INFESTATION POLICY

    Date     Page(s)                       Comments                          Approved by
  June 2010              Updated in line with the Trust’s Policy     Caroline Becher,
                         Writing & Ratification Policy.              Chief Nurse

Compiled by:                           The Infection Control Team
In consultation with:                  Control of Infection Committee
Ratified by:                           Clinical Governance Committee
Date ratified:                         November 2007
1 Review:                              June 2010
Reviewed by:                           Linda Fairhead
Review date:                           June 2012
Target audience:                       All Trust staff
Impact Assessment carried              Linda Fairhead, Consultant Nurse,
out by:                                Infection Prevention & Control
Comments on this document to:          Linda Fairhead, Consultant Nurse,
                                       Infection Prevention & Control

       Vol7                      First Ratified          Reviewed
                                                                          Issue 1       Page 1 of 4
Control of Infection                Nov. 07              June 2010
                              ASHFORD AND ST PETER’S HOSPITALS NHS TRUST

                                           INFESTATION POLICY

1.          INTRODUCTION

           Most infestations can be easily eradicated and the risk of staff or other patients
           acquiring the parasite is slight. An understanding of how they are transmitted is
           essential if the treatment is to be carried out effectively and the affected individual
           approached sensitively. It is also important to consider education and treatment of
           other members of the family.

2.         PURPOSE

           Staff follow the guidance when dealing with infestations.

3.         FLEAS

           Hot bathing will remove fleas.

4.         LICE

           Lice can only be caught by close contact, they cannot jump or fly but need to be close
           enough to walk onto another contact. They feed from the host, usually taking blood 5
           times a day. An allergic reaction develops to the bites causing them to itch. This
           reaction can take up to three months to develop.

           There are 500 different species of lice but only THREE of these use humans as their
           host and each lives on a specific part of the body.

4.1        Body lice (Pediculus humanus humanus)

           •      These adhere to underclothes and occasionally to the body.
           •      Bathing and washing of clothing at 60°, dry cleaning or tumble drying will remove
           •      No treatment of the skin or isolation precautions are necessary.

4.2        Head lice (Pediculus humanus capitis)

           •      This species lives on the head and eyebrow hair. Transmission occurs when two
                  heads are in close contact.
           •      The scalp and hair may be treated with Malathion, Permethrin or Phenothrin.
           •      The choice will depend on current recommendations from Pharmacy as resistance
                  to present therapy is becoming a problem. The combination of physical combing
                  on wet conditioned hair and chemical treatment is recommended.
           •      Follow instructions appropriate for each preparation.

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 Control of Infection                        Nov. 07       June 2010
           •      Repeat treatment after one week with another chemical agent if live lice are still
           •      Family members and intimate contacts may require treatment.
           •      All of these treatments should be followed by wet combing with a lice comb and on
                  conditioned hair.
           •      Daily combing with this method may be used as an alternative non-chemical
                  method and regular wet combing thereafter.

4.3        Crab lice (Phthirus pubis)

           •      Treat hairy parts of the body with Malathion or Carbaryl as for head lice.
           •      Do not use insecticides on eyelids but apply white soft paraffin three times a day for
                  2-3 weeks.
           •      Isolation precautions are not necessary.

5.         SCABIES (Sarcoptes scaibel)

           Mites may be present for several days or weeks before itching commences. Scabies
           can be a difficult diagnosis to make. The taking of skin scrapings to confirm the
           diagnosis is recommended.

           Staff caring for patients with known or suspected scabies should wear gloves and pay
           particular attention to hand hygiene. Anyone who develops an itchy rash, who has
           been in contact with scabies should report to the Occupational Health Department or

           The distribution of lesions should be noted before treatment to check afterwards
           whether any persist, are slow to heal or if there are fresh eruptions. Follow-up at 4
           weeks post treatment should be carried out especially in an outbreak situation.

           The patient’s family and all close personal contacts should be treated to prevent
           reinfestation. In ward settings where patients and staff may require treatment, it is
           important to co-ordinate the treatment of everyone (including night staff)

           The treatment of choice will depend on current practices (Malathion or Permethrin) as
           recommended by Pharmacy. Treatment should be applied to cool, dry skin. It is not
           recommended to have a bath before treatment.
           The treatments should be applied to every part of the body from the neck down
           including the soles of the feet and under the nails - a brush can be helpful in applying
           the lotion. Only a thin film is necessary but no part should be missed. The treatment
           should re-applied to the hands if they are washed during the treatment time. With most
           effective pesticides a single application should be sufficient. It should be washed off
           with cool water the next day.

           Itching can increase following a successful treatment and may last for two weeks,
           symptomatic treatment for the first few days following treatment can help e.g.
           Crotamiton 10% cream (Eurax), Calamine lotion, antihistamines.

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 Control of Infection                         Nov. 07        June 2010
           In crusted scabies several applications of a pesticide may be required eg. applied daily
           for 3 days and the patient followed up 7 days later to observe for any mites.

           Oral ivermectin has a significant role in institutional outbreaks.

           Early reporting to the CCDC in outbreaks involving institutions is vital in the
           control of scabies.


           The policy has been written by the Infection Control Team, agreed by the Control of
           Infection Committee and ratified by the Clinical Governance Committee. The policy will
           be available on TrustNet and as a hard copy at ward/department level for ease of


           Monitoring compliance of the policy will be undertaken within each individual case. If
           there is onward transmission the Infection Control Team will investigate and have
           required outbreak team convened.


           The Trust has a statutory duty to carry out an Equality Impact Assessment (EIA) and
           an overarching assessment has been undertaken for all infection control policies.


           This is a Trust-wide document and archiving arrangements are managed by Quality
           Dept. who can be contacted to request master/archived copies.

10.        REFERENCE

                  Roberts D.T. (ed) (2000) “Lice And Scabies, A Health Professionals Guide To
                  Epidemiology And Treatment”. PHLS, London.

                  Wilson J. 2006. Infection Control in Clinical Practices. Balliere Tindall. London.

        Vol7                               First Ratified    Reviewed
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 Control of Infection                         Nov. 07        June 2010

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