not specifically licensed for the treatment of head louse infections.
• Do play an active part in providing regular accurate information about head lice to parents and staff. This should be done in conjunction with your local Consultant in Communicable Disease Control and the head teacher, and should preferably be integrated into a package along with information on other health issues.
• Do not wait until there is a perceived major outbreak and corresponding agitation in the school. A regular educational programme rather than a reactive "campaign" is more sensible.

(This document was originally appendix 3 of Head Lice: a report for Consultants in Communicable Disease Control (CCDCs).)