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Head lice Information & Treatments Tracy dickens School Nurse March 2012 PowerPoint PPT Presentation


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Head lice Information & Treatments Tracy dickens School Nurse March 2012. Head lice ( pediculus humanus capitus. Six legged, no winged insects They live close to the scalp They feed from blood from the head They spread through head to head contact.

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Head lice Information & Treatments Tracy dickens School Nurse March 2012

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Head lice information treatments tracy dickens school nurse march 2012

Head lice

Information

&

Treatments

Tracy dickens School Nurse March 2012


Head lice information treatments tracy dickens school nurse march 2012

Head lice

(pediculushumanuscapitus

Six legged, no winged insects

They live close to the scalp

They feed from blood from the head

They spread through head to head contact

They vary in size from a full stop – about

3-4mm long

Female louse lays eggs when she is about

10 days old she will lay about 50-150 eggs during her lifespan

Lice are the insects, young lice called nymphs are transparent until after their first blood

Meal

Lice lay eggs close to the scalp which makes them difficult to detect

Nits are the empty shells that stick to the hair shaft


Head lice information treatments tracy dickens school nurse march 2012

  • Detection of head lice

  • 1. CHECK

  • Parents once a week check your childs head

  • Wet hair, condition, leave conditioner in, use head lice comb

  • If lice are detected treatment is advised

  • Diagnosis can only be made when live louse are found


Head lice information treatments tracy dickens school nurse march 2012

  • Treatments:

  • Four principle treatments

  • 1.Pesticides two types in the BNF

  • Malathion – (derbac)

  • Lice can develop high resistance to chemicals

  • Favourable safety record

  • Not recommended if child has eczema/asthma

  • Can cause skin irritation

  • Not to be used on broken skin

  • Eradication rate 33% (Thornton and Ross 2010)

  • Permethrin – lyclear

  • not recommended in BNF current preparation too diluted to be effective (BNFC 2011-2012)


Head lice information treatments tracy dickens school nurse march 2012

  • 2. Non pesticides:

  • Dimeticone (Hedrin)

  • Coat the outside of the louse causing interference with water balance it to die, research suggests that because this is a physical process the lice cannot build resistance. (BNF 2011; NPF 2011)

  • Less effective against eggs and needs to be repeated after 7 days (BNF 2011)

  • Eradication rate 97%

  • Avoids resistance (Thornton and Ross 2010)


Head lice information treatments tracy dickens school nurse march 2012

  • 3. Wet combing/bug busting

  • 38% – 57% effective at eradicating lice

  • Labour intensive, relies on commitment of both parent and child – therefore cannot be relied upon to tackle at community level (Schweiger 2012)

  • No chemicals involved therefore preferred by

  • Some parents


Head lice information treatments tracy dickens school nurse march 2012

4. Alternative remedies

Electronic devices

not suitable for general use

Herbal/essential oils

Eucalyptus oil/tea tree oils/lavender oil

limited evidence to assess their effectiveness some

oils can be toxic

Some products claim to act as repellents

not recommended

(Schweiger 2012)


Head lice information treatments tracy dickens school nurse march 2012

What is the best product?

Systematic review of RCTs, Case studies and Cohort studies comparing the above treatment methods found that in all cases

Dimeticone was significantly more effective

at the eradication of head lice compared to

malathion (Burgess et al 2007; Schweizer 2012)

Burgess et al (2007) was a small sample for a RCT, total random sample of 73 children with head lice

25 cures and 5 reinfections (Dimeticone)

9 cures and 1 reinfection (malathion)


Head lice information treatments tracy dickens school nurse march 2012

  • Which To Choose?

  • Age – not licensed for under 6 months

  • Contra-indications – asthma, skin problems

  • Resistance – what has been tried previously why is it not working

  • Avoiding resistance

  • Parent preference


Head lice information treatments tracy dickens school nurse march 2012

Hedrin 4% lotion – 50mls (£2.98) 150mls (£6.92)

Apply sufficient lotion evenly over

DRY hair ensuring that the scalp is

fully covered

Allow the hair to dry naturally.

• Leave on the hair for at least 8 hours

or overnight.

• Wash the hair with normal shampoo,

rinse thoroughly with water and dry.

