KISD Procedure for the Control of Head Lice Detection

Detection involves inspection of the student’s head, examining for either live head lice and/or nits. Examination is initiated when: 

1. The nurse observes either nits on a student’s head or constant scratching of the head while performing other nursing duties. 
2. The student complains of scalp irritation and/or itching. 
3. A classroom teacher reports suspicion of head lice. 
4. A parent reports suspicion or confirmation of head lice. 
5. The siblings of a confirmed case have been identified. 
6. Follow-up checks on students with chronic or repeated head lice infestations are warranted. 
7. The school nurse deems an examination screening advisable. 
8. Mass screenings are not recommended by the Center for Disease Control (CDC) or Texas Department of State Health Services; therefore, if requested, mass screenings will not be performed by the campus nurse or clinic staff as they are not a good use of time or resources and are not supported by evidence to improve prevention or control the spread of head lice.

Conducting the Exam

1. The school nurse, or other school personnel trained by the school nurse in the appropriate methods of detection, will perform the examination.  The student’s integrity and self-esteem are to be always respected.  A brief description of the procedure is to be explained to the student prior to initiation of the screening.  Assuring the student that the activity is quick, easy, and painless is of utmost importance. Disposable instruments to aid in the exam may be used (e.g., wooden sticks, tongue depressors) at the discretion of the examiner. (However, if individual instruments, such as wooden sticks, are used during multiple exams, they must be used on all students and not just selected individuals in the group. Each student will have a new instrument.)
   
   
2. To conduct the exam, the student stands or sits in front of the examiner in a well-lit area. The head is bent forward with the student’s chin down to the chest. The hair at the nape is parted and the scalp and hair are inspected for signs of head lice and/or nits. The same inspection is conducted in the hair behind each ear and at the top front of the head. The rest of the head may be inspected as deemed necessary by the school nurse, but the minimum screening involves the four stated sites. The screening may take place in the classroom, the clinic, or other appropriate site to be determined by the school nurse or health aide.

Treatment

1. There is no preventative treatment for head lice, therefore, if no active cases are detected, no treatment or notification is warranted.
2. Should an active case of live head lice be detected, the student will be excluded from school and the parent/guardian of the student will be notified and asked to pick up the student for treatment. 
   1. If an active case of lice (nits, nymphs, or adults) is observed by the campus nurse or reported to the campus by a parent, the Texas Senate Bill (SB) 1566 and Texas Department of State Health Services (DSHS) mandates notices be sent to parents of the affected class within 5 school days. SB 1566 also mandates a formal notice must be sent to the affected student’s parents within 48 hours of lice (nits, nymphs, or adults) being observed by the campus nurse or reported by the parent.
      1. Texas law does not speak to local (district) board policy regarding exclusions. Notices must include the recommendations of the Centers for Disease Control and Prevention for the treatment and prevention of lice.
      2. Cessation of close or head-to-head activities in the classroom should be initiated until the classroom is clear of any cases.  The school nurse along with KISD Health Services Department will work closely with the teacher to resolve any questions or problems.
3. Should a heavy infestation of nits be noted with obvious and continual scratching, and/or signs of scalp infection noted, the parent will be notified.  The parents will be encouraged to remove the nits and instructed in further action that might be needed.
   1. The parents will be sent general information about head lice.  The school nurse should encourage and assist the parent as needed to make sure all nits have been removed from the child’s head so that follow-up checks will be valid, and the unsightliness and stigma of visible nits are eliminated. 
   2. However, this district does not adhere to a “no nit” policy, with our goal being to keep the student in class and to work with the parent to resolve any problems.  
   3. There are other alternative treatments such as mayonnaise, tea tree oil, Vaseline, mineral or olive oil, and vinegar rinses do not have any ovicidal effect. The use of these products does not eliminate the importance of nit-removal with an FDA-approved treatment.
      1. These treatments are not approved by the Food and Drug Association, and the Department of State Health Services does not support either the efficacy or inefficacy of such treatments.  

Exclusion

1. Any student infested with live lice (nymphs or adults) will be excluded from school until treatment is administered and the student is free of all live lice.
2. The parent will be contacted and instructed to pick up the child immediately.
3. School bus transportation will not be provided from school to home on the day the student is excluded.
4. Upon returning to school, the student will be cleared by the school nurse or clinic aide before reporting to class.
   1. If there is still evidence of infestation with live lice, the child will not be allowed to remain in school. 
5. For resistant or repeated cases, the student may be referred to his/her primary care physician to rule out other medical conditions and to provide additional treatment alternatives. 
6. It is primarily a parental responsibility and if not resolved appropriately, the principal or designee may report the neglect to a district review committee for resolution. The goal of these guidelines is to allow for early and effective treatment of head lice, to minimize the potential spread of lice in the school setting, and to minimize school absences related to this condition.
   1. Lice do not carry disease and are considered a social issue by the CDC and the Texas DSHS. Contacting Child Protective Services will not be deemed as an appropriate action for resistant or untreated cases of lice without related concerns for the child’s welfare and safety.

Guideline Appeal  

1. The principal or designee may appeal the “no nit” policy to a district review committee to address extenuating circumstances.

Follow-up  

1. Follow-up on pediculosis cases should be with the student, parent, and teacher as deemed necessary by the school.
2. Checks for re-infestation may be made as often as necessary as determined by the school nurse.