Time for Change: Nits OK to Stay!

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TIME FOR CHANGE

Time for Change: Nits OK to Stay!

Anita Riddle, RN

Ferris State University

Abstract

The 2011-2012 school year is underway. Already there have been many cases of pediculosis capitis (head lice) infestations within the Harper Creek School district. Currently there is no published pediculosis policy or standardized procedure to follow. As a school nurse advocate for students, I am supporting the implementation of a standardized pediculosis capitis policy. The policy will support keeping students in school while receiving treatment at home. A team will be selected, data collected, a policy written, presented to the school board for acceptance, education provided and implemented in the school district. A standardized pediculosis capitis policy needs to be created and implemented to ensure students stay in school, and receive the necessary treatment, while protecting classmates from exposure.

Time for Change: Nits OK to Stay!

Pediculosis capitis (head lice) has presented a challenge to the public health system for thousands of years. “Head lice infestation is common in the United States among children 3 to 12 years of age; approximately 6 to 12 million have infestations per year” (Frankowski & Weiner, 2002, p. 638). Head lice do not carry diseases and are not linked to any communicable disease. The harm of lice lies in the humiliation it causes to the infested child and the potential loss of days from school. The diagnosis of head lice can initiate an interruption in the education of a child, causing them to get behind and struggle to catch up. “Schools frequently quarantine children because of the mistaken beliefs that head lice are a health problem or are associated with parental neglect" (Herman, 2000 para 7).

Currently, I serve the Harper Creek School District as a school nurse in the Beadle Lake, Sonoma and Wattles Park elementary schools. Since the beginning of the school year I have diagnosed, and monitored 27 cases of head lice in the elementary schools. When inquiring about the school policy regarding head lice, I received 3 different versions of the district’s head lice policy. As of yet, there has not been a written version produced. While meeting with the school secretaries prior to the beginning of the school year, head lice was a priority, as they were the ones who were responsible to handle this issue, as there has not been a school nurse available to them until this school year.

Due to the lack of standardization on this policy, (or lack of policy), it became difficult to enforce any regulations. One school had a policy of, white nits may stay, and brown nits and/or live bugs must leave the school immediately. Another enforced a “no nits” policy, and one has left it up to the school nurse. Overall, I have found a lack of education related to head lice and nits, not only with the staff but with the parents, students and the general public.

In recent years research has provided updated information to urge schools to discard their current “no nit” policies. Once a case of lice has been identified, most likely it has been there for 3-4 weeks. Will a few more hours in school infest more children, most likely not. Head lice do not carry or promote disease. When a case of lice is discovered within a classroom there is rarely a second case found, and if there is, it is commonly found to be a playmate or family member who has spent time with the student outside of the school environment (Pontius, 2011, p. 357).

What is at stake? Bottom line the student’s education! There are many education days lost to the misunderstanding of head lice. There is an abundance of information available which advocates allowing the student to stay in school the remainder of the day, notifying parents to provide treatment, and allowing the student to return to school the next morning after being rechecked. The American Academy of Pediatrics, the National Association of School Nurses and the Harvard School of Public Health support this approach and feel “No Nit policies are meritorious in principle, they are virtually always counter-productive when applied” (The Communicator, 2004, p. 62)

It is my recommendation to form a committee, research data related to head lice in elementary schools, evaluate the data, create a policy, and present it to the school board, and the Calhoun County Public Health medical director, for approval, then education and implementation can take place. “Schools do not send children home with active cases of the common cold, which is clearly transmitted in schools and impacts health and attendance of students”, so why are we currently sending children home with head lice? (Pontius, 2011, p. 357). It is time to research, develop, educate, and implement an evidence-based head lice policy to promote good health, and allow students to stay in school.

The Team

We have a mission, now we need the team to tackle it. The team will be selected using a multi-disciplinary approach. Members will be representative of all elementary schools, (on a volunteer basis); including secretaries, teachers, principals, and parents, as each are directly affected either professionally and/or personally by the issue of head lice. The following professionals will also be asked to participate, the social worker from the Beadle Lake site (the school with the highest number of students diagnosed with head lice), the Health Officer from the Calhoun County Health Department (has access to county and state data), and myself.

As a team we will review the unwritten head lice practices currently being used in each of the elementary school settings. The number of cases confirmed this school year (as there is no previous documentation), and the number of absences related to head lice. We will contact other area schools and other schools in Michigan to seek copies of their current head lice policies. Parents on the committee can contact random parents to gain their insight and education related to the prevention and treatment of head lice. Other member will research other organizations such as The American Academy of Pediatrics, The National School Nurses Association, and the Michigan Department of Community Health, who support allowing student s to stay in school. We will also look at some of the opponents to this approach to provide a well-rounded approach.

Data Collection, Preparation and Approval

The data obtained will be systematically organized and analyzed. A policy (appendix A), will be composed using the research information obtained from the team members. Once the committee is in agreement, a presentation will be created using a visual approach such as PowerPoint. Included will be statistics, research findings, number of cases this school year (appendix C), and the number of head lice related absences (appendix C), that have already occurred, a head lice policy and a plan for education prior to its implementation. The proposed policy will be forwarded to the medical director of the Calhoun County Public Health Department, Dr. Harrington, who will then have the opportunity to review and make any suggestions for improvement. Once approval is obtained from Dr. Harrington, the team will then ask to be put on the School Board’s next meeting agenda.

