Head lice, unlike body lice, do not transmit any disease agent and do not present a public health threat.  But lice cause a high level of anxiety among parents of school age children. The psychological, social and economical impact of head lice infestations can create a problem in the community. The School District of Kettle Moraine will take the necessary measures to reduce the loss of instructional time for students and actively assist families in managing cases of head lice. Number of lice cases should be reported to public health (not names of individuals).  It is absolutely imperative that the confidentiality of students and families be maintained.
 

Prevention

It is probably impossible to prevent all had lice infestations. (AAP P. 394)  Understanding the life cycle of lice and the mode of transmission will help alleviate some of the anxiety surrounding lice infestation, avoid unnecessary exclusion of students, misdiagnosis and inappropriate treatment.

Prevention strategies in the school setting should allow for flexibility and take into consideration student age and the environmental learning space and class activities. Educating school staff and parents on the signs and symptoms of head lice infestation and  mode of transmission will help with early identification and minimize risk of transmission.  The school nurse is responsible for investigating reported cases of head lice and responding to referrals from teachers.

School and classroom practices can be implemented as needed.  Examples include:

• Assign individual hooks or lockers for student belongings.
• Have students keep their hats inside their coat sleeves.
• Discourage sharing of personal items such as combs, brushes, or hair ornaments..
• Provide students with individual headphones.
• Provide education for staff and families on the district website.

Managing isolated cases of head lice

Students who have lice may return to school immediately after treatment with a lice killing shampoo.

• When parents report finding lice at home, treatment should be confirmed and the student should be screened by the school nurse upon return and rescreened in 3-4 weeks, the length of time needed to establish infestation.  Screening of siblings and whole classrooms is at the discretion of the school nurse and building administrator. Screening for nits alone is not an accurate way of predicting which children are or will become infested and screening for live lice has not been proven to have a significant effect on the incidence of head lice in a school community over time (AAP clinical report 398)

Staff who suspects head lice should report this immediately to the school nurse.

Intense itching is the presenting symptom of head lice. The gold standard for diagnosing head lice is finding a live louse on the head.  Any student identified by the school nurse as having lice and / or confirmed untreated nits within 1cm  of scalp may be excluded for treatment as soon as practicable. All live bugs should be manually removed as soon as lice are detected.  The student may be removed from the class room with the least disruption as possible.  Health staff will contact the parent(s) or guardian(s) and advise treatment as soon as possible.

• Residual or old devitalized empty nits should not be mistaken for infestation. Children should not be over treated with a lice - killing shampoo.  Evidence of live lice is the only indication for treatment with lice killing shampoo and  re- treatment never sooner than 7 to 10 days.
• Instructions for treatment should be given to the family of each student identified with active lice. The school nurse should confirm that the family understands the instructions and has the resources to follow through with the treatment plan.
• The school nurse or other trained personnel will examine all children in the affected classroom as soon as practicable. Rechecks of all students in classroom should be done in 10 days and in 4 weeks.
• Students will be readmitted to school after the first treatment with written or verbal confirmation from the parent or guardian that treatment has been completed.
• Each re-entering student will be examined by trained personnel to look for evidence that the treatment was performed satisfactorily.
• Parents will be encouraged to thoroughly inspect their children’s heads for lice as school screenings do not take the place of these more careful inspections.
• If a child is assessed as having head lice, confidentiality must be maintained so the child or family is not embarrassed.
• A child should be allowed to return to school after proper treatment. Parents should be encouraged to remove as many nits as possible. Some schools have “no nit” policies under which a child is not allowed to return to school until all nits have been removed. The American Academy of Pediatrics and the National Association of School Nurses (www.nasn.org/positions/nitfree.htm) discourage such policies as it prolongs school absence unnecessarily.
• If an active case of lice (5+ live bugs) is found please ask maintenance to vacuum the carpeting and any upholstered furniture at the end of the day.
• Lice do not live more than 24-48 hours off a body and do not survive in cold temperatures.
  
  

PROCEDURES FOR MANAGING A HEAD LICE OUTBREAK

An outbreak is considered to have occurred when greater than 8 - 10% of the individuals in a classroom, school, or child care facility have evidence of lice infestation. If the number of cases is considered to be an outbreak, intensified measures of exclusion, head checks and environmental controls should be considered.

• Send home for treatment any individuals with evidence of live lice.
• Send home for treatment any individuals who have nits within 1 cm of the scalp but have NOT yet been treated or it has been 4 weeks since the last treatment.
• Check all heads in affected classrooms daily if practicable until all evidence is eliminated.  Recheck in 4 weeks.
• Vacuum carpeted classrooms and upholstered furniture daily during outbreak.
• Put coats and outer wear in plastic bags.
• Remove all pillows, bean bags and stuffed animals from classrooms.
• Discontinue temporarily activities that involve close person-to-person contact.
• Do not spray classrooms with pesticides.
• Parents should be warned against over treating.  If treatment failure is suspected, confirm that the parents used an effective product exactly per package instruction and that the head was thoroughly saturated with shampoo for the required time. 
• Siblings and close personal contacts should be examined, and if infected, should be instructed on treatment procedures.
• Send general fact sheet and a notice of the outbreak home to all parents.
• Elicit help of all parents to check for head lice daily.
• Encourage parents to notify the school, childcare provider, and other close personal contacts when head lice have been identified.

All information for the development of this protocol has been adapted from the  AMERICAN ACADEMY OF PEDIATRICS CLINICAL REPORT, PEDIATRICS

PEDIATRICS Volume 135, number 5, May 2015

 http://pediatrics.aappublications.org/content/pediatrics/early/2015/04/21/peds.2015-0746.full.pdf