Isolation Guidelines


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  • Lice

    Isolation requirements

    • Disease: Lice (pediculosis) - head lice, body lice, pubic lice
    • Category: Contact
    • Infective material: Infested areas
    • Duration of isolation: Continue isolation for 24 hours after initiation of therapy
    • Comments: All linen should be changed and disposable pillow discarded. Family members may also be infested and serve as source of reinfestation. Treat roommate only if visibly infested. Health care providers require therapy only if visibly infested. No need for fumigation of room.

    There are three kinds of lice that infest humans, head lice, body lice, and public lice commonly called “crabs." Eggs are laid on body hairs or fibers of clothing in oval “nits." After 7-10 days, small nymphs emerge from the eggs and must feed on blood within 24 hours.

    Methods of transmission

    • Head lice – Direct contact with personal items such as brushes, combs or bedding.
    • Body lice – Direct contact or contact with clothing or bedding. Body lice cling to clothing, especially seams, and may be absent from the body of an infested person. Eggs (nits) may attach to hairs.
    • Pubic lice – Close physical contact, especially sexual. Transmission via clothing, bedding or toilet seats is extremely uncommon because of death of lice when off human host. 

    Treatment of pediculosis

    • For head or pubic lice, 1% gamma benzene hexachloride (i.e., Kwell, Rid, Nix) is the treatment of choice.
      • Shampoo rubbing affected areas vigorously for approximately 4 minutes. Hair is then rinsed thoroughly with water, dried with a clean towel, and combed with a fine-tooth comb to remove remaining “nit” shells.
      • Cream or lotion is applied topically to affected area and left on skin for prescribed amount of time. Check package insert for specific instructions.
      • One treatment is usually sufficient when used correctly. Treatment may be repeated after one week if live lice or “nits” are detected.
      • Precautions – 1% gamma benzene hexachloride can be absorbed through intact skin following topical application, and has the potential for central nervous system toxicity. Its use with mucus membranes, and urethral meatus should be avoided. Kwell and other pediculicides should not be applied to acutely inflamed skin or raw, weeping surfaces.
    • Eyelid involvement can be treated by petrolatum ophthalmic ointment or 1% yellow oxide of mercury ophthalmic ointment.
    • Application of a pediculicide to patients with body lice is usually not indicated. Patients should be bathed and clothes treated
    • Alternative drugs include malathion (Prioderm) and pyrethrin (RID).

    Control measures

    • Family members and other intimate contacts should be examined and treated only if infested. The exception is sexual contacts of patients with pubic lice may be treated simultaneously without exam.
    • Personal care items such as combs or hair brushes may be soaked in 2% Lysol for one hour.
    • The patient’s clothing should be placed in a plastic bag and sent home or
    • securely sealed for 48 hours for head/pubic lice and 30 days for body lice.

    Methods of prevention and disinfection

    • Potential for fomite spread is very limited as eggs do not hatch in the inanimate environment at room temperature. For this reason, insecticide spraying or fumigation of rooms is not recommended. Routine terminal cleaning and carpet vacuuming are sufficient environmental controls.
    • Machine washing on hot cycle, tumble drying, dry cleaning or hot ironing will kill all lice and nits. The patient’s bed linens should be bagged and placed in dirty laundry.
    • Contact Precautions (gowns and gloves) should be followed for 24 hours after start of effective therapy. Thereafter, isolation is not necessary once the patient’s clothing and bedding are properly disinfected.
    • Hospital employees who have contact with a patient infested with lice do not require treatment unless the employee shows evidence of infestation.