Comprehensive Pediculosis Screening Programs for Elementary Schools Ellen Rudy Clore, Leah Ann Longyear
ABSTRACT: Pediculosis (head lice) is a major school and community health problem with an estimated 6-12 million cases annually resulting in $367 million a year in consumer costs, lost parental wages, and school system expenses. The greatest incidence is seen in children ages 5-12; however, the incidence in the 24-36 year old group is increasing due to their exposure to infested children. Developing comprehensive pediculosis screening programs in elementary schools provide.\ an effective method f o r preventing epidemics from occurring by accomplishing early derection. These programs also promote primary health care and education among elementary schoolchildren, school officials, educators, and parents. A n effective program includes screening the entire school three times a year: mid-September, December, and near spring 1 acation, and enforcing a “No Nit” policy. Establishing a successful approach to control pediculosis results in decreased incidence and transmission, reduced absenteeism, and financial savings f o r parents and school districts. (J Sch Health. 1990:60f5):212-214~
P
ediculosis,commonly known as head lice, continues to be a major school and community health problem across the United States. The incidence is increasing and an estimated $367 million is spent annually trying to eradicate the problem.’ Of the 6-12 million persons who contract head lice each year, children between the ages of 5-12 are most often infested. There is, however, an increased incidence in the 24-36 age group. This population represents teachers, parents, relatives, and baby sitters who come in contact with the infested 5-12 year olds. Juranek2 also found the incidence of head lice infestation to be higher for children who are female, ride the school bus, share lockers, attend special education classes, and are transported to school via car pools. He reported the incidence to be very low among American black families. In the authors’ experience screening about 14,000 elementary schoolchildren, only one black child was found to be infested. However, for other children the problem has become so common during the first few weeks of school that September is designated as National Pediculosis Month. Reports across the country indicate much time is missed from school. Absenteeism is costly to a school district, both in terms of time and money. There are documented cases where children are absent up to 12 weeks of school and that children and their families are reported to the Dept. of Health and Rehabilitative Services for neglect and abuse. In one extreme case during the 1987-1988 school year, a child in a Florida elementary school missed about 57 days. The family, chronically infested with head lice, was reported to the Dept. of Health and Rehabilitative Services. Officials investigated and the home environment proved to be the source of louse infestation. The family now has a housekeeper who cleans twice a week. The Salvation Army also generously donated new carpet and furniture to help solve the lice reinfestation problem in this particuEllen Rudy Clore, RN, MSN, FNP, Assistant Professor, University of Florida, College of Nursing, 711 Lake Estelle Drive, Orlando, FL 32809; and Leah Ann Longyear. RN, MSN. Certified Family Nurse Practitioner, 7821 S. Leewynn Drive, Sarasota. FL 34240. This article was submitted Julv 5, 1989, and revised and accepted f o r publication November 20. 1989.
212
Journal of School Health
May 1990, Vol. 60, No. 5
lar household.’ Parents often become upset when the school nurse telephones them at their place of employment to inform them of their child’s infestation and to request they come and collect their child. They frequently blame the school as the source of head lice infestation and demand that school officials control the problem. Pediculosis management also is expensive for the family in terms of lost wages from work and expense of the treatment products. Additional expense is incurred from the amount of time spent in combing nits from the hair, as well as cleaning the environment. The emotional trauma and embarrassment experienced by the family and child also can be extensive and costly. The school nurse can offer educational assistance and emotional support to parents. Preventing head lice is a parental responsibility as well as a school duty. Working together to prevent head lice infestations can decrease the incidence by identifying those children early in the school year before a pediculosis epidemic can occur. Communities will be most successful in controlling head lice when all appropriate personnel are involved in determining the policy. School board members, superintendents, community health officials and nurses, physicians, school principals, school nurses, parents, and teachers need to do their part to promote health, prevent disease, prevent absenteeism, and decrease loss of money per child. The school nurse is in a key position to facilitate and coordinate such a screening program.
