What should you do if a patient has lice? - briefly
Confirm infestation and apply an FDA‑approved topical pediculicide according to the label. Follow with meticulous nit removal, laundering of clothing and bedding in hot water, and instruction to avoid head‑to‑head contact.
What should you do if a patient has lice? - in detail
When a patient presents with head‑lice infestation, immediate steps focus on confirmation, containment, therapeutic intervention, environmental sanitation, and ongoing monitoring.
First, verify the diagnosis by inspecting the scalp and hair for live lice or viable nits attached within 1 cm of the hair shaft. Use a fine‑toothed comb under adequate lighting; record findings in the medical record.
Second, isolate the individual from close contact settings—school, daycare, or communal living areas—until effective treatment has been administered and confirmed.
Third, initiate pharmacologic therapy. Preferred options include a 1 % permethrin lotion applied to dry hair, left for 10 minutes, then rinsed off; or a 0.5 % malathion shampoo applied for 8–12 hours. Follow manufacturer instructions precisely. For resistant cases, consider oral ivermectin at 200 µg/kg, single dose, repeat after 7 days if necessary. Document dosage, timing, and any adverse reactions.
Fourth, prescribe a mechanical removal regimen. Instruct the patient or caregiver to comb wet hair with a nit comb at 48‑hour intervals for at least three sessions. Remove all visible nits; discard or disinfect the comb after each use.
Fifth, address the environment. Wash bedding, clothing, and towels used within the preceding 48 hours in hot water (≥ 60 °C) and tumble‑dry on high heat. Items that cannot be laundered should be sealed in plastic bags for two weeks. Vacuum carpets, upholstered furniture, and car seats; discard vacuum bags promptly.
Sixth, arrange follow‑up evaluation 7–10 days after initial treatment to confirm eradication. If live lice persist, repeat the chosen medication or switch to an alternative agent. Provide written instructions for the next treatment cycle if required.
Seventh, educate the patient and close contacts on transmission pathways, personal hygiene practices, and the importance of regular head inspections. Emphasize avoidance of sharing combs, hats, or hair accessories.
Finally, record all interventions, outcomes, and educational components in the patient’s chart. Notify public‑health authorities if the case occurs in a school or institutional setting, following local reporting guidelines.