Head Lice

Anyone who notices the following symptoms of lice should make a referral to a nurse or other authorized person who can provide a head check exam to determine the presence or lice or nits.  A full complete head check is not necessary once any evidence of lice or nits are found.  Treatment is recommended even if only 1 nit or louse is seen.  A thorough follow-up head check must be done following treatment. 

  1. Unusual prolonged itching of the head.  Other health problems causing itching may be detected.

  2. Skin irritations at the hairline of the neck and ears – this can be the result of scratching.

  3. Light infestations may not cause symptoms, therefore itching should not be relied upon as a definitive diagnostic sign.  Lice “bites” cannot be felt – itching is a result of lice saliva that builds up on the scalp.
  4. Actually seeing the louse – they are very small (about the size of a sesame seed), but visible, ranging in color from cream to black.  They move very quickly and are good at hiding in the hair so may be difficult to find.  They do not jump or fly.

  5. Seeing the nits (eggs).  These are more numerous and stationary so are easier to find.  The nit is a tiny tear-shaped speck on the hair shaft ranging in color from white, yellowish or brown.  It does not flake off like dandruff or dry skin and cannot be brushed out.  The eggs are firmly cemented to the hair and must be pulled off in order to remove.

  6. Nits are most commonly found around the nape of the neck and the ears where it is warmest. Finding numerous nits within 6 mm of the scalp is highly suggestive of active infestation. Finding nits more than 6 mm from the scalp could be indicative of previous infestation, but still require treatment.

  7. When a child is found to be infested with head lice or nits, all contacts and/or classmates who sit within touching distance should be promptly examined, as well as any siblings in the school.  If more children are found infested in those classrooms, all the students in those classrooms should be examined.

Ultimate responsibility for treatment and control of head lice falls on parents or guardians, not the school.  School personnel are responsible for parental notification, cleaning in infested classrooms, and completing a head check after treatment to allow return to school. 

  1. Treatment should be started as soon as lice or nits are found. 

  2. There are multiple lice-killing products available, including shampoos, lotions and cream rinses.  Some are available over-the-counter and some by prescription only.  All must be used carefully and exactly as directed on the package to be effective.  Most pediculicides are pesticides or contain harsh chemicals and can be toxic if not used properly or too frequently.  They should not be used on infants, pregnant women or nursing mothers.  Lice have become  resistant to some of these products and there is a 7-14 day wait required between treatments.
  3. The ACCHD recommends the use of De-Bug Shampoo and/ or De-Bug Lice Oil.  This is a non-toxic, safe, effective, organic enzyme-based alternative to pesticides or other toxins.  It works by breaking down the outer “shell” of lice, causing them to die.  Treatment can be repeated the same day until all lice and nits are gone and can be repeated daily or weekly as needed.
  4. Children can usually be back in school the next day, thus reducing absenteeism.

  5. De-Bug is only sold to health departments and schools, so is not available through drug stores.  Families can be referred to the ACCHD for De-Bug products and provided with written information and verbal instructions on the proper use of this product.

  6. De-Bug products available at ACCHD:
    • 16 oz bottles of De-Bug Spray Shampoo, enough for 8 – 16 treatments - recommended for family use. - $10
    • 4 oz bottles of De-Bug Lice Oil Spray - $5
    • Plastic shower caps, and fine-tooth steel nit combs – free with purchase of any De-Bug product.

For more information on De-Bug Lice Treatment – www.safe4people.com

A thorough follow-up head check is required following treatment to determine if treatment was successful in eliminating all lice and nits. Students will not be re-admitted to school until a head check shows them to be nit-free.  All schools in Ashland County must provide this follow-up exam by the school nurse or a trained school employee before an infested child is re-admitted to school.  Schools may choose to also check non-school-attending family members or they may refer them to the ACCHD for examination. For adults or when school is not in session, ACCHD Nursing Division will conduct head checks as needed for suspected cases as well as follow-up head checks after treatment.

Environmental Control of Lice 

a.   Thorough cleaning of bedding and all objects that were in contact with infested persons in the 48-hour period before initial treatment is necessary to eliminate the entire chain of transmission of lice.

b.  Indirect transmission can occur within 48 hours of contact via lice-carrying fomites such as: 

    • Brushes
    • Hats, scarves, helmets
    • Combs
    • Upholstered furniture
    • Pillows and cushions
    • Towels and bed linens
    • Clothing
    • Costumes and masks
    • Stuffed animals, doll, cloth-covered toys
    • Carpeting                                            

c.   Effective disinfection can be achieved by vacuuming, machine washing, machine drying, dry cleaning, ironing, freezing, or storing fomites in tightly sealed plastic bags for two weeks.  The following recommendations are based on the fact that temperatures of 125 degrees F or higher are lethal to lice and nits.

      1. Floors, rugs, pillows, and upholstered furniture should be thoroughly vacuumed to remove hairs that might have viable nits.  Lice only live off the head for 1-2 days.
      2. All clothing, linen, and cloth toys that the infested person might have worn or handled in the 48 hours before diagnosis should be machine washed in hot water (125 degrees F) or placed in a freezer overnight.   
      3. Items that cannot be machine washed but can be machine dried should be dried at the hottest setting for at least 20 minutes.
      4. Other items may be dry-cleaned, carefully vacuumed, placed in a freezer overnight, or sealed in plastic bags for two weeks. 
      5. Combs and brushes should be soaked in hot water (125 degrees F) for one hour. 

d.  School personnel are responsible for vacuuming infested classrooms and collecting and removing loose articles of clothing as well as rugs, blankets or pillows used by children for naps or activities.

e.   It is not necessary (or recommended) to spray, fumigate, or otherwise chemically treat the home, school, or child care center for lice.

f.   Human lice can be temporarily carried around on pets and animals but cannot live on them.

Call ACCHD Nursing Division at 419-282-4357 for more information.

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