PURPOSE OF PROGRAM The purpose of a head lice screening program in the elementary school is twofold. First, early detection can prevent epidemics. An epidemic is considered to exist when 5% or more of the student body is infested.* Secondly, the screening program promotes primary health care and education among elementary schoolchildren, school officials, educators, and parents. The National Pediculosis Association is a nonprofit organization devoted to educating the public about head lice (National Pediculosis Association, P.O. Box 149, Newton, MA 02161; 617/449-6487.) The NPA suggests
three formal schoolwide screenings occur during the academic year, taking place during the first week of school, the week following Christmas vacation, and again during the last week of school. The NPA’s position regarding these screenings is based on the assumption that parents will check their children before allowing them to return to school after vacations, and that fewer infestations will occur because parents will have already identified and treated them. However, parents often do not comply with this schedule and, therefore, it is ideal to make the screening process a partnership between the parent and the school. Schools should formally screen all children three times a year: mid-September, December, and near spring vacation. The rationale for this particular schedule rather than the one proposed by the National Pediculosis Association is if screening occurs two-three weeks after school is in session, children who have head lice can be treated appropriately before infestations become epidemic. When children are screened near Christmas vacation and spring vacation, the school is vacant for about two weeks. Therefore, any live lice or nits that have fallen into the environment will die because no children will be there for them to feed on. Though they usually feed every three-five hours, lice are capable of surviving about 48 hours without a host. Nits are capable of hatching within 10-12 days if the environmental temperature remains constant. Before screenings occur in an elementary school, parents should be notified. This measure will encourage them to check at home and it will also help to reassure the children when formal mass screenings take place at school. Additional spot checks or limited screenings by the school nurse during the year can be scheduled as necessary. Limited screenings are necessary when a child exhibits signs and symptoms of head lice between the formal screenings.
RECRUITMENT OF COMMUNITY VOLUNTEERS The number of persons involved in a screening program will depend on the school enrollment. It may be necessary to contact volunteers. Any parent whose child has had head lice usually is willing to participate in the screening program. Women’s religious groups, community clubs, parent-teacher organizations, and nursing students also are sources of volunteer assistance. A two-hour training program for volunteers is recommended as most schoolwide checks are efficiently carried out by trained volunteers working in conjunction with the school nurse. Volunteers should be taught information on lice biology, characteristics, signs and symptoms, diagnosis, treatment, and prevention of head lice infestation. They should be shown samples of lice and nits so they know exactly what they are looking for. With 10-12 well-trained volunteers, screening for about 850 children can be accomplished in about 1% to 2 hours. However, assistance also is needed to contact parents and supervise children. Each volunteer should carry the class roster. Absenteeism should be noted so the school nurse can check children when they return to school. Materials needed for the screening process are relatively inexpensive. Pedicu-sticks, available from the NPA, are used so
volunteers do not have to touch children’s hair. Two new sticks should be used for each child, disposing of the old ones as volunteers proceed to check the next child. Volunteers can wear rubber gloves if sticks are unavailable.
