Primary prevention
Although fomite (i.e., an inanimate object that can carry infectious organisms) transmission is relatively insignificant, primary prevention can be attempted by teaching children to avoid the use of brushes, combs, and hats belonging to others. Parents should be reluctant to instruct their children to 'never get close' to anyone.
There is some controversy about whether it is appropriate for school nurses to routinely examine the heads of children in the school setting. No studies exist that prove the efficacy of this approach. It would be time consuming for a school nurse to accomplish this at school. It seems more appropriate for school nurses to alert parents of students if there is a significant number of cases of head lice in a particular setting, inform parents of the proper way to diagnose and treat head lice infestations, and be available to advise parents who have particular questions. Because of the prevalence of head lice in young school-aged children, parents of these students should assume that their child can be exposed at any time. Checking for head lice routinely once a week could aid in early diagnosis, make treatment easier, and prevent excessive spread.[6][29][30]
Parents of school-aged children are often asked to screen their asymptomatic children for head lice infestation if their child has been exposed or had close contact with someone with an infestation. The circumstances could be an exposure in a school classroom, camp, or sleepover party in the preceding month. The parent should receive instructions on how to effectively look for live lice. Alternatively, parents of young school-aged children could assume exposure could take place at any time, and screen their children for live lice on a weekly basis, using the same effective technique (wet combing).[9][31][32]
Secondary prevention
Head lice infestations are almost impossible to prevent. Because head-to-head contact is the major mode of spread, close contact with others can be discouraged, but probably cannot be eliminated. At best, children can be instructed to avoid sharing hair care items and fabric hats (lice cannot grasp smooth surfaces such as plastic). Spread of infestations can be decreased by early detection of new cases and prompt treatment with effective and safe products or methods. Early detection can best be accomplished by weekly screening at home by parents of children most at risk (3- to 12-year-old school children). Parents should be encouraged to check their child by wet combing before and after sleepover events, including camp experiences. School nurses can help with case detection of symptomatic children. If there is an unusually high incidence of lice infestation in a particular classroom, school nurses can help with additional case finding. There are no convincing data that show enforced exclusion policies are effective in reducing the transmission of lice, and 'no nit' policies are discouraged by organisations such as the National Association of School Nurses and the American Academy of Pediatrics.[9][31][97] Schools and health authorities can assist with the detection and proper treatment of head lice infestations by having available appropriate educational materials and policies if necessary.
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