First Aid/Emergency Health Care Regulation Code: 4250-6130R2
Head Lice Control Procedures
Head Lice (Pediculosis capitis) is a common infestation found most often in children 3 to 12 years of age. Head lice are not a health hazard, a sign of uncleanliness and are not responsible for the spread of any disease. The adult louse is 2 to 3 mm long (the size of a sesame seed) and is usually light gray, although color may vary. The female can live 3 to 4 weeks and lays approximately 10 eggs, or nits, per day. These tiny eggs are firmly attached to the hair shaft near the scalp with a glue-like substance produced by the louse.
Viable nits are most easily seen at the posterior hairline (near the neck). The eggs incubate using body heat and hatch in 10 to 14 days. Once the eggs hatch, nymphs grow for approximately 9 to 12 days, mate, and females lay eggs. If left untreated, this cycle may repeat itself every 3 weeks. The louse feeds itself by injecting small amounts of saliva and taking small amounts of blood from the scalp every few hours. Lice crawl and are unable to hop or fly. Transmission most often occurs by direct contact with personal belongings of an infested individual (combs, brushes, hats, etc.). Head lice usually survive less than one day away from the scalp and their eggs cannot hatch at ambient temperatures lower than that near the scalp. In general, lice found to be more than 1 inch from the scalp are not likely to be viable.
The following guidelines will assist with the management of head lice:
- 1) Parents should notify their child’s school if lice or lice eggs are found in their child’s hair.
- 2) If lice or lice eggs are found in a child’s hair at school:
- A. Inspect all students in the child’s vicinity and other close contacts (e.g. best friends, playmates, siblings, etc.) If several students in a classroom are infested, all children in the classroom are to be inspected.
- B. Letters should go home to all families of children in the classroom.
- C. All siblings in other classrooms are to be examined.
- D. If nits are found one inch or closer to the scalp or if live lice are seen, the student shall leave school as soon as possible with a letter explaining treatment procedures. The student will only be admitted back to school following proof of treatment, which may include a box top or a verbal or written statement of the treatment by the parent/guardian or physician.
- E. If nits are found more than one inch away from the scalp and no lice are noted, the student may attend school the rest of the day. A letter will be sent home with the student encouraging treatment as a preventative measure. The student will only be admitted back to school following proof of treatment.
- Students should not be excluded from school after appropriate lice treatment when nits remain one inch or more away from the scalp. Further monitoring for signs of re-infestation is appropriate.
- 3) The classroom should be arranged to discourage the spread of lice
- A. The children should keep their outer garments at their desks if they do not have individual lockers or storage areas.
- B. Children should use their own personal mat, blanket, towel, etc. for napping.
- These items should be stored individually.
- C. If several cases of lice exist in one classroom, non-washable items can be placed in a tightly sealed plastic bag for 10 days.
- D. Classrooms that have a student with lice should be vacuumed.
- 4) Families may contact their medical provider or local pharmacist to obtain the most up to date information on lice treatment. Families should follow the directions on over the counter lice treatment shampoos and second treatments should be completed if indicated. Proof of treatment is required for all treatments. (Refer to section 2, letter D.) “Natural products” marketed by health food stores and occlusive agents (such as mayonnaise) may be used. Manufacturers directions should be followed for “natural products.” Occlusive agents should be massaged on the entire surface of the hair and especially the scalp, covered with a shower cap and left on overnight. Diligent shampooing is usually necessary for the next 7 to 10 days to remove the residue. Continue monitoring once a week for signs of re-infestation, meaning lice noted or nits noted within one inch of the scalp. Flammable or toxic substances, such as gasoline or kerosene, should never be used and are not acceptable means of treatment. Products intended for animal use should not be used to treat head lice in humans.
- 5) 7-10 days after the initial treatment, a second treatment is required to kill any newly hatched louse.
- 6) Non-compliance will result in exclusion from school. Effective treatment should not keep a student out of school for more than two days. All other days missed will be unexcused per occurrence.
- 7) If lice or nits within one inch of the scalp are found upon returning to school, the student shall be refused re-admission.
Bed Bug Control Procedures
Bed bugs are a growing problem across North Carolina and the United States. Bed bugs can live anywhere and be transported between children’s homes and schools in backpacks, clothing, luggage, books or other items. They are small, brownish, flattened insects that feed on people while they sleep. Bed bug bites may develop into an itchy red area similar to a mosquito or tick bite. While they do not carry disease, bed bugs can cause anxiety and sleeplessness and are difficult and expensive to control. Bed bugs can be found in any home regardless of ethnic background, type of home or socio-economic status.
Bed Bug Prevention Methods (from Dini Miller, Ph.D., Virginia Tech Department of Entomology)
Alert Parents to the National Bed Bug Problem
- Provide parents with a bed bug awareness brochure including pictures of bed bugs.
- Advise parents that school will not close if bed bugs are found.
- Provide parents with information on how to prepare their child’s belongings if they already know they have an infestation.
- Clutter is the bed bug’s best friend.
- Remove stacks of paper and unused teaching aids.
- Make it a priority to reduce unused items by at least half.
Limit Items Being Brought to School
- Repeatedly transporting items between home and school increase the possibility of bed bugs hitching a ride.
Containing Bed Bugs if They Come to School
- Clear plastic storage containers can be used to store backpacks, lunch containers, coats and other cold weather clothing.
- Visually inspect the containers at the end of the day to identify the source of an infestation.
- Schools can work with parents to help reduce the chances of bed bugs coming to school.
Finding a Bed Bug on a Student or in Your Classroom
- Sample Protocol for Bed Bugs Found in NC Schools, North Carolina School IPM Program, Feb., 2011; Bed Bugs: What Schools Need to Know, Michigan Bed Bug Working Group, May, 2010;
Do not panic or overreact.
Do not apply any pesticides.
If found on a student, the student should be discreetly removed from the classroom so that the school nurse or other qualified staff member can examine the students clothing and other belongings. It is important to treat every student with dignity and respect. Remember, the student who has the bed bug may not be the student who brought it to school.
Any bugs found should be removed, saved in a plastic bag and kept for positive identification.
Inspect any items that the student might need for the rest of the day, separating items that might be infested and allow the student to return to his/her classroom. There is no need to remove the student from the classroom or be sent home from school.
If possible, have the student change in to different clothes and place infested items in a clothes dryer set on high for at least 30 minutes (including shoes). Have the child change back in to his/her clothes and treat the temporary clothes for 30 minutes.
Parents or guardians should be contacted to inform them of the bed bug presence. Educational material should be sent home with the child.
Conduct a thorough inspection (both visual and if possible, using a canine) to identify all affected sites. Remember to inspect all areas the student may have contacted.
If the student rode the bus to school, inspect the seat of the student and surrounding seats before students are allowed to board the bus.
If there is a confirmed infestation in a classroom or classrooms, the principal or school nurse should consider notifying parents in the affected class or classes. A sample notification letter can be found on the Student Services website.
Contact the Assistant Superintendent for Auxiliary Services and report the findings. The Auxiliary Services Department will determine if the pest control company needs to be contacted and whether Integrated Pest Management (IPM) will need to be initiated. The pest control service will advise the school as to any preparations needed for treatment.