Lice

The Lice Frequently Asked Questions (.pdf) may also provide helpful information.


Head lice continues to be an ongoing nuisance. The school district attends to the guidelines of the Office of Superintendent of Public Instruction for the treatment and eradication of head lice. Health Services also considers community standards and impact in developing this protocol.

The goals of the school district are to:

  • Decrease school absenteeism.
  • Support families in their efforts to control and eliminate head lice.
  • Maintain student privacy.
Procedures for lice detection and management at school

In working with head lice and student surveillance, it is important to keep the following elements in mind:
  • Implementation of head lice surveillance and control procedures is based on current scientific research and best practice.
  • School staff is trained by the School Nurse in head lice detection and management procedures.
  • Information about head lice infestation is to be shared on a "need to know" basis as deemed appropriate by the building Certificated School Nurse.
  • Maintaining confidentiality of student information in compliance with FERPA.
  • Consideration of the student's ability to understand whether or not they have head lice and if having this information is developmentally appropriate.
  • The importance of the School Nurse and/or school staff documenting head lice surveillance efforts.
1. When a student is found to have live lice:
a) The parent is notified and information related to detection and elimination of head lice can be provided at that time or sent home with the student in a sealed envelope. A letter is available in the online handbook for this notification. Best practice is to also attempt contact personally.
b) The student is not sent home from school, however if the parent offers to pick up the student, that is acceptable.
c) The parent is instructed that the student should be treated before returning to school.
d) In some cases (based on the School Nurse's professional judgment), it may be appropriate to have the student's head checked upon return to school.
i. If lice and/or nits are found, the parent is notified to keep nit-picking and combing (at least daily per day for the next two weeks).

ii. Student hair strands can only be cut if parent permission has first been obtained either in person or by telephone—this is to be documented on Skyward Office Visit.

iii. Follow up head checks may be done by school staff to confirm lice management efforts.
  • Record these head checks in Skyward as an office visit.
  • If live lice/nits are found the process of notification to parents/guardians begins again.
2. When a student is found to have nits present (no live lice detected)
a) The parent is notified and encouraged to treat the student and nit-pick (at least daily for the next two weeks). A letter is available in the online handbook for this notification. Best practice is to also attempt contact personally.

b) The student is not sent home from school.

c) Information related to detection and elimination of head lice is sent home in a plain envelope with the student.

d) If future checks reveal an increased number of nits present or it is obvious to the screener that the student's hair has not been treated, the parent will be contacted for follow-up and support.

e) Student hair strands can only be cut if parent permission has first been obtained either in person or by telephone—this is to be documented on Skyward Office Visit.

f) Please see #7 for documentation.
3. When to check beyond the identified student with live lice or nits

If live lice or nits are detected in a student it is best practice to:

a) Determine if the student has siblings. If yes, then check the siblings in the immediate school.

b) If the student has other siblings (not in the immediate school building), notify the parent/guardian of the advisability of checking family members and taking precautionary measures to avoid family infestation.

c) If a student is found to have head lice, they are to be documented on the confidential lice log and parent notification is to occur as previously stated.

d) Full Classroom screenings for head lice are NOT done: "Current evidence does not support the efficacy and cost-effectiveness of classroom or school-wide screening for decreasing the incidence of head lice among children" (per CDC, May 2007).
4. Classroom environment
a) The classroom is only one of many environments where head lice can be transmitted. According to the CDC, most transmissions occur in the home environment (friends, sleepovers, camp etc.)
b) Classroom tips:
i. Notify the custodian to vacuum the affected classroom and all upholstered furniture within.

ii. Stuffed animals and pillows can be bagged for two weeks.

iii. Past practices of separating coats, jackets, combs, brushes or other personal items have been found not to be as important as in the past:
"...inanimate objects (such as combs, brushes, hats, helmets, headphones and hair accessories) are insignificant in harboring or transmitting head lice or their eggs. Hence, there is little, if any, reason to focus efforts ... to bag clothing, toys or other items with the intent of reducing the transmission of head lice" (from" Frequently Asked Questions)
iv. No environmental pesticide treatments (pesticidal bombs) are to be used.

v. Girls with long hair may want to wear their hair in "contained" hair styles (ponytails, buns, braids, etc.).

