DC170-Head Lice and Nits Prevention and Treatment Policy

Registration Number: {{org_field_registration_no}}

Head Lice and Nits Prevention and Treatment Policy

1. Purpose and Scope

This policy provides clear guidance for our domiciliary care staff on the prevention, identification, and treatment of head lice and nits among service users. It ensures that our care service maintains high hygiene standards, complies with CQC regulations, and protects the dignity and well-being of our service users. Head lice infestations are common and not indicative of poor hygiene, but without prompt treatment, they can cause discomfort, distress, and potential secondary infections. Our goal is to manage infestations effectively while ensuring service users receive safe, dignified, and high-quality care.

2. Responsibilities of the Care Provider

Our domiciliary care service must ensure that all staff members are well-informed and trained to handle head lice cases efficiently. We are responsible for implementing preventative measures, early detection protocols, and appropriate treatment methods. Additionally, we must ensure that all service users and their families are educated about lice prevention and treatment. This policy supports compliance with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Regulation 12 (Safe care and treatment) by setting out how we prevent avoidable harm through proportionate infection prevention and control (IPC), risk assessment, safe working practices, and appropriate escalation when concerns arise. Where this policy results in changes to our regulated activity information, we will update relevant governance documents and, where applicable, our Statement of Purpose in line with the Care Quality Commission (Registration) Regulations 2009, Regulation 12 (Statement of purpose).

3. Prevention Strategies

3.1 Education and Awareness

It is crucial that both staff and service users understand how lice spread and what measures can prevent infestations. Lice are transmitted primarily through direct head-to-head contact, making it important to encourage awareness among service users and their families. Care staff should regularly provide service users and families with educational materials, explaining the importance of regular hair checks, avoiding the sharing of hair accessories, and maintaining good personal hygiene.

3.2 Personal Hygiene Standards

All service users should be encouraged to maintain good hygiene, including regular hair washing and combing. Staff should assist service users who require help with personal care by ensuring their hair is combed and cleaned frequently. Combs, brushes, and towels must be designated for individual use to prevent cross-contamination. Any personal hygiene items must be stored separately and cleaned properly after use. Service users with long hair should be advised to keep their hair tied back where possible to reduce the risk of lice transmission.

3.3 Staff Training

Care staff should undergo training on how to identify lice infestations and how to use effective treatment methods. This includes understanding the lice lifecycle, proper techniques for wet combing, and the appropriate use of medicated treatments. Infection control training should also emphasise the importance of hygiene and best practices for preventing cross-infection between service users. Staff must be confident in addressing concerns sensitively and reassuring service users that lice infestations are manageable and common.

3.4 Proportionate IPC and safe working practices (Regulation 12 – Safe care and treatment)

Head lice are spread mainly by direct head-to-head contact and are not a sign of poor hygiene. We will apply proportionate precautions to prevent avoidable cross-transmission while maintaining dignity and normal daily living.
Staff must:

Perform hand hygiene before and after any hair care.
Wear disposable gloves only when there is likely contact with bodily fluids, broken skin, or when applying a treatment product (follow product safety instructions).
Use the service user’s own comb/brush where possible. If agency equipment is used (e.g., a nit comb supplied by the provider), it must be cleaned and decontaminated after use according to the manufacturer’s instructions and our infection prevention policy.
Avoid sharing hair accessories/brushes between people.
Do not undertake unnecessary environmental ‘deep cleaning’ in response to head lice; instead focus on correct treatment and checking close contacts.
These arrangements support compliance with Regulation 12 (Safe care and treatment) and our IPC governance arrangements.

4. Identification and Early Detection

4.1 Signs of Head Lice Infestation

Care staff should be vigilant in identifying symptoms of a lice infestation. Common signs include persistent itching, visible white nits (eggs) attached to hair shafts close to the scalp, and live lice moving in the hair. The most common areas for lice to be found are behind the ears and near the nape of the neck. Redness and irritation may also be present due to scratching, which could lead to secondary infections if left untreated.

4.2 Routine Checks

Regular head checks should be incorporated into service users’ personal care routines. Service users with long hair or those who live in shared environments should be monitored more frequently. If an infestation is suspected, a thorough scalp examination should be conducted using a fine-toothed nit comb. If lice or nits are found, immediate action should be taken to prevent further spread.

4.3 Consent, capacity and best-interests

Head checks, wet combing, and the application of any treatment product require the person’s informed consent. Staff must explain what will happen, why it is needed, and offer the person choices (for example, timing, who is present, and whether a family member wishes to assist).
If there is reason to believe the person may lack capacity to consent to checks or treatment, staff must follow the Mental Capacity Act process used by the service (capacity assessment and best-interests decision-making), involve those close to the person as appropriate, and record the decision clearly in the care record and care plan.

