Head Lice in schools - below is a recent report document from the stafford area

Tweet

It is about headlice (in schools) Head Lice: a report for Consultants in Communicable Disease Control (CCDCs) The "Stafford Document" Back to PHMEG home page Back to PHMEG documents page Download Word version of full document Download Acrobat version of full document Contents Authors of this document Head Lice: a report for Consultants in Communicable Disease Control (CCDCs) Introduction General Responsibility for control of head lice Diagnosis Prevention and treatment A special word on schools Campaigns National and Regional responsibilities APPENDICES. Appendix 1: notes and guidance for the primary care team Appendix 2: notes and guidance for community pharmacists Appendix 3: notes and guidance for school nurses Appendix 4: notes and guidance for head teachers Appendix 5: have you got head lice? - notes for families Appendix 6: how to treat head lice - notes for families Appendix 7: head lice; the truth and the myths - notes for families Appendix 8: Glossary and Terminology Head Lice: a report for Consultants in Communicable Disease Control (CCDCs) Introduction Back to contents list. This Statement should be read in conjunction with the Appendices which contain notes and guidance for involved professional groups (appendices 1-4, 8) and suggested key messages for public information (appendices 5-7). The latter are written in everyday non-technical language so as to be readily developed for distribution to the public, but should also be of value for training professional groups and for the development of protocols for them. There has been insufficient research into the epidemiology of head louse infection for a high level of scientific certainty to be accorded to many aspects of the management of the problem. After careful consideration of diverse professional views, the authors, however, believe that a summary Statement will be of value to colleagues around the country and will encourage a consistent approach. The Statement represents what the members of the Stafford Group believe to be a reasonable summary, based on the current state of scientific knowledge and on their own, and many colleagues’, professional experience. The word "infection" is used throughout these documents to be consistent with the view that the term "infestation" has pejorative, stigmatic overtones and should be avoided in public information leaflets. See also Appendix 8: Glossary and Terminology. The Statement is lengthy because it is intended to be an explanatory document, and to serve as the basis for the development of local policies and protocols. Because readers may selectively read sections applicable specifically to themselves, there has inevitably had to be some repetition in the document as a whole. Recommendations have not been separated from the main text, since the authors believe it is important that readers understand the reasoning behind them. General Back to contents list. Prevalence Health implications A problem of society Prevalence Although head louse infection is an infectious disease many of the problems associated with the infection are due to society’s reaction to it rather than the organism itself. The true prevalence of infection is unknown but is probably much lower than the public and professional perception. Health implications Head lice are not a serious health problem in this country. They rarely, if ever, cause physical health problems other than itching of the scalp. Adverse health effects mainly derive not from the lice themselves, but from the human perception of them: excessive public and professional reactions lead to an inflated perception of prevalence, to unnecessary, inappropriate, or ineffective action, and to a great deal of unwarranted anxiety and distress. these actions and reactions in themselves cause problems, especially from the misuse and overuse of treatments. A problem of society Head louse infection is more a societal than an infectious disease problem Responsibility for control of head lice Back to contents list Parents Primary Care Team Pharmacists School Health Services Head Teachers The Communicable Disease Control Team Parents The primary responsibility for the identification, treatment and prevention of head lice in a family has to lie with the parents, if only for reasons of practicality. Parents, however, cannot be expected to diagnose current infection, or to distinguish it from successfully treated previous infection or other conditions if they are not adequately instructed and supported by the following professionals. Primary Care Team (see "Appendix 1: notes and guidance for the primary care team".) The primary professional responsibility for the diagnosis, management, and treatment of any individual for any disease lies with the general practitioner with whom the patient is registered, as also for advice and support on disease prevention. Historically, because of a misplaced emphasis on head louse infections in schools, the former system of head inspections, and the (now discontinued) distribution of large quantities of insecticidal lotions from Health Authority clinics, primary care teams did not traditionally involve themselves to any major degree. Nowadays, for primary care workers to refuse all responsibility for the management of individuals and families registered with them is as illogical as it would be to do so for measles, impetigo, threadworms or immunisation. General practitioners (or another member of the primary care staff) should therefore be knowledgeable and competent in the control of head lice, be able to teach parents the technique of detection combing, and be prepared to advise appropriate treatment. Treatment should never be advised unless the responsible officer is convinced by physical evidence that living lice are present on the head of at least one of the family. Pharmacists (see "Appendix 2: notes and guidance for community pharmacists".) Local pharmacists should inform themselves of local district policies and protocols and should adhere to them. Every opportunity should be taken to give accurate information to the public. Customers should be dissuaded from the inappropriate, repeated, or unnecessary use of insecticidal preparations. Pharmacists (or another member of their staff) should therefore be knowledgeable and competent in the control of head lice, be able to teach parents the technique of detection combing, and be prepared to advise appropriate treatment. Treatment should never be advised unless the responsible officer is convinced by physical evidence that living lice are present on at least one of the scalps of the family. Consideration should be given to the prescribing of insecticidal lotions by pharmacists. School Health Services (see "Appendix 3: notes and guidance for school nurses".) It is regrettable that a School Health Service is no longer available in some areas. In those where it is, the school nurses (or equivalent) have responsibility for professional advice to staff, parents and children and for carrying out local policies, which should be agreed with the Consultant in Communicable Disease Control. They should provide clear, accurate, up to date information about head lice. This should be done on a regular basis not only when parents’ or teachers’ concern is already raised or there is an "outbreak" in the school. It should generally be integrated with the management of other school health problems rather than as a special separate topic. School nurses should be prepared to teach detection combing to individuals, to families (at their homes if appropriate), and to groups of parents, children and staff as required, and give advice on treatment and prevention. They should not undertake head inspections as a routine screening procedure. Head Teachers (see "Appendix 4: notes and guidance for head teachers".) The head teacher should work with the School Nurse and the Consultant in Communicable Disease Control to produce a local protocol and adhere to it. The "alert letters" system should be discontinued. The Communicable Disease Control Team (Consultant in Communicable Disease Control and Infection Control Nurse colleagues.) The Consultant in Communicable Disease Control (CCDC) is responsible for advising other professionals on the control of head lice in the population as a whole. Adequate guidelines and protocols should be produced for all involved professionals including school nurses, school doctors, nursery nurses, general practitioners, health visitors, practice nurses, community paediatricians, infection control teams, pharmacists, and head teachers (see appendices). It is particularly important that school nurses and other community nurses are given adequate support by the CCDC, including regular training sessions and advice about specific problems. In the absence of suitable nationally produced information leaflets, local leaflets should be produced in consultation with the other professionals. Information should be made available to the public in whatever way possible, including the use of the local news media. Diagnosis Back to contents list. Only one sure way Detection combing Self diagnosis Imaginary lice Only one sure way A diagnosis of head louse infection cannot be made with certainty (no matter how many nits are present, how many reported cases there are in school, how bad the itch is, or however dirty the pillows are) unless a living, moving louse is found. Detection combing The only reliable method of diagnosing current, active infection with head lice is by detection combing (the technique is described in "Appendix 5: have you got head lice? - notes for families"), though there may be other clues to their presence such as pillows being dirtier than usual in the morning. The techniqu