Outcomes and Evaluation

A policy (appendix A), will be developed that clearly defines management (appendix B), of head lice in the elementary school setting. The identified outcome is to decrease absenteeism related to head lice, while preventing further infestations. A student found with live head lice and/or nits will not immediately be sent home from the school setting, but returned to the classroom. The success of the policy will be measured by, a decrease in head lice related absenteeism (goal 0), no increase in the number of head lice cases in the school, and an increased education level of educators, students, parents and the community, as evidenced by support of the head lice policy.

Implementation

Once accepted by the medical director of the Calhoun County Public Health Department, and the Harper Creek Board of Education, education of staff, parents, students and the general public will begin. I will be responsible for the education process. Supportive data collected by the team will be used. The PowerPoint will be adapted to meet the needs of the audience receiving the information. The policy will not be implemented until the education process is completed.

Education for school staff will be provided at the first scheduled staff meeting in each of the three elementary schools. Notes will be sent home to introduce the policy and an informational meeting will be scheduled at each site for parents, students and the general public to attend. Finally an assembly will be held at each site directed at students. Their presentation will primarily focus on what lice are, what habits to avoid (sharing of personal items, hats, combs, etc.), signs and symptoms, and who to tell when they think they may have lice. The goal in educating the students is to keep them lice free, let them know anyone can get lice, know where to get help and assist them to stay in school.

Conclusion

The infestation of head lice is increasing in the Harper Creek elementary schools. This increase is causing an increase in absenteeism and humiliation for many children. Absenteeism is causing an interruption in their education process, and the humiliation is hurting the self-esteem we are trying to build. With updated information from reliable professional national organizations, the local educators and health care providers, a head lice policy can be developed, and implemented for the benefit of our children. As a school nurse, I am held responsible and accountable to be an advocate for children, keeping them healthy, active and in school.

References

Frankowski, B., & Weiner, L. (2002). Clinical report: Head lice. American Academy of Pediatrics, 110(3), 638-643.

Herman, R. (2000). Head lice are frequently misdiagnosed resulting in missed school days and inappropriate medication. Retrieved from http://www.hsph.harvard.edu/news/press- releases/archives/2000-releases/press08092000.html

Michigan Department of Community Health. (2009). Michigan school head lice prevention and control policy. Retrieved from http://www.goodrich.k12.mi.us/Reports/2009- 2010%20Head%20Lice%20Policy.htm

Missouri Department of Health and Senior Services. (2010). School health. Retrieved from http://health.mo.gov/living/families/schoolhealth/pdf/DHSSHeadliceMmgtFlowchart.pdf

National Association of Elementary School Principals. (2004). Compromising on school for students with head lice. The Communicator, 1(6), 61-63.

Pontious, D. (2011). Hats off to success: Changing head lice policy. NASN School Nurse, 26(6), 357-362.

Park, A. (2010, July 26). Report: Head lice is no reason to keep kids out of school. Time. Retrieved from http//www.time.com/time/printout/0,8816,2006397,00.htmi

Appendix A

Harper Creek School District

Elementary School Head Lice Policy

Beadle Lake Elementary

Sonoma Elementary

Wattle Park Elementary

Background: For many years, Harper Creek School District has excluded students from school immediately upon finding head lice or nits and requiring complete nit removal before returning to school. Current evidence suggests that these requirements are not warranted. The present procedure results in unnecessary absence from school, along with increased anxiety on the part of staff and parents. "Excluding children from school with lice does not affect the total number of cases each year. Education of families on how to prevent and treat lice does affect the numbers in school" (American Academy of Pediatrics, 2002).

Procedures:

When a member of school staff suspects a child is infested with head lice, the following procedures should be followed:

1. The child should be restricted from activities involving close contact (i.e., hugging) or sharing personal items (i.e., hats, clothing, and brushes) with other children.

2. The school/facility must be notified, and the parents must be contacted (verbal communication is preferred). Immediate removal of the child is unnecessary. If the child has lice, they probably have been infested for weeks and prompt removal of the child could lead to embarrassment and ridicule. The child can be sent home at the end of the day. Children should be allowed to ride the school bus home. Transmission via school bus seats is not likely because of the biology of head lice.

3. A letter should be sent home notifying classmates’ parents that a case of head lice is suspected and asking them to check all of their children for head lice. The school should also provide parents with a copy of an information sheet on head lice infestation and treatment options.

4. The child may be allowed to return to school the next morning, but must be re-checked by a trained person. They will be able to return with nits as long as the parent has proof of treatment. They will be rechecked in 2 days, sooner if returning infestation is suspected.

The above policy closely adheres to the Michigan Head Lice Prevention and Control Policy, jointly supported by the Michigan Department of Community Health and the Michigan Department of Education. Approval has been received from the Calhoun County Public Health medical director and the Harper Creek Board of Education.

Effective 12/01/2011

Appendix B

(Missouri Department of Health and Senior Services, 2010)

Appendix C

(Harper Creek School District, 2011)