5. Treatment Procedures

5.1 Non-Medicated Approach (First Line of Action)

The preferred first approach to treating head lice is the wet combing method. This involves washing the service user’s hair and applying a conditioner to facilitate easy combing. A fine-toothed nit comb should then be used to systematically remove lice and nits. This process should be repeated every 3–4 days for two weeks. In addition to combing, clean hair accessories and combs/brushes after use and avoid sharing them with others. Routine high-temperature laundering and extensive environmental cleaning are not usually necessary for head lice; efforts should focus on correct treatment, repeat checking, and checking/treating close contacts where indicated.

5.2 Treatment products

Where wet combing is not appropriate (for example, the person cannot tolerate it) or has not been effective, the service user (or their representative) may choose an over-the-counter head lice treatment from a pharmacy. Staff must not recommend a specific brand, but may support the person to follow pharmacist/NHS advice and the product instructions.

Treatment must only be applied with the person’s informed consent (or a best-interests decision where applicable).
Any product used must be used exactly as per manufacturer instructions, including the timing of any repeat application.
Staff must record: product name, batch/expiry if available, application date/time, who applied it, and the outcome in the care record/care plan.
Staff must not use medicated lotions/sprays to prevent head lice.
If there is broken skin, signs of infection, eye involvement, allergy, uncertainty about diagnosis, repeated treatment failure, or significant distress, staff must escalate to a pharmacist/GP for advice.

5.3 Follow-Up

A post-treatment check should be performed 10–14 days after treatment completion to confirm that the infestation has been fully resolved. Continued weekly checks should be encouraged as part of a regular hygiene routine to prevent future infestations. Service users should also be reminded to avoid close head-to-head contact with others and to keep their hair tied back where possible.

5.4 Care planning, escalation and safeguarding

The care plan must specify: who will carry out checks/treatment, the agreed method (wet combing and/or product use), frequency, and how outcomes will be monitored.
Staff must escalate to management and seek health professional advice (pharmacist/GP) if:

there are signs of secondary infection (e.g., broken skin with redness, swelling, discharge),
infestation persists despite correct treatment cycles,
the person experiences a suspected adverse reaction to a product, or
there are concerns that personal care needs are not being met (possible neglect).
Where neglect or self-neglect is suspected, staff must follow safeguarding procedures and document actions taken.

6. Confidentiality and Dignity

All cases of lice infestation must be managed with sensitivity and discretion. Service users should not be made to feel embarrassed or stigmatised. Care staff should notify the service user’s next of kin or responsible person privately and offer support in resolving the infestation. Staff should emphasise that head lice are a common and manageable condition and that treatment is straightforward and effective.

7. Reporting and Record Keeping

7.1 Internal Reporting

All cases of lice infestation and treatment must be documented in the service user’s care plan. Staff should record when lice were first identified, the treatment method used, and the outcome. Any concerns about persistent infestations should be escalated to management for further intervention.

7.2 Statutory notifications to CQC

A head lice infestation alone is not normally a notifiable incident to CQC. However, we must make statutory notifications under the Care Quality Commission (Registration) Regulations 2009 when the criteria in the regulations are met (for example: serious injury requiring treatment to prevent death or significant harm, abuse or allegations of abuse, police involvement, or an incident that prevents the service from running safely and properly).

Where an infestation is linked to a safeguarding concern (e.g., neglect, repeated failure to meet personal care needs, or the person is unable to protect themselves from avoidable harm), this must be escalated under our safeguarding procedures and a CQC notification made if the incident meets the Regulation 18 criteria.

7.3 Monitoring, audit and learning (Good governance)

Management will review recorded episodes to identify patterns (e.g., repeated infestations, barriers to treatment, training needs). Where learning is identified, actions will be recorded (e.g., refresher training, care plan updates, liaison with family/health professionals) and checked for completion.

8. Regulatory compliance and governance mapping

This policy supports compliance with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, particularly:

Regulation 12 (Safe care and treatment): proportionate IPC, risk assessment, and escalation to prevent avoidable harm.
Regulation 17 (Good governance): accurate records, audits/learning from repeated infestations, and updated care planning.
Regulation 18 (Staffing): staff training and competence to deliver personal care safely and respectfully.
This policy also sits alongside our statutory duties under the Care Quality Commission (Registration) Regulations 2009 (including duties to notify CQC of specified incidents and changes when the regulatory criteria are met).

9. Staff Responsibilities

Care staff are responsible for following infection control protocols, conducting routine lice checks, and implementing timely treatments. They must maintain accurate records of infestations and provide education to service users and their families on prevention and treatment. Staff should also support service users in preventing reinfestation and ensure that treatment is conducted in a respectful and dignified manner.

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}}
Copyright © {{current_year}} – {{org_field_name}}. All rights reserved.