Infection Prevention and Control – Pediculosis (Body and Pubic Lice) SECTION: 14.18
Strength of Evidence Level: 3 __RN__LPN/LVN__HHA
PURPOSE:
To prevent transmission of and eliminate infestations of body and pubic lice (crab) and associated infections.
CONSIDERATIONS:
1. Contact the local public health department for additional guidance and resources regarding body lice or crab lice.
2. Types:
a. Body lice: Pediculus humanus corporis (body louse, clothes louse) Adult body lice are 2.3-3.6 mm in length. Body lice live and lay eggs on clothing and only move to the skin to feed.
(1) Transmission: Body lice infestations are spread most commonly by close person-to-person contact but are generally limited to persons who live under conditions of crowding and poor hygiene.
(2) Diagnosis: Signs are intense itching and rash. Intense itching leads to scratching which can cause sores and secondary bacterial infection of the skin. When body lice infestation is long lasting, heavily bitten areas of the skin can become thickened and darkened, particularly in the mid-section of the body. This condition is called “vagabond’s disease.”
(3) Body lice are known to transmit diseases such as epidemic typhus, trench fever and epidemic relapsing fever.
b. Pubic (Crab) lice: Pthirus pubis ("crab" louse, pubic louse). Adult pubic lice are 1.1-1.8 mm in length. Pubic lice typically are found attached to hair in the pubic area but sometimes are found on coarse hair elsewhere on the body (e.g. eyebrows, eyelashes, beard, mustache, chest, armpits, etc.).
(1) Transmission: Pubic lice usually spread through sexual contact. All sex partners within the previous month should be informed that they are at risk for infestation and should be treated. Persons with pubic lice should be evaluated for other sexually transmitted diseases.
(2) Diagnosis: Itching (“pruritus”) in the pubic and groin area is the most common symptom of pubic lice infestation. Intense itching leads to scratching which can cause sores and secondary bacterial infection of the skin. Visible lice eggs (“nits”) or lice crawling or attached to pubic hair, or less commonly other hairy areas of the body are also signs of pubic lice infestation.
[Note: Pubic lice on the head (eyelashes or eyebrows) of a child may be an indication of sexual exposure or abuse. Report immediately.]
3. Medications for pubic and body lice:
[Note: The lice medications described in this section should not be used near the eyes.]
a. CDC recommended: A lice-killing lotion containing 1 percent permethrin or a mousse containing pyrethrins and piperonyl butoxide can be used to treat pubic (“crab”) lice and are available without a prescription.
b. CDC not recommended: Lindane shampoo is a prescription medication that can kill lice and lice eggs. However, lindane is not recommended as a first-line therapy. Lindane can be toxic to the brain and other parts of the nervous system; its use should be restricted to patients who have failed treatment with or cannot tolerate, other medications that pose less risk. Lindane should not be used to treat premature infants, persons with a seizure disorder, women who are pregnant or breast-feeding, persons who have very irritated skin or sores where the lindane will be applied, infants, children, the elderly, and persons who weigh less than 110 pounds.
c. Not FDA approved for crab lice: (1) Malathion* lotion 0.5 percent (Ovide*) and (2) Ivermectin.
EQUIPMENT:
Magnifying glass
Gloves
Gown
Trash bag for receiving contaminated patient clothing
Trash bag for discarding PPE
Clean clothing for patient
Towel and wash cloth
Medication (pubic lice)
Nit comb (pubic lice)
PROCEDURE:
Body Lice:
1. Bathe or shower patient.
2. Have patient don clean clothing.
3. Have contaminated clothing laundered or discarded, if patient agrees to latter.
4. Educate patient on maintaining good personal hygiene and regular changes of clean clothes.
5. If patient shares infested clothing and/or remains in an environment where body lice are present there is a chance of reinfestation.
Pubic Lice
1. Wear gloves and gown.
2. Have patient remove contaminated clothing and bag for laundering.
3. Wash the infested area; towel dry.
[Note: See special instructions for treatment of lice and nits on eyebrows or eyelashes.]
a. If only a few live lice and nits are present, it may be possible to remove these with fingernails or a nit comb.
b. If additional treatment is needed for lice or nits on the eyelashes, careful application of ophthalmic-grade petrolatum ointment (only available by prescription) to the eyelid margins 2 to 4 times a day for 10 days is effective. Regular Vaseline should not be used because it can irritate the eyes if applied.
4. Carefully follow the instructions in the package or on
the label. Thoroughly saturate the pubic hair and medication on hair for the time recommended in the instructions. After waiting the recommended time, remove the medication by following carefully the instructions on the label or in the box.
5. Following treatment, most nits will still be attached to hair shafts. Nits may be removed with fingernails or by using a fine-toothed comb.
6. Have patient put on clean underwear and clothing after treatment.
7. Patient should avoid sexual contact with their sex partner(s) until both they and their partners have been successfully treated and reevaluated to rule out persistent infestation.
8. Refer patient to public health for STD follow up, if appropriate.
9. Repeat treatment in 9 to 10 days if live lice are still found.
AFTER CARE
1. Machine wash and dry clothing, bed linens, and other items that the infested person wore or used during the 2 days before treatment using the hot water (130°F) laundry cycle and the high heat drying cycle. Clothing and items that are not washable can be dry-cleaned.
OR
2. Seal items in a plastic bag and store for 2 weeks.
3. Soak combs and brushes in hot water (at least 130°F) for 5 to 10 minutes.
4. Vacuum the floor and furniture, particularly where the infested person sat or lay.
[Note: the risk of getting infested by a louse that has fallen onto a rug, carpet or furniture is very small.]
5. DO NOT use fumigant sprays; they can be toxic if inhaled or absorbed through the skin.
REFERENCES:
CDC. (n.d.). Centers for Disease Control and Prevention. Retrieved from www.cdc.gov/ncicoc/dpd/parasites/index.htm