Administrative Procedure 5164 - Pediculosis (Head Lice) Control in the Schools

I. Purpose

To provide procedures for conducting effective pediculosis surveillance in schools and for preventing the spread of pediculosis.

II. Policy

The Board directs the Superintendent of Schools to promote the physical, mental, and social health of students and staff through a Coordinated School Health Program. (Policy 0116)

III. Background

Pediculosis (Head lice) infestations are common in the United States among children age 3 to 12 years of age. All socioeconomic groups are affected by head lice and infestations are not associated with poor hygiene or with the spread of any disease. The only symptom is itching. Lice cannot hop or fly; they crawl and the transmission in most cases occurs by direct contact with the head of an infested individual. Transmission of head lice through indirect contact with personal belongings of an individual (combs, hats brushes, etc.) is not very common. (Center for Disease Control- CDC) Note: Animals do not carry head lice.

Both the American Academy of Pediatrics (AAP) and the National Association of School Nurses (NASN) advocate that “no-nit” policies, i.e. a child must be free of nits before they can return to school, should be discontinued for the following reasons.

Many nits are more than ¼ inch from the scalp. Such nits are usually not viable and very unlikely to hatch to become crawling lice, or may in fact be empty shells, also known as ‘casings’.
Nits are cemented to hair shafts and are very unlikely to be transferred successfully to other people.
The burden of unnecessary absenteeism to the students, families, and communities far outweighs the risks associated with head lice.
Misdiagnosis of nits is very common during nit checks conducted by nonmedical personnel.

IV. Definitions

Nits - Nits are the eggs of head lice and attach to the hair strands close to the scalp. Viable nits are nits with the potential of hatching and becoming live lice and are usually located within ½ inch of the scalp.
Pediculosis - Pediculosis is an infestation of lice

Pediculus humanus capitis (head lice) is a parasitic insect that can be found on the head, eyebrow or eyelashes of people. Head lice feed on human blood several times a day and live close to the human scalp.

V. Procedures

School Nurses Role: The school nurse is responsible for providing health education and anticipatory guidance to the school community regarding “best practices” of pediculosis surveillance and control. The school nurse’s goals are to contain infestations, provide the appropriate health information for treatment and prevention, prevent overexposure to potentially hazardous chemicals, and minimize school absences.
Screening: If a student in a school is suspected of having head lice the following procedures will be followed:
1. The person suspecting the lice infestation should contact the school nurse or, if unavailable, the school-based administrator. The school nurse will look closely through the hair and scalp of the student to determine if there are live lice and/or nits that are located ½ inch or closer to the scalp. Children who have live head lice do not need to be sent home early from school: they can go home at the end of the day, be treated, and return to class after appropriate treatment has begun.
2. If the nits are located ½ inch or more from the scalp, no further action is necessary.
3. If live lice or nits located less than ½ inch from the scalp are identified, the school nurse will notify the parents/guardians in writing or verbally of the identification of head lice and provide information about the needed treatment and the requirements for the student’s remittance into school.
4. The school nurse will inform the principal or designee of any case(s) of pediculosis in the school.
5. The school nurse will check siblings and close friends of the infested child and may notify school nurses in other schools where siblings may attend. If live lice or nits located less than ½ inch from the scalp are identified, #3 above will also be followed for siblings and close friends.
6. The school nurse will send home a Head Lice Fact Sheet from the Maryland Department of Health and a letter to parents of students in the child’s classroom.
Follow up:
1. Students will be readmitted to school with proof of treatment such as:
  1. A note from a medical provider or;
  2. An empty package or box top from an over the counter medication and receipt of recent purchase.
2. The school nurse will rescreen all infested children 7 to 14 days after treatment and may recommend retreatment.
Environmental Interventions: Objects, clothing, furniture or carpeting that came into contact with the scalp of the affected child in the last 24 to 48 hours before treatment should be cleaned. Items that can’t be washed should be bagged in a tightly sealed plastic for 2 weeks. Carpet and furniture should be vacuumed.

VI. Monitoring and Compliance

Review monitoring tool in the electronic health record. Report to be run quarterly basis by School Health Supervisor or designee.

VII. Maintenance and Update of These Procedures

These procedures originate with the Department of Student Services, Office of School Health and will be updated as needed.

VIII. Cancellations and Supersedures

This Administrative Procedure cancels and supersedes Administrative Procedure 5164, dated May 1, 2011.