L ICE is an age-old problem for children in preschool and elementary school. An estimated 5 million cases are reported by schools each year, although it is also estimated that a significant number of cases are not reported (School Health Corporation, 1998). The classic treatment for this parasite requires that a caregiver shampoo the child's hair with a chemical solution, after using a fine-toothed metal comb to remove both lice and nits. Typically, a second treatment is necessary in 7 to 10 days after the initial shampoo because of reinfestation. An alternative treatment is now available in the United States, and it is distributed by School Health Corporation. Robi-Comb is an electronic head lice detector and remover that was developed in Israel in 1991. It is advertised as safe, effective and chemical free (School Health Corporation, 1998). Reported studies from Beilinson Medical Center and Tel Aviv University indicate that it is as effective as permethrin at resolving initial infestation, and possibly more effective at preventing reinfestation. Robi-Comb has been used in the U.S. since the fall of 1997 when it was tested in two states: Massachusetts and California. The distributor reports that these initial testing sites suggested modifications to the device which have been completed, and now the electronic comb is used in 43 states. As an alternative to the classic fine-toothed metal comb that must be used on wet hair, this comb is touted as an excellent removal and screening tool that causes no discomfort. Often times, visualizing lice can be difficult and infestation can be fairly significant by the time it is noticed. Robi-comb has an auditory alert that signals a louse has been discovered. This electronic comb, which is powered by a single AA battery, makes a soft humming noise until a louse is detected between the comb's teeth, at which time the sound stops and a small electrical charge passes from one tooth through the louse to the next tooth, killing the louse. Insulation o n the teeth prevent any irritation or sensation on the scalp, so treatment is not uncomfortable. After trapping the louse, a small brush is used to remove the dead louse from the comb, and the user can continue to comb through the child's hair to detect and kill further lice. As with chemicals, the Robi-Comb does not kill the nits or eggs. Pesticides leave a residue in the hair for 2 or 3 days, and lice can he killed as they hatch. Repeated use of the Robi-comb provides the same coverage. To destroy any new lice, it is recommended that the Robi-comb be used at least 5 minutes daily for 2 weeks. To maintain a lice-free scalp, it should be used 2 or 3 times a week for a month or two, or until the day care/school epidemic has passed. Shampoos are successful, but increased resistance to chemicals are being reported, and many health providers are concerned about the repeated exposure to strong chemicals on the scalp. Therefore, the electronic comb appears to offer a safer treatment morality. Robi-Comb is not without problems. There are two concerns about using the comb as a screening tool. One is avoiding transferring lice from one child to the next. Prior to using the comb on another child, the teeth should be inspected for lice and using the brush provided, remove the dead lice. A second issue of concern is sanitizing the comb. Before the comb is used on another child, the comb needs to be sanitized with a spray germicidal or 91% isopropyl alcohol. When screening classes in large groups, two combs are recommended so that one can dry after sanitizing, while the other is used to comb through the subsequent child's hair. The current list price for Robi-comb is around $29.95 plus the cost of a AA battery. This approxi-
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May 1, 2023
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