Background: Due to a lack of evidence, controversy exists about the role of bedding in the transmission of head lice.
Aims: To determine the proportion of the head lice population found on pillowcases of people with head lice, and to test strategies available to householders to kill head lice on pillowcases.
Methods: To assess the incidence of head lice on pillowcases, people with active pediculosis had their head lice collected and counted and the pillowcase they had used the night before examined for head lice. To test strategies to kill head lice on pillowcases, live head lice were experimentally placed in miniature pillowcases, and the cases were subjected to a hot wash, a cold wash, hot dryer, and hanging out to dry on an outdoor clothes line.
Results: Forty-eight people and their pillowcases were recruited from Townsville, Qld, Australia (dry tropics). One thousand, eight hundred and forty-five lice were collected from their heads to give an average and median intensity of infection of 38.4 and 21 lice, respectively. Two of the 48 pillowcases contained live lice, one nymph on each, 2 h and 9 h after the pillowcases had been removed from the bed. Another pillowcase contained a dehydrated nymph. The incidence of live lice on pillowcases was 4.2% per night and the proportion of the head louse population on the pillowcases was 0.11%. Heat (hot wash and hot clothes dryer) killed head lice experimentally placed in pillowcases. Cold wash and hanging pillowcases out to dry did not kill head lice.
Conclusions: Head lice transfer to pillowcases at night, but the incidence is low. Pillowcases pose a risk for re-infection with head lice, but the risk is low, and changing the pillowcase is a reasonably cost-efficient strategy to minimize this risk. Lice on pillowcases can be killed by heating the pillowcase by immersion in water at > 60 degrees C, by a hot wash, or by 15 min in a hot clothes dryer.