METHODS OF SCREENING Screening can be accomplished in several ways. The method should be discussed and determined by those who are involved. The principal, school teacher, and trained volunteers all must agree to the same method. Screening can occur either in or out of the classroom, though classroom screening seems least disruptive of the school day for the teacher and students as it takes about five-eight minutes per class. Upon entering each room, the screener briefly explains to the children what will be done. Absent children are noted. Usually two or three volunteers are needed per classroom. One or two persons actually do the screening while the third records the results; often the teacher offers to record. Only children with head lice should be noted on the class roster. This practice will save time so lists of children’s names need not be completely reviewed again. The volunteer can call children two at a time to the window as natural light is best for screening purposes. After each child’s hair is inspected, regardless of whether a head lice infestation is suspected, the children return to their seats. When each class check is completed, volunteers move to the next classroom. If the classroom does not have a window, it may be helpful and time-saving to simply allow children to remain in their seats. Each child is then checked in a systematic manner, again noting those who have a positive diagnosis of pediculosis. The volunteer must be careful to conceal the identities of children with lice so as not to embarass them in front of classmates. The second method of screening involves designating a separate screening room. Individual classes are called to the room and volunteers proceed to check each child. At the completion of all head checks, students return to the classroom with their teacher. Teachers are encouraged to have their hair checked along with the class. AFTER-CASE IDENTIFICATION After children with head lice have been identified by volunteer screeners, they need to be rechecked by the school nurse or school health aide to verify the findings. Children whose names have been checked on the class rosters can be called to the health clinic individually for a recheck. This measure provides privacy and reduces embarrassment for the child. Children should bring their books and personal belongings as they will not be allowed to return to the classroom if a positive infestation of head lice is confirmed. Parents are contacted to pick up their child from school. To decrease the possibility of further transmission, a room should be made available for the children to wait in until their parents arrive. Since 59% of infested persons have another infested household member,2 any siblings attending the same school should be rechecked. Other susceptible people, particularly those who have had direct contact with the
Journal of School Health
May 1990. Vol. 60, No. 5
213
infested child as well as car-pooling children, bus riding partners, locker partners, and teachers should be assessed. The NPA recommends a “Dear Parent” letter be sent home to the parents of all enrolled students.’ In addition to the “Dear Parent” letter, parents of children with head lice should be given a treatment sheet to be filled out and returned with the box top from the pediculicide they used on their children. The school nurse also needs to educate parents about examining family members, appropriate treatment, proper handling of personal belongings, and cleaning of the environment. To more effectively control pediculosis, schools are encouraged to adopt a “No-Nit” policy. Parents need to be informed that it may take a great deal of time and patience to remove all nits from the hair, but the “NoNit” policy represents major protection against reinfestation for their child. The NPA has identified five benefits of nit removal:6 It prevents self-reinfestation and transmission to others during the seven days prior to the second treatment. It decreases or eliminates the eventual need for a second treatment, thereby limiting exposure of young children and possibly their pregnant or nursing mothers to pesticides. It eliminates diagnostic confusion and serves to document treatment for school nurses. It equalizes the efficacy of pediculicides, permitting the use of less-toxic products. The enforcement of no-nit policies encourages parents to inspect their children often - the best form of prevention and control. Misinformation regarding the ovicidal potential of the pediculicides is responsible for much of the parental and physician resistance to the no-nit policy. Research by Meinking et a17 report up to 32% of nits hatch following treatment with a pediculicidal product. Therefore, nit removal appears to be the only defense school systems have to control transmission and reinfestation. The school nurse needs to assess classroom environments. Providing individual hooks for children to hang their coats after they have tucked their caps in coat Table 1 Examples of Screening Programs School
Number of Tlme for Volunteers Scrwninga
Infestations Screenings First %
#1
6
2.0 hrs.
39 (384) 10.2
#2C
10
4.0 hrs.
#3
10
#4
8
Second
NO.^
%
Third N0.b
%
24 (390) 6.2
20 (394) 5.1
(856) 11.8
65 (857) 7.6
37 (853) 4.3
1.5 hrs
35 (513) 6.8
12 (520) 2.3
8 (532) 1.5
2.5 hrs
58 (689) 8.4
38 (731) 5.2
34 (734) 4.9
101
aTime for screening mtiy vary depending upon the skill level of the volunteer bTotal number of chiidten screened is in (parentheses) and includes all ethnic groups. CSchool #2 included only 342 non-black children. Incidence of head lice infestation for this population was 59.9%, 26.6%. and 10.8%.
