| FAQ - Disease and Disease Agents - 2013
Are there any guidelines on head lice or drug resistant scabies?
The 2003 CDC guidelines for infection control in dentistry states the following regarding work restrictions for dental healthcare workers with head lice infestation (pediculosis):
Work restriction: Restrict from patient contact
Duration: Until treated and observed to be free of adult and immature lice 1
The US Centers for Disease Control and Prevention (CDC) Website contains further information regarding head lice:
Adult head lice are roughly 2-3 mm long. Head lice infest the head and neck and attach their eggs to the base of the hair shaft. Lice move by crawling; they cannot hop or fly.
Head lice infestation, or pediculosis, is spread most commonly by close person-to-person contact. Dogs, cats, and other pets do not play a role in the transmission of human lice.
Both over-the-counter and prescription medications are available for treatment of head lice infestations. 2
Treatment for head lice is recommended for persons diagnosed with an active infestation. All household members and other close contacts should be checked; those persons with evidence of an active infestation should be treated. Some experts believe prophylactic treatment is prudent for persons who share the same bed with actively-infested individuals. All infested persons (household members and close contacts) and their bedmates should be treated at the same time. 3
Which also states:
If, after 8-12 hours of treatment, no dead lice are found and lice seem as active as before, the medicine may not be working. Do not retreat until speaking with your health care provider; a different pediculicide may be necessary. If your health care provider recommends a different pediculicide, carefully follow the treatment instructions contained in the box or printed on the label. 3
The CDC states the following regarding head lice and disease transmission:
Head lice are not known to transmit any disease and therefore are not considered a health hazard.
Head lice infestations can be asymptomatic, particularly with a first infestation or when an infestation is light. Itching ("pruritus") is the most common symptom of head lice infestation and is caused by an allergic reaction to louse bites. It may take 4-6 weeks for itching to appear the first time a person has head lice.
Other symptoms may include:
- a tickling feeling or a sensation of something moving in the hair;
- irritability and sleeplessness; and
- sores on the head caused by scratching. These sores caused by scratching can sometimes become infected with bacteria normally found on a person’s skin. 4
In summary, CDC guidelines for infection control in dentistry recommend that dental healthcare workers with active head lice infestations should be restricted from patient contact. Qualified healthcare professionals should be consulted for treatment of head lice infestation and for those cases which appear to not be responsive to treatment. Your state and local health departments may be able to offer additional information and guidelines.
Further information can be accessed at:
The 1998 CDC guidelines for infection control in healthcare workers states the following regarding work restrictions for healthcare workers with scabies:
Summary of suggested work restrictions for health care personnel exposed to or infected with infectious diseases of importance in health care settings, in the absence of state and local regulations (modified from ACIP recommendations9) 5
Work restriction: Restrict from patient contact
Duration: Until cleared by medical evaluation 5
The CDC Website also contains further information about scabies:
Human scabies is caused by an infestation of the skin by the human itch mite (Sarcoptes scabiei var. hominis). The microscopic scabies mite burrows into the upper layer of the skin where it lives and lays its eggs. The most common symptoms of scabies are intense itching and a pimple-like skin rash. The scabies mite usually is spread by direct, prolonged, skin-to-skin contact with a person who has scabies.
Scabies occurs worldwide and affects people of all races and social classes. Scabies can spread rapidly under crowded conditions where close body contact is frequent. Institutions such as nursing homes, extended-care facilities, and prisons are often sites of scabies outbreaks. 6
The CDC Website also states the following regarding scabies:
Early detection, treatment, and implementation of appropriate isolation and infection control practices are essential in preventing scabies outbreaks. Institutions should maintain a high index of suspicion that undiagnosed skin rashes and conditions may be scabies, even if characteristic signs or symptoms of scabies are absent (e.g. no itching). New patients and employees should be screened carefully and evaluated for any skin conditions that could be compatible with scabies. The onset of scabies in a staff person who has had scabies before can be an early warning sign of undetected scabies in a patient. Skin scrapings should be obtained and examined carefully by a person who is trained and experienced in identifying scabies mites. Appropriate isolation and infection control practices (e.g. gloves, gowns, avoidance of direct skin-to-skin contact, etc.) should be used when providing hands-on care to patients who might have scabies. Epidemiologic and clinical information about confirmed and suspected scabies patients should be collected and used for systematic review in order to facilitate early identification of and response to potential outbreaks.