vi. Encourage students to avoid sharing hats, combs, coats, pillows, or other personal items.
c) The building School Nurse can use professional judgment to determine when unusual measures are necessary to respond to extraordinary cases.
5. Notification Procedures
a) The customary notification for the presence of head lice is to be done on an individual/case by case basis to the parent/guardian of an infested student. Classroom notifications are not done with typical head lice cases.

b) In the rare case a student is to be excluded (see Exclusion Procedures), a notice will be given to the parent in person, a phone contact will be attempted and documented. If there is concern about the delivery of the notification, it can be sent by certified mail. A template is available for the School Nurse to use for this notification.

c) In very unusual cases, it may be appropriate in the professional opinion of the School Nurse and in consultation with the School Principal to consider a general parent/guardian notification for a high number of identified cases of head lice. A template is available for the School Nurse to use for this notification.
6. Exclusion Procedure support

"No healthy child should be excluded from school or allowed to miss school time because of head lice or nits... 'No-Nit' policies that exclude children until all nits are removed may violate a child's civil liberties..." (D. e1362, 2015).
"Immediate or long-term exclusion is no longer recommended." (I, 76, 2014).

Note: the presence of severe infestations of untreated head lice can be disruptive to the educational setting.
a) In the rare case that a student has either: 1) chronic head lice infestation or 2) severe head lice infestation that is disruptive to the learning environment, the building nurse will be consulted.

b) If in the nurse's professional judgment it is determined that Exclusion needs to be considered, the nurse will consult with the building administrator about implementing Exclusion. This measure will only be taken with careful consideration:
i. With chronic head lice infestation cases, the nurse will secure documentation of repeated and unsuccessful head lice management measures.

ii. See Notification Procedures

iii. The return of a student after exclusion will be predicated on a head check in the main office with evidence of progress in head lice management and progress toward eradication of the head lice. Evidence will look like elimination of live lice and a decrease in the number of nits.

iv. It may be appropriate in the judgment of the School Nurse to monitor progress of lice management over a period of time; the goal is supporting the family in eradication of this pest.
7. Documentation
a) All students identified with head lice will have their names and the dates the lice/nits were found, recorded in a confidential lice log maintained in the office or health room. The confidential lice log is to be shredded at the end of the year; this is considered a "working" document and is not FERPA compliant as a method of documentation.

b) If a student is checked in the Health Room for head lice that head check is to be documented as a Health Room visit in Skyward Office Visit as well.
8. Outdoor School and Overnight Field Trip Considerations
Some outside facilities have head lice policy and procedures that are not in alignment with Edmonds School District's Head Lice Protocol. When a facility presents with requirements that are counter to our district's Protocol, an Edmonds School District staff member will consult will that facility and advise them of our Protocol. After consultation with the facility, parent/guardians will be advised of any provisions related to head lice prior to attending the event and any factors that may impact them.

RESOURCES:

Center for Disease Control: Head Lice: http://www.cdc.gov/lice/head/schools.htmlMay 16, 2007.

Clinical Report On Head LiceBarbara L. Frankowski, MD, MPH, Joseph A. Bocchini, Jr, MD, Council on School Health and Committee on Infectious Disease, PEDIATRICS Vol. 126 No. 2 August 2010.

Exclusion of Children with Head Lice or Nits from Child Care (white Paper) July 22, 2010. Washington State Department of Early Learning,

Fact Sheet: Head Lice: Snohomish Health District. Revised September 2010.

Frequently Asked Questions: Head Lice. Identify Us. 2010.

Infectious Disease Control Guide for School Staff; Washington State Department of Health; Office of Superintendent. of Public Instruction. June 2004.

Informal Parent Survey of Parent Attitudes Around Head Lice Notification, Buter, Leslie A. RN, BSN, & Sutherland, Nancy N. RN, MEd. October, 2010.

Managing Head Lice in the School Setting (PowerPoint). Cole, Marjorie, RN MSN. 2005. National Assembly of School Nurses Listserve.

SCHLRN List Serve: Cross State Lice Procedures Inquiry/Responses (anecdotal information from practicing School Nurses). 11.29.2010

Snohomish Health District Memorandum on Head Lice; August 16, 2010, Goldbaum, Gary, MD.

Snohomish Health District Memorandum on Lice; September 30, 2010, Goldbaum, Gary, MD.
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