Recurring Pediculosis

Specialties Geriatric

Published

Id like to know if any nurses have experience managing a lice outbreak.

The circumstance is this....we have a pt (let's call this person #1) with a severe rash and it was assumed the rash was due to pediculosis of the body. This was assumed because one of the Pts sex partners was found to have so many lice they were crawling on the Pts body, bed, etc.

Both parties were treated as well as their (known) sexual contacts. Live lice were not found on all contacts, only a rash was found on some.

For months, #1 has continued to have skin sores, c/o pruritis, etc. #1 has been tx with tac cream, permethrin, Benadryl, etc. The pt was was referred to a dermatologist, but refused to see #1 due to the type of insurance.

#1 is very snugly / sexually active with both genders. One partner, let's call this person #2, was discovered to have genital lice and tx. A few days later, #2's roommate who is intimate with no one, was found to have pediculosis of the hair, body and genital region. This person will not comply with the ordered tx.

As an aside, a new person was discovered to have lice covering their whole body. Their (known) sexual partners, as well as their partners, were not found to have any lice, but recvd tx.

Another pt who has no sexual / intimate contact with anyone nor does this person share a room with anyone affected, was found to have genital lice, and tx.

I, as well as the other health care providers, are at a loss as to what is going on and how to stop it.

Any ideas? This is a large, LTC.

I was thinking of suggesting PO lice meds. Or perhaps tx the entire population.

Has anyone ever experienced something like this? And beat it?

Specializes in LTC,Hospice/palliative care,acute care.

Treatment failure is very common in LTC. Years ago we had a really bad time on a dementia unit.We had admitted a woman with what turned out to be Norwegian scabies and she walked around dropping flakes of skin from her body for days. After treating the residents and staff several times without success here is what FINALLY worked. We washed EVERYTHING-window and privacy curtains and every stitch of clothing. The residents wore gowns for a day. Beds were stripped and scrubbed. Stuffed animals were washed or bagged and stored. We treated everyone topically. A very important aspect is the fingernails-we clipped them, cleaned under them with orange sticks and applied the lotion on,around and under the nails with toothbrushes. All staff were also treated. This finally did the trick. What a nightmare it was!

How many times do you see a nude resident rise from a wet bed and wrap themselves in the curtain? They are always in and out of each other's closets. We could not get our admin to listen to us,our protocol did not cover this either. Finally several staff members called the DOH-that's when we were finally able to take the appropriate action

A number of our residents really suffered.I remember calling the supervisor to the unit a number of times to visualize a rash on another resident and hearing "Oh,the bath water was too hot" or "Look at her nails, those are clearly scratches" Some of us really took the time to do some research.It's amazing what some people don't know- false negative skin scrapings are VERY common....If it looks like a duck,quacks like a duck,darn it-the chances are pretty good you have a DUCK.

Up Vote Up Vote ×
Specializes in Critical Care, Med-Surg, Psych, Geri, LTC, Tele,.
OP - did you ever figure out how the bugs were spreading? I'd love to know, purely out of curiosity.

Nope! And today I decided to check the body of one of the afflicted and what do you think I found?!?! Living lice. He refused tx at first but after a show of force, he complied. But he went after me for taking away his belongings!! Aughhh!

Up Vote Up Vote ×
Specializes in Critical Care, Med-Surg, Psych, Geri, LTC, Tele,.
Treatment failure is very common in LTC. Years ago we had a really bad time on a dementia unit.We had admitted a woman with what turned out to be Norwegian scabies and she walked around dropping flakes of skin from her body for days. After treating the residents and staff several times without success here is what FINALLY worked. We washed EVERYTHING-window and privacy curtains and every stitch of clothing. The residents wore gowns for a day. Beds were stripped and scrubbed. Stuffed animals were washed or bagged and stored. We treated everyone topically. A very important aspect is the fingernails-we clipped them, cleaned under them with orange sticks and applied the lotion on,around and under the nails with toothbrushes. All staff were also treated. This finally did the trick. What a nightmare it was!

How many times do you see a nude resident rise from a wet bed and wrap themselves in the curtain? They are always in and out of each other's closets. We could not get our admin to listen to us,our protocol did not cover this either. Finally several staff members called the DOH-that's when we were finally able to take the appropriate action

A number of our residents really suffered.I remember calling the supervisor to the unit a number of times to visualize a rash on another resident and hearing "Oh,the bath water was too hot" or "Look at her nails, those are clearly scratches" Some of us really took the time to do some research.It's amazing what some people don't know- false negative skin scrapings are VERY common....If it looks like a duck,quacks like a duck,darn it-the chances are pretty good you have a DUCK.

Thanks so much for the input. I like the parts about cleaning under the nails as well as treating all their belongings.

Unfortunately, we can't force tx on anyone. And we have many Pts who refuse to fully comply with tx.

. ]

Up Vote Up Vote ×
+ Add a Comment