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a blood meal every four to six hours,
so do not survive for long away from the
scalp.5 Nits require optimal conditions
(temperature and humidity as found
close to the scalp) to hatch. However
if optimal conditions are provided,
they can survive away from the scalp for
up to 10 days.
Extensive environmental cleaning
efforts are therefore not considered
necessary. However, given lice and nits
can be found on inanimate objects,
combs and hair brushes should be
soaked in hot water (>60C) for
30 seconds and pillowcases washed
in hot water or put in a hot clothes
dryer for 15–20 minutes.
If a person
is concerned about other items
that have been used or worn while
infested (e.g. linen, blankets, coats,
toys, clothing), washing in hot water
or putting in a hot clothes dryer for
15–20 minutes can be recommended.
Alternatively, objects can be stored
in a tightly‐wrapped plastic bag for
10–14 days or placed in the freezer for
Questions to ask: What product did you
use? Did you check that lice had been
killed the day after each treatment?
The reappearance of head lice a short
time after a successful treatment (i.e. all
lice were dead after the recommended
application time), does not indicate
resistance. If lice were dead immediately
after application, reinfestation or
treatment non‐compliance should
Resistance is unlikely with physical
insecticides. In contrast, resistance
has been reported for all neurotoxic
insecticides, although the actual
prevalence is unknown.
If other causes of treatment failure
have been explored, resistance may
be suspected. Re‐treatment with a
different product immediately and again
in seven days is recommended.
use of physical insecticides should also
When a person reports that a head lice
treatment has failed to eradicate an
infestation, it is important to consider
the likelihood of true and perceived
treatment failure for that individual.
Strictly following instructions for initial
detection, treatment, and confirmation
of treatment success should be
Providing written information (e.g. the
PSA Self Care Fact Card Head lice) to
support verbal instructions will be useful
given the specific approach required
and the course of treatment spanning
2–3 weeks. Written information will be
particularly useful in this case, where
different parents are responsible for
managing the treatment of the child
over the full course of the treatment.
1. Counahan M, Walsh H, Speare R. Head lice as an OHS risk
to primary school teachers in Australia. J Occup Health
Safety – Aust NZ 2009;25(6):477–81.
2. Bauer E, Jahnke C, Feldmeier H. Seasonal fluctuations
of head lice infestation in Germany. Parasitol Res
2009;104:677–681. In: Lindh J, et al. Head lice surveillance
on a deregulated OTC-sales market: a study using web
query data. PLoS ONE 2012;7(11).
3. Healthy Heads without headlice: Management guidelines
for the control of headlice in South Australia. Adelaide:
Department of Health, Government of South Australia;
4. Frankowski B, Bocchini J, Council on School Health and
Committee on Infectious Diseases. Clinical report – Head
lice. Pediatrics 2010;126:392–403.
5. District Health Authority Public Health Services and
the Department of Health Promotion and Protection.
Guidelines for treatment of Pediculosis Capitis (head lice).
Nova Scotia: Public Health Services; 2008.
6. Fact sheet: Head lice. Brisbane: Queensland Health; 2008.
7. Australian Medicines Handbook. Adelaide: Australian
Medicines Handbook; 2013.
8. Wet combing for the eradication of head lice. Aust Fam
Phys 2013;42(1/2):128–9 .
9. Exclusion periods for infectious conditions. In: Australian
Pharmaceutical Formulary and Handbook, 22nd edition.
Canberra: Pharmaceutical Society of Australia; 2012.
10. MIMS Online. MIMS Australia; 2013. Accessed 28/11/2013.
1. Which of the following is the BEST
indicator of an active head lice
a) Pruritis on the scalp.
b) Presence of eggs/nits attached to the
c) Presence of live lice in hair.
d) Any of the above.
2. Which of the following factors will be
LEAST likely to influence successful
eradication of head lice?
a) Using an adequate exposure duration
for the treatment selected.
b) The timing of the second application of
the treatment selected, after the first.
c) Extensive cleaning of the environment.
d) Simultaneous treatment of all infested
3. Resistance to insecticides for the
treatment of head lice:
a) Is likely if head lice are detected a short
time after a successful treatment.
b) Is commonly reported with physical
c) Requires immediate re-treatment with a
different product and again in 7 days.
d) Should be the cause of treatment failure
that is first suspected.
4. Which of the following head lice
treatments should be avoided in
c) Wet combing.
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