IPC 3.4B Infestations - Pubic 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
5.10 Occupational exposure
6.0 Surveillance
7.0 Outbreaks
8.0 References/Source documents
Records of changes

1.0 Introduction

Organism - Pubic Lice (Pediculosis pubis)

Pubic lice are cause by the insect Phthirus pubis. They are approximately 2mm in length, grey-brown in colour, eggs are a yellow/white appearance and smaller than a pinhead Pubic Lice - NICE. They can infest in coarse hair such as facial hair, eyebrows/eyelashes, chest hair, back hair and pubic or perianal hair.

 

Individuals at risk

Close physical contact with the infested person, occasionally through contact with clothing, towels or bedding. But this is rare Pubic lice - NHS.

 

Notifiable disease

No

 

Informing IPC team

Yes

 

2.0 Safeguarding

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

• 06.01 (Issue 10) Safeguarding Children
• 06.04 (Issue 13) Safeguarding Adults at Risk
• 01.03 (Issue 3) Chaperone Policy

Investigate if these are recurrent infestations or neglect. For pubic lice, children (or adults) may have contracted innocently but further advice is to be sought to enable appropriate management as per safeguarding policies.

 

3.0 Mode of transmission

Pubic lice are spread by close physical body contact or sexual contact. They can be transferred through clothing, towels or bedding but this is rare. Pubic lice - NHS.

 

3.1 Risk factors

Close, physical contact with the infested person. Determine if the pubic lice infestation has been acquired via sexual or nonsexual contact. If sexual contact, consider safeguarding implications/referrals and refer to GUM clinic for potential contact tracing, treatment and screening for other sexually transmitted infections. Avoid close bodily contact until treatment has been successfully completed. Scenario: Management of pubic lice - NICE.

 

3.2 Signs and symptoms - clinical indications

• Itching in coarse hair, especially at night (may take up to 3 weeks to develop).
• Small red or blue spots on the skin (lice bites).
• White or yellow dots from lice eggs attached to the hair.
• Crusty or sticky eye lashes if affected.
• Dark red or brown spots on underwear from the lice faeces.

 

3.3 Screening

If direct contact with an individual known to be infested. Only confirmed if pubic lice or eggs have been detected on examination. A fine-toothed comb may be useful for detection in areas with excessive hair.

 

4.0 Antimicrobial treatment guidance

Appropriate topical insecticide is required see formulary guidance Skin and soft tissue infections - Pubic lice (Notts APC) which includes eyelash infestation guidance.

Some are not licensed for use in children or breastfeeding women Pubic lice - NICE.

A second treatment is required after 7 days to ensure any remaining lice have been eradicated Skin and soft tissue infections - Pubic lice (Notts APC). If able, the person is to examine for the presence of live lice 7 days after treatment is completed to ensure no live lice are present. If they are unable to self-check, the clinical healthcare professional to do so with consent and chaperone using fine-toothed comb if required for excessive hair.

Identify any close contacts (sexual or shared bedding or towels) who will need to undertake a self-examination as they may require treatment or referral to genito- medicine (GUM). Self-care leaflet - Pubic lice - NHS.

 

5.0 Infection prevention and control principles

 

5.1 Isolation

No requirement for isolation but to avoid close contact, and do not share bedding, towels or hygiene products.

Prison settings and places of detention guidance Isolation

Patients with head and/or pubic lice do NOT require isolation - appropriate treatment is required. Patients who have body lice require treatment with chemical insecticide. Laundry Bed linen, towels, clothing to be sent to laundry as infected and washed or dried at temperatures above 50°C or sealed bag for two weeks. 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

Gloves and apron when handling infected linen or applying treatment if a patient requires assistance, considering chaperone and consent.

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

Check the bed mattress is sealed, no rips/tears. Vacuuming the mattress may be advised for patients living in their own home.

NHS England » Chapter 2: Transmission based precautions (TBPs)

 

5.6 Environmental cleaning

NHS England » Chapter 2: Transmission based precautions (TBPs)

 

5.7 Linen

Secure clothes and bedding in a plastic bag for at least a week if unable to wash clothes and bedding on a hot wash (minimum 50°C).

Skin and soft tissue infections - Pubic lice (Notts APC) 

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

 

5.8 Body fluids

Not applicable.

 

5.9 Waste

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

 

5.10 Occupational exposure

Any lice exposure to refer to Occupational Health/own General Practitioner.

 

6.0 Surveillance

GUM clinic referrals may be required and discussion with Infection Prevention and Control (IPC) Team for contact tracing.

 

7.0 Outbreaks

Discussion with IPC if 2 or more cases.

 

 

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 NHS.

• Pubic lice - NHS
• 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 Health Service (2022) Pubic Lice . (Accessed: 8 August 2023).
• National Health Service England (2023) National infection prevention and control manual (NIPCM) for England . (Accessed 15 February 2024).
• National Institute of Health and Care Excellence (2018) Pubic Lice. (Accessed: 1 February 2023).
• Nottinghamshire Area Prescribing Committee (2022) Skin and soft tissue infections: Pubic Lice. (Accessed: 8 August 2023).
• UK Health Security Agency (2023) UKHSA guidance on the management of scabies cases and outbreaks in long-term care facilities and other closed settings. (Accessed: 1 February 2023).

 

Record of changes

Record of changes

Version	Date	Expert writer	Status (New or edited)	Comments and details of changes being made
1	23/01/2017	Diane Churchill-Hogg	Edited	Three yearly review completed. References updated. Minor amendments only. Section 4.1 Changed in line with research-based evidence regarding safety of Permethrin.
2	June 2018	D.Holmes	Edited	Minor amendments only Section 3.2 Changed to The Adult Scabies mite is approximately 0.4 mms 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. Transfer to new Trust policy template.
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.
5	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.
6	January 2024	K Hodgkiss and Infection Prevention Control team	Edited	Policy reviewed and edited to new Trust approved template. Head lice, Pubic lice and Scabies listed separately. Minor adjustments to treatment section.