Skip to content
View in the app

A better way to browse. Learn more.
allnurses

A full-screen app on your home screen with push notifications, badges and more.

To install this app on iOS and iPadOS
  1. Tap the Share icon in Safari
  2. Scroll the menu and tap Add to Home Screen.
  3. Tap Add in the top-right corner.
To install this app on Android
  1. Tap the 3-dot menu (⋮) in the top-right corner of the browser.
  2. Tap Add to Home screen or Install app.
  3. Confirm by tapping Install.
Discussion

Recurring Pediculosis

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?

  • Quote

    • Featured Replies

    • Expert

    Is this a geri psych unit?

    I am confused about all the sexual activity....active group aren't they?

    You can treat the patient but you need to find out where they are getting it. They need their clothing and bedding all treated. Hair brushes and their personal items have to be de-bugged as well. Cloth furniture, rugs, stuffed animals..... need to be treated as well.

    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.
    Being the devils advocate...because of my ER brain is there any possibility that you have a staff member infecting the residents?

    Outbreaks in the Nursing Home: Responding Responsibly

  • Quote
    • Author

    Thanks for replying ESME. It's not Geri psych. The clients are allowed to have sex, we promote safe sex and provide condoms. It is their "home". The ages range from 20-60. Many are there because they've hurt others (criminally) but were found mentally ill and unable to stand for trial. Some are simply so gravely disabled by their mental illness that they can't take care of themselves without supervision.

    I think that treating all of their personal items is appropriate, but our protocol only allows for treating themselves and their bedding and their room. (Not inside of their closets, drawers, etc)

    I feel like we're playing hit and miss. Tx 1 person here, 1 person there. Oh there it is again, a few months later on another person. Not sure if they keep getting reinfested due to new admissions or if we just never got rid if it in the first place.

    Shoot...I guess it could be a staff member. It could be anyone.

    Thanks for the article. It was good reading. (-: I wish I could implement everything in it.

    I am trying to learn that I can't fix everything. But I feel sorry for the Pts who are affected. )-: and those at risk- which is the entire population. )-:

    So many rashes!!!

  • Quote
    • Expert

    I think you need to consult infectious disease or a public health nurse. This can't be allowed to spread unchecked. The facility MUST have some policy about the treatment of parasites. Without these precautions you will continue to have a problem.

    CDC - Lice - Head Lice

  • Quote
    • Expert

    I moved the thread to Long term care...you might find helpful answers here.

  • Quote
    • Author

    Thanks! I couldn't decide if I should put it here, in prison nursing or LTC!

  • Quote
    • Author
    I think you need to consult infectious disease or a public health nurse. This can't be allowed to spread unchecked. The facility MUST have some policy about the treatment of parasites. Without these precautions you will continue to have a problem.

    CDC - Lice - Head Lice

    We do have a policy. I just don't feel it addresses how to control an epidemic, I Feel it is helpful for isolated cases.

  • Quote

    Ahh the joys of mixed sex forensic psychiatric units.

  • Quote
    • Author
    Ahh the joys of mixed sex forensic psychiatric units.

    Yup!!!!! (-; lol!!!!'

  • Quote

    What a mess. Unless there is a mass tx of all residents affected and all of their belongings (closets, dressers, etc) I don't think this will end. Ugh.. Now I'm all itchy! Hopefully you don't bring any critters home on you. :sour:

  • Quote

    I wonder if practices in the laundry could play a part. Maybe the water's not hot enough to kill nits shed onto linens? Are patients' clothes all washed together? Or something?

  • Quote

    OP - did you ever figure out how the bugs were spreading? I'd love to know, purely out of curiosity.

  • Quote

    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.

  • Quote

    • Join the conversation

    You can post now and register later. If you have an account, sign in now to post with your account.

    Guest
    Add a Comment
    Go to topic listing

    Currently Reading 0

    • No registered users viewing this page.

    Account

    Navigation

    Search

    Search

    Configure browser push notifications
    Chrome (Android)
    1. Tap the lock icon next to the address bar.
    2. Tap Permissions → Notifications.
    3. Adjust your preference.
    Chrome (Desktop)
    1. Click the padlock icon in the address bar.
    2. Select Site settings.
    3. Find Notifications and adjust your preference.