IPC 3.4A Infestations - Scabies, Lice

Contents

1.0 Introduction
2.0 Safeguarding
3.0 Mode of transmission
3.1 Risk factors
3.2 Signs and symptoms - clinical indications
3.3 Screening
4.0 Antimicrobial treatment guidance
5.0 Infection prevention and control principles
5.1 Isolation
5.2 Hand hygiene
5.3 Respiratory / Cough hygiene 
5.4 Personal protective equipment
5.5 Equipment
5.6 Environmental cleaning
5.7 Linen
5.8 Body fluids
5.9 Waste standard
5.10 Occupational exposure
6.0 Surveillance
7.0 Outbreaks
8.0 References/Source documents
Appendix 1
Appendix 1(b)
Appendix 2

 

1.0 Introduction

Organism - Head lice (Pediculus humanus capitis)

Head lice are very small insects (up to 3mm long) that feed on blood from the scalp several times a day. Head lice live for up to 30 days and can survive up to 1-2 days off the scalp (NICE, 2021). They most often affect children and their families. They are very difficult to spot, and are spread through direct transfer from head-to-head contact, or by sharing head wear, towels or combs.

Nits are head lice eggs which can be hard to see as have a similar appearance to dandruff. They take about a week to hatch. The egg cases will remain after hatching and can be seen as white spots attached to the hair.

Nymphs are baby lice that hatch from the nits, take approximately seven days to mature and receive nourishment from blood.  

Adults are approximately 3mm, have six legs and are tan to greyish white. Adults can live up to 30 days and also feed on blood Head lice (pediculosis) - GOV.UK

 

Incubation period

The incubation period of the egg (nits) are 7-10 days, adult lice can live for up to 30 days. May take up to 2 weeks for pruritus (itching) to occur.

 

Period of communicability

Immediately if direct contact with the louse.

 

Individuals at risk

Contact with the infested person of direct head-to-head contact or sharing towels, combs or headwear.

 

Notifiable disease

No

 

Informing IPC team

Yes

 

2.0 Safeguarding

Consider safeguarding principles for infestations and refer to Trust Clinical Policies below:

• 06.01 Safeguarding Children
• 06.04 Safeguarding Adults at Risk

Escalate concerns as per policy if these are recurrent infestations or neglect.

 

3.0 Mode of transmission

Direct transfer from head-to-head contact with the infested person, or by sharing head wear, towels, or combs. Only by finding live lice will determine if the person has head lice (NHS, 2021).

 

3.1 Risk factors

Direct head-to-head contact with the infested person or by sharing head wear, towels, or combs. Close living conditions.

 

3.2 Signs and symptoms - clinical indications

The main symptoms of a head lice infestation are pruritus (itching), sores on the scalp or movement in the hair. The infestation may be present without any symptoms as it can take up to two weeks for pruritus to occur. 

Finding live lice will determine if head lice are present. Check the scalp/eyebrows, eye lashes for nymph or adult louse. They can be difficult to find and so a fine-toothed comb (detection comb) must be used.

 

3.3 Screening

Wet combing with a fine-toothed comb (detection comb).

 

4.0 Antimicrobial treatment guidance / options

• Wet combing with a fine-toothed comb (detection comb). See Appendix 1
  (a) Image of head lice (Pediculus humanus capitis) and Appendix 1
  (b) Instructions for Wet Combing. See Appendix 1b.
• If appropriate, Dimeticone (example brand Hedrin) is effective against head lice and acts on the surface of the organism. Other treatments are available, to discuss with clinician as precautions may apply. Caution as some products may be flammable. Follow instructions as directed with use of PPE, gloves, apron, eye protection if risk of splashing.
• Treatment with lotion or liquid formulations are only to be used if live lice are present. A contact time of 8-12 hours or overnight treatment is recommended for lotions and liquids. A 2-hour treatment is not sufficient to kill eggs. Shampoos are too diluted to be effective.
• 3-5 days after treatment, use a fine-toothed comb to check for lice. Self care headlice (nottsapc.nhs.uk).
• In general, a course of treatment for head lice should be 2 applications of product 7 days apart to kill lice emerging from any eggs that survive the first application. Check for head lice 3-5 days after second treatment. All affected individuals should be treated simultaneously (Nottinghamshire Area Prescribing Committee, 2023) Self care headlice (nottsapc.nhs.uk)

 

5.0 Infection prevention and control principles

Treat all affected, discussion with Infection Prevention Control Team.

 

5.1 Isolation

Patients do not need to be isolated but avoid head contact with others do not share towels, head wear and combs. On completion of treatment, the combs that are obtained from pharmacy, are single patient use and should be discarded. All contacts within the clinical setting must be identified and hair checked using wet combing method.

 

Prison Settings and Places of Detention Guidance

Patients with head and/or pubic lice do NOT require isolation - appropriate treatment is required. Patients who have body lice require treatment with a chemical insecticide.

Bed linen, towels, clothing to be sent to laundry as infected and washed/dried at temperatures above 55°C.

Contacts - ‘Investigate cell mates and treat those infested, according to site of infestation (Department of Health, 2011, p.19)

Prevention of infection and communicable disease control in prisons and places of detention (publishing.service.gov.uk)

 

5.2 Hand hygiene

NHS England » Chapter 1: Standard infection control precautions (SICPs)

 

5.3 Respiratory / Cough hygiene

Not applicable

 

5.4 Personal protective equipment

Plastic aprons and single-use gloves to be worn when applying treatment, consider eye protection if risk of splashing.

