Head Lice Treatment In The Hospital? Cut the Beard? Sikh No!

Every now and then I get to admit a patient infested with lice.   I think it's important to understand what kind of patients usually carry these contagious bugs before we can understand the appropriate treatment modalities and what it means for their physical and mental health.

In my experience, patients with head lice are usually homeless and or lack the mental capacity and  ability to care for themselves.  They usually have advanced stages of disease or severe presentations of acute disease that all the insurance in the world isn't going to cure.  Whether it's an incredible form of apathy for life or a disabling life long mental inability to process basic standard social expectations, these people aren't going to get cured with Obama's health care reforms.

Short of institutionalizing these folks, it's not health care finance reform that will fix them, it's life reform.  One of the worst consequences of poor personal hygiene is head lice.  As doctors and nurses, we often find ourselves caring for folks with the least ability to care for themselves.  Getting head lice is one of those consequences.   What are we to do when a patient is admitted to the hospital with head lice?     What's the best treatment for head lice in these folks?
  1. Shave their head.  This is the quickest and the easiest and most desirable for all the nurses, doctors and other health care professionals which must enter the room on a daily basis.
  2. Cetaphil.  I was told by a nurse this over the counter cream can be rubbed into the hair and blown dry with a hair dryer to create a Cetaphil helmet (it apparently dries as hard as a helmet).  This apparently suffocates the nits and then the hair is washed out
  3. Permethrin.  This is a prescription product that is rubbed in.  Then the hair must be combed and washed and reapplied within a week if head lice are still present.
Head lice is a communicable disease and I think the hospital doctors and nurses have an obligation to immediately rid the bugs to prevent an outbreak of hospital acquired infestation of other patients. I'm sure many nurses would vote for shaving the beard since they are the ones working around the lice all day long  I have no idea what my hospital's policy is on beard shaving without consent.  What do you think?  Is it OK to shave a man's  beard without his permission? I don't know the answer..  But I do know situations like this can get a little hairy at times, especially if the patient happens to be a Sikh. 

Oops.  Talk about the Sikh hitting the fan.    Maybe we should just stick with the Cetaphil helmet and tell the nurses not to worry.  Unless of course they start itching.  This original Happy Hospitalist ecard helps to explain.

"You think YOU have problems?  My patients have more bugs than a Volkswagen convention."

You think YOU have problems?  My patients have more bugs than a Volkswagen convention nurse ecard humor photo.

This post is for entertainment purposes only and likely contains humor only understood by those in a healthcare profession. Read at your own risk. 

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