214
Journal of School Health
CONCLUSION Establishing a successful approach to controlling this highly communicable condition through a screening program results in numerous benefits to the school and community, as well as to the children. The school provides an excellent setting to increase the knowledge and decrease the incidence and transmission, and the school nurse can assume a leadership role. Absenteeism is reduced resulting in economic advantages to the school. The cost of lost wages for parents is reduced proportionately when children do not have to miss school and the health and educational benefits to the children are greatly enhanced. rn References
~~
N0.b
sleeves, discouraging “dress-up” centers, vacuuming carpeted areas frequently, and providing individual “cubbies” for personal belongings will assist in preventing head lice infestations. Other measures include giving children their own combs during picture-taking times, discouraging body contact and the sharing of personal items such as brushes, hair ribbons, baseball batting helmets, and hats, as well as seating children in every other seat if possible.’ Education is another important line of defense against pediculosis. School systems can capitalize on their accessibility to the community by providing consistent education to parents, teachers, and children. Prevention programs should be aimed at the entire student population. Several educational products are available. A 12-minute video, “Advice on Lice,” available from Walt Disney Telecommunications is aimed at the elementary school level and can be shown to the children on the day of formal screening. Comic books, coloring books, posters, and educational pamphlets are available from many drug manufacturers and the National Pediculosis Association. Maintaining accurate records is strongly recommended. School nurses and officials can begin to identify chronically infested children and families and may request additional assistance from public health departments in their communities. A child found to be infested repeatedly may need to be spot checked more often by the school nurse. Evaluating the success of the screening program also is a benefit of accurate record keeping. An effective program will most likely result in a decreasing incidence over the three school screenings.
May 1990, Vol. 60, No. 5
1. Lawson D, Robinson R. Head Lice: A Community-Based Epi-
demiological Confrol Workshop. New York: Pfizer Inc; 1981. 2. Juranek D. Pediculosis capitis in school children. In: Orkin M, Maibach H, eds. Cutaneous Infestations and Insect Bites. New York: Marcel Dekker; 1985;199-211. 3. Personal communication with M Snell, Coordinator, School Health, Seminole County, Florida, August 1988. 4. National Pediculosis AssoQiation. Questions and answers: Moving toward more effective pediculosis prevention in schools. Progress. 1985;1 (2):2-3. 5. National Pediculosis Association. Dear Parent letter. Newton, Mass: National Pediculosis Association; 1985. 6. Altschuler DZ, Kenney LR. The “no-nit policy:” What it is and why do we need it? Progress. 1988-1989;4(4):2-3. 7. Meinking TL, Taplin D, Kalter DC, Eberle MW. Comparative efficacy of treatments for pediculosis capitis infestations. Arch Dermafol. 1986;122:267-271. 8 . Clore ER. Nursing management of pediculosis. Pediafr Nurs Forum. 1988;3(2):3-13.
ABSTRACT: Pediculosis (head lice) is a major school and community health problem with an estimated 6-12 million cases annually resulting in $367 million a year in consumer costs, lost parental wages, and school system expenses. The greatest incidence is seen in children ages 5-12; however, the incidence in the 24-36 year old group is increasing due to their exposure to infested children. Developing comprehensive pediculosis screening programs in elementary schools provide.\ an effective method f o r preventing epidemics from occurring by accomplishing early derection. These programs also promote primary health care and education among elementary schoolchildren, school officials, educators, and parents. A n effective program includes screening the entire school three times a year: mid-September, December, and near spring 1 acation, and enforcing a “No Nit” policy. Establishing a successful approach to control pediculosis results in decreased incidence and transmission, reduced absenteeism, and financial savings f o r parents and school districts. (J Sch Health. 1990:60f5):212-214~
P
ediculosis,commonly known as head lice, continues to be a major school and community health problem across the United States. The incidence is increasing and an estimated $367 million is spent annually trying to eradicate the problem.’ Of the 6-12 million persons who contract head lice each year, children between the ages of 5-12 are most often infested. There is, however, an increased incidence in the 24-36 age group. This population represents teachers, parents, relatives, and baby sitters who come in contact with the infested 5-12 year olds. Juranek2 also found the incidence of head lice infestation to be higher for children who are female, ride the school bus, share lockers, attend special education classes, and are transported to school via car pools. He reported the incidence to be very low among American black families. In the authors’ experience screening about 14,000 elementary schoolchildren, only one black child was found to be infested. However, for other children the problem has become so common during the first few weeks of school that September is designated as National Pediculosis Month. Reports across the country indicate much time is missed from school. Absenteeism is costly to a school district, both in terms of time and money. There are documented cases where children are absent up to 12 weeks of school and that children and their families are reported to the Dept. of Health and Rehabilitative Services for neglect and abuse. In one extreme case during the 1987-1988 school year, a child in a Florida elementary school missed about 57 days. The family, chronically infested with head lice, was reported to the Dept. of Health and Rehabilitative Services. Officials investigated and the home environment proved to be the source of louse infestation. The family now has a housekeeper who cleans twice a week. The Salvation Army also generously donated new carpet and furniture to help solve the lice reinfestation problem in this particuEllen Rudy Clore, RN, MSN, FNP, Assistant Professor, University of Florida, College of Nursing, 711 Lake Estelle Drive, Orlando, FL 32809; and Leah Ann Longyear. RN, MSN. Certified Family Nurse Practitioner, 7821 S. Leewynn Drive, Sarasota. FL 34240. This article was submitted Julv 5, 1989, and revised and accepted f o r publication November 20. 1989.
