Denton Independent School District: Health Services Department
Theresa Grant, RN 1212 Bolivar St.
Phone # (940) 369-0685 Denton, Texas 76201
Fax # (940) 382-4908
Denton ISD Health Services Standard of Practice:
Management of Pediculosis in the School Setting
Screening Procedures:
School RNs will screen students for pediculosis on an individual student basis as the preferred method. Entire classroom screenings, campus-wide assessments and “routine” screenings are generally not productive and result in a potential loss of privacy of health information, embarrassment for students, and decreased instructional time due to classroom disruption. These types of screening produce minimal return, as students may present with pediculosis at any time, and school, although a potential source of lice infestation, is not the only source of infestation.
Preferably, screening is performed in the health room one student at a time in a confidential manner, based on referral of a student or students by themselves, their parents, and/or school personnel. Referral is based on these symptoms of pediculosis:
· frequent scratching of the head and/or back of the neck or student statement “my head is itching.”
· pink to red marks on the scalp and/or back of neck
· unexplainable sores and/or scabs on the scalp/back of the neck
· yellowish white or brown eggs (nits) attached to strands of hair that can't be washed out or flicked off with the finger
· white to gray crawling forms about the size of a sesame seed
(in advanced cases the adult lice are larger and are a darker color, and they move quickly through the hair when the hair is parted) There are often several stages of lice development present at the same time.
Classroom screenings may be performed on occasion at the request of the campus principal when there is concern that an infestation may be more widespread than two or more students, although it is still preferable to assess the students in a more confidential setting.
When classroom screenings are done, the nurse and teacher will collaborate on a plan prior to the screening that will allow identification of any positive cases without exposure of findings to other students.
Nurses new to the school health environment will undergo training at the beginning of the school year with experienced school RNs to learn appropriate screening procedures based on guidelines from the Texas Department of State Health Services and DISD protocol.
Parent/Guardian Notification:
Elementary school parents will receive the DISD Head Lice Information Sheet at the beginning of each school year, outlining prevention measures, DISD standard procedures,
and general information on pediculosis.
In the event of identified infestations, the school nurse will notify the parent/guardian of the infested child by phone or email if possible, and by parent letter sent home.
On occasion, if two or more students in the same classroom are found to have active cases of pediculosis, a general information letter may be sent out to parents/guardians of all students in that classroom. These letters are done at the discretion of the campus principal with input from health services. Recurrences of pediculosis in that classroom do not require that another letter be sent out, as the information and requested response is the same.
Under no circumstances will a school employee disclose to any parent or guardian the name(s) or private health information of affected students other than their own.
The teacher will receive a classroom checklist to follow minimizing the chance of further classroom infestation, and directions given to the custodial staff for a vacuuming schedule for two weeks. (see classroom and custodial protocol sheets).
Exclusion Protocol: Our exclusion protocol is designed to protect the integrity of the school day, and to minimize embarrassment and unnecessary isolation of students with pediculosis. It is founded on evidence-based practice and recommendations from the Texas Department of State Health Services, the American Academy of Pediatrics, the National Association of School Nurses, and the Harvard School of Public Health.
By Texas law (follow the link below) http://info.sos.state.tx.us/pls/pub/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=25&pt=1&ch=97&rl=7 students who have evidence of active pediculosis (the presence of live adult or nymph lice) will be excluded from school as soon a possible that day so that treatment may begin as quickly. Additionally in Denton ISD, we monitor nits that are visibly noted to be closer than ¼ inch to the scalp as an additional determination of the potential for active pediculosis.
Students may remain in the classroom until parents can pick the child up; the classroom teacher can monitor close contact (head to head) with other children until that time, taking care not to isolate or identify the student to others. If a student is unable to be picked up until the end of the day, the nurse will make contact with whomever is taking the child home to address the issue of minimizing close contact with other children and to ensure that the parent letter is passed on and treatment is begun in a timely fashion.
The nurse will also contact the school RN for any school-age siblings/others who live in the home so those students may also be assessed.
Students who have signs of past infestations or previously treated infestations (presence of nits that are farther away from the scalp than ¼ inch with no evidence of live lice) do not have to be excluded from school. The nurse will notify the parent/guardian of her assessment and provide them with information on the removal of nits.
Readmission Criteria:
Students who have been excluded from school for active pediculosis must be examined by the school RN prior to readmission to the classroom. Parents are requested to bring the child in to the health room prior to readmission and be present during that examination.
The nurse will assess for efficacy of treatment and will readmit the student to the classroom when no signs of active pediculosis are present.
Students who have nits that are all farther than ¼ inch from the scalp and no signs of active pediculosis must show daily signs of progress being made in nit removal to remain in class.
No treatment protocol is 100% effective to prevent reinfestation, and it is difficult to monitor what treatments have actually taken place in the home. Daily progress in removal of nits is an assurance that the condition is being monitored and cared for, and a protective measure to minimize the chance of exposure to other students. The school nurse will check the student at least twice each week to determine level of progress, and communicate with the parents the results of her assessment.
Excessive Absences:
Although time-intensive, the recommended treatments for pediculosis are inexpensive and relatively easy to perform. Students absent more than two full school days for pediculosis will have a follow-up call from the school nurse to assess progress and any additional needed resources. At that time, the principal or his/her designee will also review Texas Compulsory Attendance laws with the parent/guardian to assure compliance with those laws, and will submit to district attendance officers any concerns for excessive absenteeism.
Awareness and Education:
In addition to the parent notification statements above, the school nurse will provide annually to campus faculty and staff information on:
· prevention, identification and treatment of head lice
· new trends in public health and current research regarding pediculosis
· district standards and campus procedures for appropriate management of head lice, and
· laws, policy, and ethics related to confidentiality, and the right to privacy and dignity for student and their families.
Classroom presentation will be made to Kindergarten and 1st grade classes on prevention, and other grade levels at teacher/principal request (may be done in the larger context of infection control, such as handwashing, etc.)
School RNs will also maintain a section on their campus websites related to pediculosis, including prevention and management, as will the director of health services on the main health services website.
PTA newsletters, parent meetings, and Monday folders also present opportunities for further education and awareness.