Most recent reports recommend an aggressive approach to preventing and controlling scabies in institutions, particularly when crusted (Norwegian) scabies is confirmed or suspected. 7
Scabies outbreaks have occurred among patients, visitors, and staff in institutions such as nursing homes, long-term care facilities, and hospitals. Such outbreaks frequently are the result of delayed diagnosis and treatment of crusted (Norwegian) scabies in debilitated, immunocompromised, institutionalized, or elderly persons. The characteristic itching and rash of scabies can be absent in such persons, leading to frequent misdiagnosis and delayed or inadequate treatment and continued transmission. Scabies often is not recognized until it begins to appear among staff and other patients at the institution.
Local and/or state health departments may be able to provide guidelines for preventing and controlling scabies outbreaks. 8
Products used to treat scabies are called scabicides because they kill scabies mites; some also kill mite eggs. Scabicides used to treat human scabies are available only with a doctor’s prescription. No “over-the-counter” (non-prescription) products have been tested and approved to treat scabies. The instructions contained in the box or printed on the label always should be followed carefully. Always contact a doctor or pharmacist if unsure how to use a particular medicine. 9
And, in the CDC FAQ section for scabies the following information can be found:
When can I return to work if I am a health care provider who has been diagnosed with scabies and my job requires skin-to-skin contact with patients?
Scabies usually is spread by prolonged skin-to-skin contact with a person who has scabies. Scabies sometimes also can be spread by contact with items such as clothing, bedding, or towels that have been used by a person with scabies, but such spread is very uncommon, with the exception of crusted scabies. Persons with crusted scabies should be considered highly contagious and appropriate isolation procedures should be used to protect other persons from becoming infested.
In general, a person diagnosed with scabies could return to work once treatment is begun. CDC recommends contacting the appropriate local and state health department for guidance pertaining to any workplace restrictions for persons with scabies. 10
In summary, CDC guidelines for infection control pertaining to healthcare workers with active scabies infestation state that the affected worker should be restricted from patient contact. Qualified healthcare professionals should be consulted for treatment of scabies infestation and for those cases which appear to not be responsive to treatment. Your state and local health departments may be able to offer additional information and guidelines.
Further information can be accessed at:
1) Kohn WG, Collins AS, Cleveland JL, Harte JA, Eklund KJ, Malvitz DM, Centers for Disease Control and Prevention (CDC). Guidelines for infection control in dental health-care settings—2003. MMWR Recomm Rep 2003;52(RR-17):1-61. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5217a1.htm Accessed on August 20, 2013.
2) US Centers for Disease Control and Prevention. Parasites - Lice - Head Lice. http://www.cdc.gov/parasites/lice/head/index.html Accessed on August 20, 2013.
3) US Centers for Disease Control and Prevention. Parasites - Lice - Head Lice – Treatment.
http://www.cdc.gov/parasites/lice/head/treatment.html Accessed on August 20, 2013.
4) US Centers for Disease Control and Prevention. Parasites - Lice - Head Lice – Disease. http://www.cdc.gov/parasites/lice/head/disease.html Accessed on August 20, 2013.
5) US Centers for Disease Control and Prevention. Guideline for infection control in health care personnel, 1998. http://www.cdc.gov/hicpac/pdf/InfectControl98.pdf Accessed on August 20, 2013.
6) US Centers for Disease Control and Prevention. Parasites - Scabies http://www.cdc.gov/parasites/scabies/ Accessed on August 20, 2013.
7) US Centers for Disease Control and Prevention. Parasites - Scabies – Prevention. http://www.cdc.gov/parasites/scabies/health_professionals/prevent.html Accessed on August 20, 2013.
8) US Centers for Disease Control and Prevention. Parasites - Scabies – Institutional Settings. http://www.cdc.gov/parasites/scabies/health_professionals/institutions.html Accessed on August 20, 2013.
9) US Centers for Disease Control and Prevention. Parasites - Scabies – Treatment. http://www.cdc.gov/parasites/scabies/treatment.html Accessed on August 20, 2013.
10) US Centers for Disease Control and Prevention. Parasites - Scabies - Workplace Frequently Asked Questions (FAQs). http://www.cdc.gov/parasites/scabies/gen_info/faq_workplace.html Accessed on August 20, 2103.