Head lice; formaldehyde storage; chewing gum in the OR; building design.

Question: We have many surgical patients who come to our facility with untreated head lice (Pediculus humanus capitis), and we cancel the elective surgery until the patient is treated. Is this correct procedure? What controls should be implemented when the surgery is on emergency and cannot be delayed for treatment of the lice? How do we protect employees and patients from the transmission of lice?

Answer: Treating the patient before elective surgery may be the preferred practice. Literature shows that nosocomial transmission of head lice is rare but possible. Head lice are not vectors of specific serious disease, but if they are not treated, complications may arise, including secondary bacterial infections such as impetigo, pyoderma, and lymphadenopathy.(1)

Head lice infestations have been part of human history since the beginning of recorded time. Nit combs have been found in the Judean desert dating back to 68 AD. With the development of dichlorodiphenyltrichloroethane (ie, DDT), head lice was almost eradicated during World War II. Them was, however, a resurgence of head lice in the 1960s, and the incidence continues to rise.

No area in the United States is immune to head lice. An estimated six to 12 million people are affected each year. Children between the ages of five and 12, girls more often than boys, are affected most often. More infestations occur among children with brown or red hair than among those with black or blond hair. Some children are prone to repeated infestations, and others are unaffected. Large families are infested more often than small ones, probably due to proximity rather than socioeconomic status.(2)

Head lice are attracted to people with fine hair rather than coarse hair. Except for the African-American population, lice infestation occurs in all races and socioeconomic levels. A low incidence among African-American families is attributed to the shape of the hair shaft.(3) Individuals with good personal hygiene practices are more vulnerable than people with long, dirty hair and scalps. Head lice actually prefer a clean environment.(4)

The head louse is an external parasite of the human host. It is 2 mm to 4 mm long with six clawlike legs and a flat, grayish-brown, wingless body. It lives on hair near the scalp where it finds food and warmth, feeding by sucking the host's blood. Itching is caused by injection of louse saliva into the scalp.…