For December, WFIS received an inquiry about WA K-12 policy on recurrent lice issues in a classroom.  So, for this month’s Ask Nancy, we look at how to prevent lice outbreaks and review guidelines on how school staff should address discovery of lice.  


Does recurrent lice issues in a classroom ever become a health code violation if allowed to persist?

Nancy says:

Washington State does not have a school lice policy or a health code related to lice. The Department of Health has recommendations based on national recommendations, including those of the American Academy of Pediatrics.

Head lice do not transmit disease. They are common, particularly in lower elementary school grades. They are not a reason to exclude students from school. If they are an ongoing problem for a particular student, it is hoped that the school nurse can assist the parents with knowledge on how to deal with them.

On November 13, 2018, EPA’s School Integrated Pest Management had a webinar, Head Lice – Expert Panel Discussion with a discussion of these issues. It does not appear to be posted yet, but should appear on this site in the next month. There currently is an older webinar on head lice posted from October 2015, with a Q&A section on managing head lice.

Head lice is addressed in the Infectious Disease Control Guide for School Staff, OSPI, 2014 (PDF).


Are there any types of lice in WA State that schools should be concerned about from a health perspective?

Nancy says:

OSPI Health Services explains the different kinds of lice affect the head, body, and pubic areas.  Head lice are the only common species in WA State.  Unlike body lice, head lice are not a health hazard and are not responsible for the spread of any disease.  Infestation is principally a nuisance rather than a major threat to the student’s well-being.

Head lice are parasitic insects less than 1/8 of an inch in length that feed on blood from the scalp.  Lice eggs, called “nits”, attach to a hair shaft until they hatch into live lice.  Lice and nits can be found on the head, eyebrows, or eyelashes, but are usually found on the scalp, particularly around and behind the ears and near the neckline at the back of the head.  Lice do not jump or fly – they crawl only on hair shafts.

Head lice outbreaks are common in the United States among children between the ages of 3–12 years. Head lice are not a sign of poor hygiene or unclean homes or schools. Students of all socio-economic groups can be affected.

Signs and symptoms of head lice infestation include:

  • Itching on the head and scalp.
  • A tickling feeling of something moving on the head or in the hair.
  • The detection of live lice.
  • Nits (lice eggs) or empty cases from hatched lice attached to hairs.
  • Sores or scratch marks on the head caused by scratching.
  • Irritability and trouble sleeping. (Head lice are most active in the dark.)



Are schools required to report outbreaks of lice to a State agency or the Health Department?

Nancy says:

Reporting to your local health jurisdiction is not required.   Follow this list of School Staff/ Nurse Responsibilities to understand best practices:

  • Immediate or long-term exclusion is no longer recommended.
  • Students with live head lice can remain in class and go home at the end of the school day, be treated, and return to school after the appropriate treatment has begun.
  • Students can return to school with nits following treatment. Nits may persist after initial treatment, therefore, students with nits should be allowed back in school the next day. Successful treatment should kill crawling lice.
  • Notify parent/guardian of the suspected case. Suggest resources for parents on how to treat head lice, such as those available through the Washington State Department of Health Lice web page. Other local health departments not listed on this site may also have materials available to share with families and staff (see Appendix XII for a listing of Washington State health jurisdictions).
  • Refer to a licensed health care provider for evaluation of secondary infection (such as skin infections from scratching), if suspected.
  • Maintain and support confidentiality for the student.
  • Utilize standard precautions (see Guidelines for Handling Body Fluids in Schools) which include Hand Washing Procedures, Use of Gloves, General Housekeeping Practices, and Procedures for Cleaning and Disinfection of Clothing and Linens soiled with Body Fluids.