212
Journal of School Health
May 1990, Vol. 60, No. 5
lar household.’ Parents often become upset when the school nurse telephones them at their place of employment to inform them of their child’s infestation and to request they come and collect their child. They frequently blame the school as the source of head lice infestation and demand that school officials control the problem. Pediculosis management also is expensive for the family in terms of lost wages from work and expense of the treatment products. Additional expense is incurred from the amount of time spent in combing nits from the hair, as well as cleaning the environment. The emotional trauma and embarrassment experienced by the family and child also can be extensive and costly. The school nurse can offer educational assistance and emotional support to parents. Preventing head lice is a parental responsibility as well as a school duty. Working together to prevent head lice infestations can decrease the incidence by identifying those children early in the school year before a pediculosis epidemic can occur. Communities will be most successful in controlling head lice when all appropriate personnel are involved in determining the policy. School board members, superintendents, community health officials and nurses, physicians, school principals, school nurses, parents, and teachers need to do their part to promote health, prevent disease, prevent absenteeism, and decrease loss of money per child. The school nurse is in a key position to facilitate and coordinate such a screening program.
PURPOSE OF PROGRAM The purpose of a head lice screening program in the elementary school is twofold. First, early detection can prevent epidemics. An epidemic is considered to exist when 5% or more of the student body is infested.* Secondly, the screening program promotes primary health care and education among elementary schoolchildren, school officials, educators, and parents. The National Pediculosis Association is a nonprofit organization devoted to educating the public about head lice (National Pediculosis Association, P.O. Box 149, Newton, MA 02161; 617/449-6487.) The NPA suggests
three formal schoolwide screenings occur during the academic year, taking place during the first week of school, the week following Christmas vacation, and again during the last week of school. The NPA’s position regarding these screenings is based on the assumption that parents will check their children before allowing them to return to school after vacations, and that fewer infestations will occur because parents will have already identified and treated them. However, parents often do not comply with this schedule and, therefore, it is ideal to make the screening process a partnership between the parent and the school. Schools should formally screen all children three times a year: mid-September, December, and near spring vacation. The rationale for this particular schedule rather than the one proposed by the National Pediculosis Association is if screening occurs two-three weeks after school is in session, children who have head lice can be treated appropriately before infestations become epidemic. When children are screened near Christmas vacation and spring vacation, the school is vacant for about two weeks. Therefore, any live lice or nits that have fallen into the environment will die because no children will be there for them to feed on. Though they usually feed every three-five hours, lice are capable of surviving about 48 hours without a host. Nits are capable of hatching within 10-12 days if the environmental temperature remains constant. Before screenings occur in an elementary school, parents should be notified. This measure will encourage them to check at home and it will also help to reassure the children when formal mass screenings take place at school. Additional spot checks or limited screenings by the school nurse during the year can be scheduled as necessary. Limited screenings are necessary when a child exhibits signs and symptoms of head lice between the formal screenings.