• Appendix 5b (england.nhs.uk)
• Putting on and Removing PPE v3 (england.nhs.uk)
• NHS England » Chapter 1: Standard infection control precautions (SICPs)

 

5.5 Equipment

Single patient use fine toothed combs obtained from pharmacy.

 

5.6 Environmental cleaning

Regular cleaning of the patients’ environment in line with current cleaning schedules.

 

5.7 Linen

To be treated as infected and placed in a soluble red plastic bag.

NHS England » Chapter 1: Standard infection control precautions (SICPs)

 

5.8 Body fluids

Not applicable

 

5.9 Waste standard

NHS England » Chapter 1: Standard infection control precautions (SICPs)

 

5.10 Occupational exposure

Any staff with head lice infestations to seek treatment from local pharmacy. If related to work exposure contact Occupational Health.

 

6.0 Surveillance

Monitor and check any patients that have had head-to-head contact, shared towels, headwear or combs.

 

7.0 Outbreaks

Treat all affected, discussion with Infection Prevention Control Team.

 

8.0 References/Source documents

Lice infestations can be distressing conditions and the dignity of patients/individuals should be maintained throughout. Compliance is important when dealing with these conditions, and the patient/individual should be given as much information as possible. Information leaflets can be obtained or downloaded from the UKHSA.

Head lice and nits - NHS (www.nhs.uk)

 

References

• Department of Health and Social Care (2015) Health and Social Care Act 2008: code of practice on the prevention and control of infections (Accessed 8 August 2023).
• Health Protection Agency and Department of health (2011) Prevention of infection and communicable disease control in prisons and places of detention: a manual for healthcare workers (Accessed: 1 February 2023).
• National Institute of Health and Care Excellence (2021) Head Lice. (Accessed: 1 February 2023).
• NHS (2021) Head lice and nits (Accessed: 1 February 2023).
• Nottinghamshire Prescribing Committee (2023) Head Lice(Accessed: 31 January 2023).
• Patient (2022) Head Lice Treatment and Prevention: nits (Accessed: 25 April 2023).
• Public Health England (2013) Head lice (pediculosis) (Accessed: 24 April 2023).

 

Appendix 1 

Image of head lice (Pediculus humanus capitis)

Image is courtesy of NHS Conditions Head lice and nits

• information leaflet(s)
• Screening flow chart
• Physical health guidance

 

Appendix 1(b)

Instructions for wet combing

• Order fine-toothed (detection comb) from pharmacy, if an inpatient, and a separate comb for each individual contact.
• Wash the hair with ordinary shampoo and apply plenty of conditioner then rinse.
• Use an ordinary, wide-toothed comb to straighten and untangle the hair.
• Once the comb moves freely through the hair without dragging, switch to the louse detection comb.
• Make sure the teeth of the comb slot into the hair at the roots, with the edge of the teeth lightly touching the scalp.
• Draw the comb down from the roots to the ends of the hair with every stroke and check the comb for lice each time - remove lice by wiping the comb with tissue paper or rinsing it.
• Work through the hair, section by section, so that the whole head of hair is combed through.
• Do this at least twice to help ensure you haven't missed any areas and continue until you find no more lice.
• Self care headlice (nottsapc.nhs.uk)
• Recommended on days 1, 5, 9 and 13, if lice still remain seek clinical advice. Final check on day 17.
• Scenario: Management of head lice (NICE)

 

Appendix 2

Record of Changes

Transferred head lice guidance (Pediculus humanus capitis) from the Infestation.

07.16 Infestation Management

Record of changes

Version	Date	Expert writer	Status (New or edited)	Comments
1	23 January 2017	Diane Churchill-Hogg	Edited	Three yearly review completed. References updated. Monor ammends only. Section 4.1 changed in line with research-based evidence regarding safety of Permethrin.
2	25 June 2018	D Holmes	Edited	Minor amendments only. Section 3.2 changed to The Adult Scabies mite is approximately 0.4mm long.
3	August 2020	Carol Evans	Edited	Minor amendments. 3.3.2 Hyperkeratotic Scabies or Crusted Scabies also known as Norwegian Scabies. Amendments to reflect patients and service-users throughout. References amended. Changes to wording in treatment section. Amendment to Equality Impact Assessment (EIA) screening tool. Additional link to prescribing data. Minor terminology changes of titles and group names throughout. T
4	April 2021	L West	Edited	Reference number changed to 07.16.
5	May 2023	K Hodgkiss	Edited	Full review. Policy title changed from ‘Scabies Management’ to ‘Infestation Management’. Related policies reference numbers updated, and further related policies included. Edited as per United Kingdom Health Security Agency (UKHSA) guidance on the management of scabies causes and outbreaks in long-term care facilities and other closed settings. Updated 12 January 2023. Safeguarding statement inserted. Added Pediculosis humanus capitis and Pthirus pubis to for infestation policy.
6	June 2023	I Brackenridge	Edited	'Exceptional Circumstances’ section added as per agreement reached by the Trustwide Clinical Policies and Procedures Group (CPPG) members at meeting on 07 June 2023. ‘Service-user’ removed. Some additional restructuring of policy according to Trust  approved template.