Head Lice Protocol

• The school nurse will contact the parent/guardian and provide instructions on treatments to be started as soon as possible. The student may be dismissed per the school nurse's assessment.

• A student with nits may remain in school, with parent/guardian notification of the head condition and treatment instructions. 

• Upon return to school, the school nurse will re-check the student and determine signs of treatment initiation and status of the condition. If improvement of the head condition is noted, the student may return to class with continued monitoring by the school nurse and parent following a mutually communicated plan.

• General informational letters will be sent out periodically to educate parents/guardians of their responsibility in screening/treating for nits/lice, the importance of informing the school nurse if their child has lice, and to provide resources from larger health organizations in the detection, prevention, and treatment of lice. 

Over-the-counter Lice Treatment

• Use over-the-counter lice treatment as directed. Ask a pharmacist questions if necessary.

• Use on dry hair; apply the amount listed on the product.

• Massage lice treatment thoroughly onto dry hair until hair is completely soaked.

• Leave lice treatment on hair as directed, rinse out.

• If you've tried over-the-counter lice treatments recently and feel they're not effective, contact your child's health care provider. 

Combing/Pulling Out Nits

This is the most important step in getting rid of head lice. No lice treatment kills 100% of nits, so all nits must be removed to prevent them from hatching. If one nit is left, the head lice problem could continue. 

• Good light is a necessity. Sunlight or fluorescent lights are best. Nits will be missed in regular light.

• Metal combs work better than plastic combs. Combing out nits is not the same as combing hair with a regular comb. You must divide hair into 4 sections, and take small, tiny sections (1 inch wide) of hair and comb or pull out nits. If combs do not work, you will need to pull the nits out with your fingernails.

Checking Hair Daily

Use bright light, section hair, and spend time daily searching for nits. Remember, if nits remain, they may not be dead from the lice treatment. If nits hatch, the problem will start all over again. Continue to check hair for nits daily for at least a month. Notify your school nurse if you find additional nits or adult lice. 

Re-Treat

• Re-treat hair in 7-10 Days if you see live lice. The school nurse will also plan to recheck within the plan discussed with you. 

• Retreat with lice treatment. Follow instructions. Continue to pull out nits.

Home Treatment

• Wash all bed linens and pillows daily in hot water. Place in the dryer. Vacuum mattress daily. Wash clothes worn, hats, and other washable items in hot water. Dry clean items if necessary.

• Vacuum carpet, cloth furniture, and seats of cars. Throw the bag away.

• Place all stuffed animals or items with cloth in an airtight bag for 2 weeks.

PROCEDURE:
Students exhibiting signs of possible head lice infestation are referred to the health office for assessment. Symptoms prompting a referral may include complaints of an itchy scalp, excessive scratching, or sighting of a louse, and can be made by the student or staff member. The nurse will examine the child for the presence of lice or nits. If live lice or nits are found, the student may return to class for the remainder of the school day based on nursing discretion. The student should be discouraged from close direct head contact with others. The student may be dismissed if the School Nurse’s assessment indicates that the student is uncomfortable due to the severity of the infestation. Staff will maintain the privacy of students identified as being infected with head lice.

The school nurse will contact the parent/guardian after identification of head lice or nits, and will be given specific instructions on how to treat for lice. School nurses will perform targeted pediculosis screenings based on the affected student’s known close contacts and siblings. Whole class screenings for nits alone have not been proven to be effective and will only be performed based on multiple live lice infestations found in a single class.

If a student is dismissed from school, the School Nurse will re-examine the student upon returning to determine the initial success of the recommended treatment. Students may attend class regardless of the presence of lice/nits based on the nurse’s discretion. If the infestation is unchanged, the School Nurse may request that the parent/guardian come into the Health Office for instruction on identification and removal of nits/lice.

If a cluster of cases is discovered in the same classroom, a general informational notice regarding lice may be sent home to the parents/guardians of the students in the classroom based on nursing discretion.

RECOMMENDATIONS:

• Educate parents regarding their responsibility in screening/treating for nits/lice and provide resources such as the Public Health Fact Sheet on Head Lice from the Massachusetts Department of Public Health. School nurses will periodically remind and educate parents (newsletters, student handbook, brochures) on the importance of informing their child’s School Nurse if their child has head lice.
• Educate building staff by providing copies of the fact sheet and encouraging students’ outer clothing be placed in individual lockers or separate hanging hooks.
• Educate students about how head lice are passed from person to person and from objects such as shared combs, brushes, hats, and hair accessories.