Definition
Pediculosis is a parasitic infestation caused by lice (Pediculus humanus capitis, P. h. corporis, or Pthirus pubis) that affects millions worldwide, especially children in close-contact settings. Beyond itching and sleep disturbance, unchecked infestations can lead to secondary bacterial infections, social stigma, and, in the case of body lice, transmission of serious diseases like typhus or trench fever.
Primary Treatment Objectives
- Destroy adult lice and nits (eggs) to interrupt the life cycle
- Prevent transmission to family members, peers, and the community by eradicating all infestation reservoirs
- Relieve itching, discomfort, and sleep disturbances to improve daily functioning
- Avoid secondary skin infections (e.g., impetigo) resulting from scratching
- Restore hygiene, comfort, and a sense of well-being for the patient and caregivers
Types of Infestation
- Head lice (Pediculosis capitis): live on the scalp and hair shafts, lay nits near the scalp.
- Body lice (Pediculosis corporis): live and lay eggs in clothing seams; move to feed on skin.
- Pubic lice (Pediculosis pubis): infest coarse hair (pubic area, eyelashes); transmit via close contact
Assessment & Diagnosis
- Inspect wet, conditioned hair with a fine-toothed nit comb for live lice or nymphs; nits >6 mm from scalp are likely non-viable.
- Examine clothing seams for body lice and nits; use magnification if needed.
- Confirm pubic lice by visualizing adults or eggs at hair bases; consider Wood’s lamp inspection.
Articles
Preparation of Equipment
- A clean tray containing;
- Big triangular bandage or sling.
- Apron.
- Bowl with nonabsorbent cotton balls.
- Gauze pad or sponge cloth.
- Gauze pieces.
- Bowl with antilice shampoo or medications like 25% benzyl benzoate or other commercial preparations.
- K-basin with disinfectant (1% Lysol).
- Safety pins.
- Comb.
- Spatula or rag pieces.
- If the patient is bedridden, then articles for hair wash should also be collected.
Procedure
| Nursing Action | Rationale | |
| 1. | Explain the procedure to the patient. | To gain cooperation. |
| 2. | Assemble equipment on the right side of the bed. | For convenience of work. |
| 3. | Provide privacy. | To maintain dignity of the patient. |
| 4. | Position the patient comfortably in sitting or lying position. | To promote comfort. |
| 5. | Wear apron. | To prevent contamination. |
| 6. | Spread bath towel over the patient’s shoulders and fix it with safety pin. | To prevent spreading of lice over the body. |
| 7. | Comb hair. | To remove tangles. |
| 8. | Instruct the patient to close eyes and cover eyes with the gauze pad or sponge cloth. | To avoid eye irritation. |
| 9. | Pour medication or antilice shampoo in a bowl. | To use effectively. |
| 10. | Divide hair into several sections. | For thorough application. |
| 11. | Apply antilice medication or shampoo to the scalp and hair using a spatula or rag pieces. | To destroy pediculi and nits. |
| 12. | Spread triangular bandage/towel under head with its apex facing head end of bed. | To avoid transmission of pediculi. |
| 13. | Cover the entire hair with triangular sling or towel; pin it, leave it for a period of time based on the medicine used. | To avoid the spread of pediculi. |
| 14. | Clean and disinfect the comb and other articles after use. | To prevent the spread of pediculi and nits. |
| 15. | If the patient is dependent, provide hair wash; in case of ambulatory patients, instruct them to have hair wash. | To remove the medication and shampoo off the hair. |
| 16. | Wash hands thoroughly. | To prevent the spread of pediculi and nits. |
| 17. | Remake the bed with clean linen. | For cleanliness of environment. |
| 18. | Position the patient comfortably. | To promote comfort. |
Mechanical Removal
- After each treatment, comb wet hair every 2–3 days for 2–3 weeks to remove residual lice and nits.
- Use a nit comb on clean, conditioned hair; wipe teeth between strokes.
- For pubic or body lice, shave or trim hair in localized areas to facilitate inspection and treatment.
Do’s and Don’ts
| Do | Don’t |
|---|---|
| Follow the full course of pediculicide instructions | Skip retreatment when required |
| Coordinate treatment of all close contacts simultaneously | Share combs, brushes, hats, or bedding |
| Perform nit combing every 2–3 days for 2–3 weeks | Use flammable products (kerosene, gasoline) |
| Launder or seal items per guidelines | Rely on unverified home “suffocation” remedies |
| Monitor for reinfestation and treat promptly | Overuse pediculicides—follow age and dosing |
Special Considerations
- Permethrin 1% lotion is approved for children as young as 2 months; pyrethrins require age ≥2 years.
- Ovicidal activity varies: non-ovicidal agents (permethrin, pyrethrins) need retreatment at 7–10 days to catch newly hatched lice; strongly ovicidal agents (malathion, spinosad) only require a second course if live lice persist.
- Permethrin and pyrethrins with piperonyl butoxide are considered safe in pregnancy and breastfeeding; ivermectin has low risk but is not first-line in this population.
- HIV-positive or immunocompromised patients follow the same pediculicide regimens, but monitor closely for secondary bacterial infections and treatment failures.
- Do not combine different head-lice medications simultaneously; if live lice persist after two proper treatments with one class, switch to an alternative pediculicide.
- Lindane is neurotoxic and reserved only for documented failure of safer agents; avoid in infants, young children, pregnant or lactating women, and those with seizure disorders.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
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