Duration of treatment

• It is important that Hedrin® Lotion is

applied again after seven days to deal

with any lice which may hatch in that

time. Failure to repeat the treatment may

result in the return of a louse infestation

Thornton and Ross (2010)


Head lice information treatments tracy dickens school nurse march 2012

Hedrin once – liquid gel (100ml (£8.00) 250ml (£17.35)

• SHAKE THE BOTTLE WELL BEFORE EACH

USE.

• Apply sufficient gel evenly over DRY hair,

to ensure that the scalp and hair are fully

covered and the hair is SATURATED.

• Work into the hair with the fingers or an

ordinary comb spreading the gel

thoroughly and evenly from the roots to

tips.

• Leave on the hair for at least 15 minutes

(or longer if more convenient).

• Apply shampoo directly to the entire

surface of the hair without first wetting it,

shampoo thoroughly then rinse with

water. Repeat the process, then apply

conditioner, rinse and dry.

(Thornton and Ross 2010)


Head lice information treatments tracy dickens school nurse march 2012

Hedrin Once spray gel 100ml (£9.00) 60ml (£5.00)

The spray comes ready assembled. Before use

remove the coloured safety clip from under the

spray nozzle. This may be retained or disposed

of safely.

• Holding the spray approximately 10cm from the hair carefully spray sufficient solution evenly over DRY HAIR to ensure

that the scalp and hair are fully covered and the hair is saturated.

• Leave on the hair for at least 15 minutes or longer

• Wash the hair with normal shampoo, do not wet hair first, rinse thoroughly with water and dry.

(Thornton & Ross 2010)


Head lice information treatments tracy dickens school nurse march 2012

Hedrin treat & Go mousse 100mls (£10.00)

  • Apply straight onto dry hair, following the instructions on the pack.

  • Shake the bottle well before use then rub or comb the lotion into the hair until it’s covered from root to tip.

  • Leave on for at least 8 hours or overnight

  • Rinse or shampoo it out, you’ll find it

  • comes out really easily.

  • Repeat after 7 days

  • (Thornton and Ross 2011)


Head lice information treatments tracy dickens school nurse march 2012

Hedrin Once spray gel 100ml (£9.00) 60ml (£5.00)

The spray comes ready assembled. Before use

remove the coloured safety clip from under the

spray nozzle. This may be retained or disposed

of safely.

• Holding the spray approximately 10cm from the hair carefully spray sufficient solution evenly over DRY HAIR to ensure

that the scalp and hair are fully covered and the hair is saturated.

• Leave on the hair for at least 15 minutes or longer

• Wash the hair with normal shampoo, do not wet hair first, rinse thoroughly with water and dry.

(Thornton & Ross 2010)


Head lice information treatments tracy dickens school nurse march 2012

References:

BNF (2011) BNF for children the essential resource for clinical use of medicines in children. London. BMJ

Burges, I. Lee P. Matlock, G. (2007) Randomised controlled, assessor blind trial comparing 4% Dimeticone lotion with 0.5% malathion liquid for head lice infestation.

Plosone (11) pp 1121-1127

NPF (2011) Nurse prescribers formulary for community practitioners.

London. BMJ.

Schweiger, M. (2012) Head lice – Evidence based guidelines based on the Stafford Report 2012 update. Public health medicine controlled group.

Thornton and Ross (2010) New best practice guidelines for tackling head lice. [online] available from:http://www.checktreatcomplete.co.uk/about-this-module/about-hedrin.php [Accessed 9/3/2012]


Practice standards

PRACTICE STANDARDS

  • Licence as a prescriber (only prescribe from relevant formulary)

  • Accountability

  • Assessment

  • Need (must be genuine clinical need)

  • Consent (information sharing)

  • Communication

  • Record keeping

  • Prescribing and administration (kept separate)

  • Prescribing and dispensing (kept separate)

  • Evidence based prescribing

  • Delegation

  • Gifts and benefits


Nmc standards of proficiency for nurse prescribers

NMC STANDARDS OF PROFICIENCY FOR NURSE PRESCRIBERS

  • Assess client’s clinical condition

  • Undertake thorough history (including medications)

  • Decide on appropriate management of condition (?prescribe)

  • Identify appropriate products if medication required

  • Advise client on effects and risks

  • Write prescription (with client consent)

  • Monitor response to medication and lifestyle advice


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