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Registration Number: {{org_field_registration_no}}

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Head Lice and Nits Prevention and Management Policy

1. Purpose

The purpose of this policy is to provide clear guidance on the prevention, identification, and management of head lice and nits (the eggs of head lice) at {{org_field_name}}, in a manner that protects the health, dignity, and comfort of all individuals receiving care, while minimising disruption and the risk of transmission. Head lice are a common, non-serious condition, but if left unmanaged, they can cause discomfort, irritation, and social stigma. This policy ensures that our care home adopts a calm, respectful, and evidence-based approach to managing head lice outbreaks, in line with Public Health Wales advice and CIW’s expectations for infection prevention, safeguarding, and person-centred care.

2. Scope

This policy applies to all residents, staff, agency workers, volunteers, and visitors at {{org_field_name}}. It includes any person receiving care who may be affected by, or at risk of, head lice infestation. It also applies to any staff member providing personal care, assisting with grooming, or involved in cleaning and laundry procedures during an outbreak.

3. Related Policies

This policy should be read in conjunction with:
CHW11 – Safe Care and Treatment Policy
CHW17 – Infection Prevention and Control Policy
CHW08 – Dignity and Respect Policy
CHW13 – Safeguarding Adults from Abuse and Improper Treatment Policy
CHW18 – Risk Management and Assessment Policy
CHW40 – Assisting with Personal Care Policy
CHW24 – Management of Accidents, Incidents, and Near Misses Policy

4. Policy Details

4.1 Understanding Head Lice and Nits

Head lice are small insects that live on the human scalp and feed on blood. They spread primarily through direct head-to-head contact and are not caused by poor hygiene. Nits are the empty egg shells left behind after lice hatch. Lice do not carry disease, but they can cause intense itching, scratching, and discomfort. In a care home, prompt identification and discreet management are essential to prevent spread while safeguarding the dignity of the individual affected.

4.2 Prevention and Early Detection

Head lice cannot be completely prevented and their presence is not an indication of poor personal hygiene or inadequate environmental cleanliness. Head lice are mainly spread through direct head-to-head contact.

Staff should remain alert to possible signs of head lice when supporting individuals with personal care, grooming or hair care. Possible signs may include:

• persistent or recurrent scalp itching;
• frequent scratching of the scalp;
• visible lice moving in the hair; or
• eggs or empty egg cases attached to the hair.

Visual observation alone must not be used to confirm an active head-lice infestation. The presence of live head lice should be established using a fine-toothed detection comb.

Where head lice are suspected:

• the individual must be approached sensitively and discreetly;
• privacy and dignity must be maintained;
• the senior member of staff on duty must be informed;
• any examination or detection combing must be undertaken with the individual’s consent, or otherwise in accordance with the Mental Capacity Act 2005 where the individual lacks capacity to make the relevant decision; and
• personal combs, brushes, hats and other items used directly on the hair must not be shared between individuals.

Staff must avoid language or actions which suggest that head lice are caused by poor hygiene or cleanliness.

4.3 Identification and Assessment

Where a member of staff suspects that an individual may have head lice, they must report the concern to the senior member of staff on duty and ensure that the matter is assessed sensitively and in private.

Possible indicators may include:

• persistent itching or irritation of the scalp;
• frequent scratching of the scalp;
• visible lice moving through the hair;
• eggs or empty egg cases attached to individual hairs; or
• redness, excoriation or sores caused by scratching.

The presence of eggs or nits alone must not be taken as confirmation of an active head-lice infestation. An active infestation is confirmed by finding a live head louse, normally through careful examination using a fine-toothed detection comb.

Any assessment must respect the individual’s privacy, dignity, communication needs and preferences.

Where an active infestation is confirmed:

• the finding must be recorded accurately in the individual’s care records;
• the individual must be informed in a manner they can understand;
• any relevant risk assessment and personal plan must be reviewed and updated where necessary;
• appropriate treatment must be discussed and arranged; and
• advice must be sought from a pharmacist, GP, community nurse or other appropriate healthcare professional where there is uncertainty about treatment, where treatment has been unsuccessful, where the person has significant scalp damage or suspected secondary infection, or where there are other clinical concerns.

Medical referral is not routinely required solely because head lice have been identified.

4.4 Management and Treatment

Head lice must be managed promptly, discreetly and in a person-centred manner.

Before treatment or wet combing is undertaken, the individual must be provided with information about the proposed treatment in a way that they can understand and must be supported to make their own decision wherever they have capacity to do so.

Where there is reason to doubt an individual’s capacity to make the particular decision about examination or treatment, staff must follow the Mental Capacity Act 2005. Capacity must be considered in relation to the specific decision at the time it needs to be made. Where the individual lacks capacity, any decision must be made in their best interests in accordance with the Mental Capacity Act 2005. Relevant family members, attorneys, deputies or others may be consulted where appropriate, but a representative must not be treated as having authority to consent unless they have the necessary legal authority.

Treatment options include wet combing or an appropriate medicated head-lice preparation.

Where wet combing is used:

• wash the hair using ordinary shampoo;
• apply sufficient ordinary hair conditioner;
• comb the whole head systematically from the roots to the ends using a fine-toothed detection comb;
• repeat the wet-combing process on days 1, 5, 9 and 13; and
• check the hair again on day 17 to establish whether live lice remain.

Where wet combing has not worked or is unsuitable, advice should be obtained from a pharmacist or other appropriate healthcare professional regarding a suitable medicated lotion or spray. The product must be checked for suitability for the individual, including any contraindications, allergies, age restrictions and other relevant health considerations.

Where a medicinal product is administered or supported by staff, this must be managed and recorded in accordance with CHW21 – Medication Management Policy and the individual’s medication arrangements. Staff undertaking medication-related activities must be appropriately trained and competent.

