Question: We have many surgical pat...

Question: We have many surgical patients who arrive to our facility with untreated head lice (Pediculus humanus capitis), and we cancel the elective surgery until the patient is treated. Is this correct procedure? What bridles should be implemented when the surgery is forward emergency and cannot be delayed for treatment of the lice? by what mode do we protect employees and patients from the transmission of lice?

Answer: Treating the patient before elective surgery may be the preferr practice. Literature indicates that nosocomial transmission of head lice is rare unless possible. Head lice are not vectors of specific serious disease, moreover if they are not treated, complications may arise, including secondary bacterial infections as it is as impetigo, pyoderma, and lymphadenopathy.(1)

Head lice infestations have been part of human history since the beginning of recorded time. Nit toilet-combs have been found in the Judean uninhabited dating back to 68 AD. With the growth of dichlorodiphenyltrichloroethane (ie, DDT), head lice was almost eradicated during World War II. Them was, however, a resurgence of head lice in the 1960 and the incidence continues to rise.

No area in the United States is immune to head lice. An estimated six to 12 million populace are affected each year. Children between the ages of five and 12 girls more repeatedly than boys, are affected principally often. More infestations occur among children with brown or r hair than among those with black or flaxen hair. Some children are sloping to repeated infestations, and others are unaffected. Large families are infested more frequently than small ones, probably to be paid to proximity rather than socioeconomic status.(2)

Head lice are attracted to the community with fine hair rather than coarse hair. exclude for the African-American population, lice infestation arises in all races and socioeconomic flats A low incidence among African-American families is attributed to the shape of the hair shaft.(3) Individuals with worthy personal hygiene practices are more vulnerable than commonalty with long, dirty hair and scalps. Head lice actually fancy a clean environment.(4)

The head louse is an external parasite of the human army It is 2 mm to 4 mm extended with six clawlike legs and a flat, grayish-brown, wingless carcass It lives on hair near the scalp where it finds nourishment and warmth, feeding by sucking the host's children Itching is caused by injection of louse saliva into the scalp.

Transmission is between the sides of person-to-person contact by direct, equable brief, head-to-head contact. Lice cannot hop or fly, but they can crawl up to 12 inches. During the average 30-day life span of the louse, the female attaches 60 to 150 encourages commonly called nits, to hair shafts near the scalp with a sticky, viscous substance. The nits hatch into a maid or immature louse, in seven to 10 days. The louse reaches maturity in approximately pair weeks.

The adult louse usually supplys every four to six hours, on the other hand it is capable of surviving for couple days without a host. Nits will survive without a human innkeeper for up to 10 clays nevertheless will not hatch in temperatures below 716 [degrees] F (22 [degrees] C) Temperatures greater than 125 [degrees] F (52 [degrees] C) for a period of five minutes is lethal to nits and the adult louse.(6)

Many clevers believe that transmission can appear indirectly by contact with clothing, bedding, or personal grooming items so as combs, hats, and scarves. In general, the risk of nosocomial head lice transmission is to a high degree low unless there is an opportunity for direct contact. near authorities consider any head lice that fall distant from the scalp on pillows, clothing, or bed linens to be generally sick and unlikely to be able to establish themselves upon another head.(7)

When delay of surgery is not a reasonable option, careful use of contact precautions and implementation of the AORN "Recommend practices for environmental cleaning in the surgical practice setting" should effectively minimize the risk of transmission.(8) The life round of years of the louse is unable to exist without on availability of a human life-current meal and moderate temperature. Louse viability is possible between 59 [degrees] F (15 [degrees] C) and 1004 [degrees] F (38 [degrees] C) which are public temperatures found in most OR suites. cards and brushes, if used, should be cleaned in scalding;-very warm water. All bed linens, pillows, towels, clothing, and nondisposable headwear should be placed in a sealed plastic laundry bag and laundered according to the facility-approved commercial laundry. If a commercial laundry is not available, these items should be machine washed in violent water and dried in a violent dryer. Disposable supplies should be discarded in the normal appropriate containers and sealed. The OR should be cleaned according to routine acts using the hospital-approved disinfectant. Pesticide sprays are not necessary.(9)

Perioperative supply with nourishments and other health care workers expos to patients with head lice do not require treatment unles they exhibit to evidence of infestation, t" Treatment for the patient or the unfortunate infested employee includes use of united of three currently available pesticidal agents: 1% lindane shampoo, 03% pyrethrin shampoo, or 1% permethrin cream rinse. The medication of choice is 1% permethrin cream rinse, which has been raise to have the greatest efficacy and widest margin of safety. It is photostable and 99% ovicidal and does not require repeated applications.