Lice are small, grayish-white, wingless bugs, about the size of tiny ants. They live on human blood. Lice lay oval, hard, whitish nits (eggs), on the hair shaft, usually less than one-half-inch from the scalp. It takes about 6 days for nits to hatch. The main problem caused by lice is severe itching from their bites. The nits are usually found attached to hair at the back of the neck but can also be found in any hairy area of the body.

Lice are easily spread where people are crowded together or have frequent contact. Head lice cannot hop or jump but are spread by close contact with infested articles such as hats, brushes, combs, pillows, backs of chairs, car seats or close contact with people who have lice. The nits are spread in the same way. Once head lice infestation starts it can spread rapidly and prompt action is needed to get rid of the pest. The usual treatment is a medicated shampoo or cream rinse that will kill both the lice and the nits.

Examine all other residents carefully for the presence of lice. Treat residents who have symptoms. It is very important that the treatment last for the time period noted on the medication. Don't rewash hair or use any hair product that day. Repeat the treatment only as advised by the doctor. After treatment, remove nits by using an extra-fine tooth comb.

All clothing, towels and bedding should be thoroughly laundered once all those with head lice begin their treatment. This prevents head lice from reinfesting. Laundry should be washed in hot water (120 deg. F) and dried in a hot dryer or dry cleaned if not washable. Vacuum sofas and chairs. Combs, brushes and barrettes should be soaked for at least 15 minutes in hot water (over 120 deg. F, equal to hot tap water in most homes). Unwashable items can be enclosed in plastic bags, securely tied for two weeks. Lice can survive for five to ten days without being on a person.

What are some preventive measures?
Regularly change and wash clothing.
When laundering clothing and bedding use hot water (over 120 deg. F).
Do not share clothing or other personal articles such as hair brushes or combs with one another.
What is the recommended regimens for pubic lice?
Permethrin 1% creme rinse applied to affected areas and washed off after 10 minutes. OR
Lindane 1% shampoo applied for 4 minutes to the affected area, and then thoroughly washed off. This regimen is not recommended for pregnant or lactating women.
The recommended regimens should not be applied to the eyes. Pediculosis of the eyelashes should be treated by applying occlusive ophthalmic ointment to the eyelid margins twice a day for 10 days.

Bedding and clothing should be decontaminated (i.e., either machine-washed or machine-dried using the heat cycle or dry-cleaned) or removed from body contact for at least 72 hours. Fumigation of living areas is not necessary.

What follow-up is recommended?
Residents should be evaluated after 1 week if symptoms persist. Re-treatment may be necessary if lice are found or if eggs are observed at the hair-skin junction. Residents who do not respond to one of the recommended regimens should be re-treated with an alternative regimen.

Ice Handling Recommendations

The Centers for Disease Control and Prevention (CDC) published an advisory on Sanitary Care and maintenance of ice-storage chests and ice-making machines in health care facilities in April 1998. The following is a list of the recommendations:

1. All ice handlers should be taught the following precautions:
   - Wash hands before handling ice
   - Hold the scoop by the handle; do not touch other parts of the scoop
   - Do not touch ice with hands
   - Do not return unused ice to the ice-storage chest
   - Keep access doors to an ice-storage chest closed except when removing ice
2. The ice scoop should be cleaned daily with soap and water or in a dishwasher.
3. Limit access to ice-storage chests.
4. Ice-storage chests should be cleaned weekly. Ice-making machines should be cleaned monthly to quarterly. All ice should be removed from the unit, clean all surfaces with fresh soap or detergent solution after the unit has been disconnected. Rinse all surfaces fresh tap water, wipe dry and rinse again with 10- to 100-ppm chorine solution (1 to 8 ml per gallon of water) and allow surfaces to dry before returning the unit to service.
5. During cleaning of the ice-making machines, inspect the gaskets, door tracks, guides. A 50- to 100-ppp chlorine solution should be run through the system according to the manufacturer¹s specifications. The solution should remain in the system for 2-4 hours. The system should be flushed with fresh tap water before it is returned to service.
6. Routine culturing of the unit is NOT recommended.

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   James Marx © 1998