Any medicated preparation must be used strictly in accordance with the manufacturer’s instructions and any instructions provided by the pharmacist, prescriber or other healthcare professional. Where the product instructions require a second application, this must be completed at the specified interval.

Treatment and examination of the hair must be undertaken privately and in a manner that preserves the individual’s dignity.

Hot washing of bedding, towels and clothing is not required solely because an individual has head lice. Routine laundry arrangements should continue unless there is another clinical or infection-prevention reason for different laundering arrangements.

Personal combs, brushes and other items used directly on the hair must not be shared between individuals. Any reusable detection comb used by staff must be appropriately cleaned between individuals in accordance with the service’s infection prevention and control procedures.

Following treatment, the outcome must be recorded in the individual’s care records and further treatment or professional advice arranged where live lice remain.

4.5 Managing Multiple Cases and Infection Control

Where more than one case of head lice is identified, the Registered Manager and Infection Control Lead must review the circumstances and take proportionate action to minimise further transmission.

The response must include, where appropriate:

• maintaining an internal record of confirmed cases while protecting individuals’ confidentiality;
• considering whether confirmed cases indicate likely close head-to-head contact between affected individuals;
• reviewing relevant individual risk assessments and personal plans;
• ensuring personal combs, brushes, hair accessories, hats and other items used directly on the hair are not shared;
• ensuring communal or reusable hairdressing equipment is appropriately cleaned between individuals;
• offering discreet detection combing to individuals for whom there is a reasonable risk of exposure, with appropriate consent;
• ensuring individuals with confirmed live head lice receive appropriate advice and treatment promptly; and
• providing accurate information and reassurance to individuals, staff and relevant family members or representatives, where disclosure is appropriate.

Routine enhanced cleaning of bedrooms, carpets, furniture or soft furnishings, and hot laundering of clothing or bedding, are not required solely because head lice have been identified.

Individuals with head lice must not routinely be isolated or prevented from participating in ordinary activities solely because of the infestation. Any restriction placed upon an individual must have a lawful, proportionate and individually assessed justification.

The Registered Manager must consider whether the circumstances give rise to any separate statutory notification requirement. Where an event meets the notification criteria in Regulation 60 and Schedule 3 of the Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017, the required notification must be submitted to the relevant authority without delay and in accordance with current CIW requirements.

4.6 Communication and Confidentiality

Information concerning suspected or confirmed head lice must be treated as confidential personal information.

Staff must:

• communicate with the individual discreetly and respectfully;
• avoid naming, identifying or singling out an affected individual to other residents, visitors or people who do not need the information;
• share information internally only with staff who require it for the safe provision, management or oversight of the individual’s care;
• provide the individual with information about head lice, treatment and prevention of transmission in a format and manner they can understand; and
• record relevant communications appropriately in the individual’s care records.

Where the individual has capacity, information must not ordinarily be shared with relatives, friends or other representatives without the individual’s consent unless there is another lawful basis requiring or permitting disclosure.

Where the individual lacks capacity to make the relevant decision about information sharing, staff must act in accordance with the Mental Capacity Act 2005 and applicable confidentiality and data-protection requirements. Relevant information may be shared with a person who has lawful authority to act for the individual, or with other appropriate persons where sharing the information is necessary and lawful in connection with a best-interests decision or the provision of safe care and support.

Where general information needs to be provided to residents, families or staff because several cases have occurred, communications must not identify any affected individual unless there is a lawful and necessary reason to do so.

4.7 Staff Considerations

Any staff member who knows or reasonably suspects that they have head lice must manage the matter promptly and must inform the Registered Manager confidentially where this may affect the safe performance of their duties.

Having head lice does not, in itself, require automatic exclusion from work. The staff member must be advised to commence appropriate treatment promptly.

Where the staff member’s duties involve circumstances in which close head-to-head contact is reasonably foreseeable, the Registered Manager must consider whether temporary, proportionate adjustments to duties are necessary while treatment is commenced. Any decision must be based on the individual circumstances and risk and must respect the staff member’s privacy and confidentiality.

Staff must take reasonable steps to minimise transmission, including avoiding head-to-head contact where practicable and not sharing combs, brushes, hats or other personal hair items.

Staff must not undertake diagnosis or treatment of colleagues as part of their employment duties. Staff requiring treatment or clinical advice should be directed to an appropriate pharmacist, GP or other healthcare professional.

Personal information relating to a member of staff’s head-lice infestation must be handled confidentially and only disclosed where there is a legitimate and lawful need to do so.

4.8 Safeguarding and Wellbeing

Repeated untreated infestations or signs of poor personal care may indicate a need for further support or safeguarding intervention. Where concerns arise, these must be reported to {{org_field_safeguarding_lead_name}}, {{org_field_safeguarding_lead_role}}, and may be referred to {{org_field_local_authority_authority_name}} as appropriate. Psychological support is offered to individuals who feel embarrassed, anxious, or distressed about the issue. Our approach is always non-judgemental and inclusive.

4.9 Monitoring and Quality Assurance

The Registered Manager ensures that any incidents or outbreaks are logged, reviewed, and used to improve future practice. Infection control audits, supervision, and training records are updated to reflect lessons learned. Staff knowledge is reviewed during spot checks and team meetings. Any complaints relating to how head lice were managed are investigated under CHW14 – Complaints Policy.

5. Policy Review

This policy will be reviewed annually or sooner if updated guidance is issued by Public Health Wales or CIW, or if a significant outbreak highlights the need for improvement. Our approach ensures responsive, dignified, and clinically safe management of head lice that supports individual well-being and community health.

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Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}
Reviewed on: {{last_update_date}}
Next Review Date: {{next_review_date}}
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