RECRUITMENT OF COMMUNITY VOLUNTEERS The number of persons involved in a screening program will depend on the school enrollment. It may be necessary to contact volunteers. Any parent whose child has had head lice usually is willing to participate in the screening program. Women’s religious groups, community clubs, parent-teacher organizations, and nursing students also are sources of volunteer assistance. A two-hour training program for volunteers is recommended as most schoolwide checks are efficiently carried out by trained volunteers working in conjunction with the school nurse. Volunteers should be taught information on lice biology, characteristics, signs and symptoms, diagnosis, treatment, and prevention of head lice infestation. They should be shown samples of lice and nits so they know exactly what they are looking for. With 10-12 well-trained volunteers, screening for about 850 children can be accomplished in about 1% to 2 hours. However, assistance also is needed to contact parents and supervise children. Each volunteer should carry the class roster. Absenteeism should be noted so the school nurse can check children when they return to school. Materials needed for the screening process are relatively inexpensive. Pedicu-sticks, available from the NPA, are used so
volunteers do not have to touch children’s hair. Two new sticks should be used for each child, disposing of the old ones as volunteers proceed to check the next child. Volunteers can wear rubber gloves if sticks are unavailable.
METHODS OF SCREENING Screening can be accomplished in several ways. The method should be discussed and determined by those who are involved. The principal, school teacher, and trained volunteers all must agree to the same method. Screening can occur either in or out of the classroom, though classroom screening seems least disruptive of the school day for the teacher and students as it takes about five-eight minutes per class. Upon entering each room, the screener briefly explains to the children what will be done. Absent children are noted. Usually two or three volunteers are needed per classroom. One or two persons actually do the screening while the third records the results; often the teacher offers to record. Only children with head lice should be noted on the class roster. This practice will save time so lists of children’s names need not be completely reviewed again. The volunteer can call children two at a time to the window as natural light is best for screening purposes. After each child’s hair is inspected, regardless of whether a head lice infestation is suspected, the children return to their seats. When each class check is completed, volunteers move to the next classroom. If the classroom does not have a window, it may be helpful and time-saving to simply allow children to remain in their seats. Each child is then checked in a systematic manner, again noting those who have a positive diagnosis of pediculosis. The volunteer must be careful to conceal the identities of children with lice so as not to embarass them in front of classmates. The second method of screening involves designating a separate screening room. Individual classes are called to the room and volunteers proceed to check each child. At the completion of all head checks, students return to the classroom with their teacher. Teachers are encouraged to have their hair checked along with the class. AFTER-CASE IDENTIFICATION After children with head lice have been identified by volunteer screeners, they need to be rechecked by the school nurse or school health aide to verify the findings. Children whose names have been checked on the class rosters can be called to the health clinic individually for a recheck. This measure provides privacy and reduces embarrassment for the child. Children should bring their books and personal belongings as they will not be allowed to return to the classroom if a positive infestation of head lice is confirmed. Parents are contacted to pick up their child from school. To decrease the possibility of further transmission, a room should be made available for the children to wait in until their parents arrive. Since 59% of infested persons have another infested household member,2 any siblings attending the same school should be rechecked. Other susceptible people, particularly those who have had direct contact with the
Journal of School Health
May 1990. Vol. 60, No. 5
213
infested child as well as car-pooling children, bus riding partners, locker partners, and teachers should be assessed. The NPA recommends a “Dear Parent” letter be sent home to the parents of all enrolled students.’ In addition to the “Dear Parent” letter, parents of children with head lice should be given a treatment sheet to be filled out and returned with the box top from the pediculicide they used on their children. The school nurse also needs to educate parents about examining family members, appropriate treatment, proper handling of personal belongings, and cleaning of the environment. To more effectively control pediculosis, schools are encouraged to adopt a “No-Nit” policy. Parents need to be informed that it may take a great deal of time and patience to remove all nits from the hair, but the “NoNit” policy represents major protection against reinfestation for their child. The NPA has identified five benefits of nit removal:6 It prevents self-reinfestation and transmission to others during the seven days prior to the second treatment. It decreases or eliminates the eventual need for a second treatment, thereby limiting exposure of young children and possibly their pregnant or nursing mothers to pesticides. It eliminates diagnostic confusion and serves to document treatment for school nurses. It equalizes the efficacy of pediculicides, permitting the use of less-toxic products. The enforcement of no-nit policies encourages parents to inspect their children often - the best form of prevention and control. Misinformation regarding the ovicidal potential of the pediculicides is responsible for much of the parental and physician resistance to the no-nit policy. Research by Meinking et a17 report up to 32% of nits hatch following treatment with a pediculicidal product. Therefore, nit removal appears to be the only defense school systems have to control transmission and reinfestation. The school nurse needs to assess classroom environments. Providing individual hooks for children to hang their coats after they have tucked their caps in coat Table 1 Examples of Screening Programs School
Number of Tlme for Volunteers Scrwninga
Infestations Screenings First %
#1
6
2.0 hrs.
39 (384) 10.2
#2C
10
4.0 hrs.
#3
10
#4
8
Second
NO.^
%
Third N0.b
%
24 (390) 6.2
20 (394) 5.1
(856) 11.8
65 (857) 7.6
37 (853) 4.3
1.5 hrs
35 (513) 6.8
12 (520) 2.3
8 (532) 1.5
2.5 hrs
58 (689) 8.4
38 (731) 5.2
34 (734) 4.9
101
aTime for screening mtiy vary depending upon the skill level of the volunteer bTotal number of chiidten screened is in (parentheses) and includes all ethnic groups. CSchool #2 included only 342 non-black children. Incidence of head lice infestation for this population was 59.9%, 26.6%. and 10.8%.
214
Journal of School Health
CONCLUSION Establishing a successful approach to controlling this highly communicable condition through a screening program results in numerous benefits to the school and community, as well as to the children. The school provides an excellent setting to increase the knowledge and decrease the incidence and transmission, and the school nurse can assume a leadership role. Absenteeism is reduced resulting in economic advantages to the school. The cost of lost wages for parents is reduced proportionately when children do not have to miss school and the health and educational benefits to the children are greatly enhanced. rn References
~~
N0.b
sleeves, discouraging “dress-up” centers, vacuuming carpeted areas frequently, and providing individual “cubbies” for personal belongings will assist in preventing head lice infestations. Other measures include giving children their own combs during picture-taking times, discouraging body contact and the sharing of personal items such as brushes, hair ribbons, baseball batting helmets, and hats, as well as seating children in every other seat if possible.’ Education is another important line of defense against pediculosis. School systems can capitalize on their accessibility to the community by providing consistent education to parents, teachers, and children. Prevention programs should be aimed at the entire student population. Several educational products are available. A 12-minute video, “Advice on Lice,” available from Walt Disney Telecommunications is aimed at the elementary school level and can be shown to the children on the day of formal screening. Comic books, coloring books, posters, and educational pamphlets are available from many drug manufacturers and the National Pediculosis Association. Maintaining accurate records is strongly recommended. School nurses and officials can begin to identify chronically infested children and families and may request additional assistance from public health departments in their communities. A child found to be infested repeatedly may need to be spot checked more often by the school nurse. Evaluating the success of the screening program also is a benefit of accurate record keeping. An effective program will most likely result in a decreasing incidence over the three school screenings.
May 1990, Vol. 60, No. 5
1. Lawson D, Robinson R. Head Lice: A Community-Based Epi-
demiological Confrol Workshop. New York: Pfizer Inc; 1981. 2. Juranek D. Pediculosis capitis in school children. In: Orkin M, Maibach H, eds. Cutaneous Infestations and Insect Bites. New York: Marcel Dekker; 1985;199-211. 3. Personal communication with M Snell, Coordinator, School Health, Seminole County, Florida, August 1988. 4. National Pediculosis AssoQiation. Questions and answers: Moving toward more effective pediculosis prevention in schools. Progress. 1985;1 (2):2-3. 5. National Pediculosis Association. Dear Parent letter. Newton, Mass: National Pediculosis Association; 1985. 6. Altschuler DZ, Kenney LR. The “no-nit policy:” What it is and why do we need it? Progress. 1988-1989;4(4):2-3. 7. Meinking TL, Taplin D, Kalter DC, Eberle MW. Comparative efficacy of treatments for pediculosis capitis infestations. Arch Dermafol. 1986;122:267-271. 8 . Clore ER. Nursing management of pediculosis. Pediafr Nurs Forum. 1988;3(2):3-13.
