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An action plan to prevent and
combat threadworm infection
AUTHOR Janet Blake, BA, RGN, is community nurse,
Kingston Hospital, Surrey.
ABSTRACT Blake, J. (2003) An action plan to
prevent and combat threadworm infection. Nursing
Times; 99: 42, 18–19.
Threadworm infection is common in preschool and
school-age children and is easily spread to the entire
family. The infection can be treated using medication,
which should be taken by all members of the family, but
good hygiene measures are equally important to ensure
reinfection does not occur.
Threadworm infection is especially common in preschool
and school-age children, but can spread to the entire
family. People in every socioeconomic group are at risk
of contracting the infection (Russell, 1991).
Around 40 per cent of children under the age of 10 are
likely to have threadworms at some stage. At least 20
per cent of all children are affected at any one time.
Nearly half the parents who report threadworm infection
in their child report repeat infection in the same year
(Ibarra,1989).
Threadworms (pinworms) are known as Enterobius
vermicularis. They look like pieces of white cotton thread
and live in the rectum of humans. They are harmless. If
they are infected, children can continue to attend nursery
school or school, but parents should inform the school
that the infection is being treated.
Transmission
Threadworms are transmitted via eggs on the fingers
and under the fingernails. Following contact between
the hands and the mouth, eggs hatch and larvae are
released into the small intestine (Box 1).
The female adult worm deposits eggs just outside the
anus at night, which causes itching. Scratching results in
the collection of eggs on the fingers and under the fingernails. The entire process of transfer will then be
easily repeated.
The eggs can be spread among family members
through sharing bath towels. They can survive for a couple of weeks on clothing, bedding and in general household dust. A family pet is never responsible. The only
host for threadworms is a human.
The symptoms and consequences
of infection
The main symptom of the infection is a tickling or itching
of the anal area at night. Sleep may be disturbed and
some children develop sore bottoms. Usually worms are
only seen in the toilet, if at all.
Many people who have the infection will show no
symptoms. In a study of 172 Swedish children aged
4–10, 41 children (24 per cent) had a positive tape-test
for the eggs but only five of them had symptoms. Thus
21 per cent of the children studied were symptom-free
carriers of the worm (Herrström et al, 1997).
Although complications of threadworm infection are
very rare, nurses should be alert to what has been
reported in the scientific literature. The most common
complication is bacterial infection of the skin around the
anus. In girls and women worms may migrate from the
skin around the anus over the perineum to enter the
vagina. Threadworms or eggs have been found in routine
vaginal and cervical smears (Chung et al, 1997), and in
peritoneal granulomas (Sun et al, 1991).
Urinary tract infections, especially in girls, can be
related to threadworms (Kropp et al, 1978). There is a
possible relationship between the infection and enuresis.
Diagnosis
If there is any doubt about the diagnosis, then a test
using transparent adhesive tape to collect eggs around
the anus may be done. The presence of the eggs can be
confirmed by microscope. The standard test has
changed very little since it was developed (Jones, 1988;
Jacobs, 1942). It should be done early in the day before
the patient washes the anal area after rising. If infection is mild, it may be necessary to carry out tests over
three or four mornings. The patient or parent may take
samples themselves on the second and subsequent
BOX 1. THREADWORM INFECTION FACT LIST
● At
least 20 per cent of all children are affected by
threadworms at any one time
● Threadworms
live in the rectum of humans
● The
female worms lay their eggs on the skin around
the anus at night
● ‘Itchy
bottom’ is the most common symptom, but
symptoms may be absent
● Eggs
on the fingers and under nails transfer to
people and clothing and are swallowed
● Eggs
can survive for up to two weeks on clothing,
towels, bedding, in carpets and in dust
● Piperazine
and mebendazole are both effective
treatments of the disease
● Drug
treatment must be combined with hygienic
measures to prevent reinfection
NT 21 October 2003 Vol 99 No 42 www.nursingtimes.net
KEYWORDS
BOX 2. THREADWORM ACTION DAY
BOX 3. PREVENTING REINFECTION
Threadworm Action Day will be held on 22 October
and provides nurses with an opportunity to promote
general infection control routines. Fred Worm is a
friendly cartoon character that will be used to engage
children and help put adults at ease by discussing the
problem. Visit www.fredworm.com
● Keep
■
Public health ■ Threadworms ■ Treatment
the nails short
● Wash
hands and scrub nails before every meal or
snack and after using the toilet
● Bath
or shower every morning (removes eggs laid
at night)
Chung, D.I. et al (2003) Live Enterobius
vermicularis in the posterior fornix of
the vagina of a Korean woman. Korean
Journal of Parasitology; 35: 67–69.
Ibarra, J. (1989) Towards a viable
approach to the thread-worm problem.
Health at School; 5: 54–57.
● Wear
occasions, bringing the tape to the nurse in sealed
bags.
An alternative method is to trap a few of the worms
when they come out of the anus at night (Ibarra, 2001).
Hypoallergenic tape pressed against the anus as the
child goes to bed, with snugly fitting underpants to hold
the tape in place make a suitable worm trap.
Alternatively, petroleum jelly used in the same way
may collect worms overnight. The samples should be
kept in a plastic bag to be viewed by the nurse.
Drug treatment
Medication is necessary to remove the infection. It is
available over the counter or on prescription. Effective
drug treatments for threadworm include piperazine
(paralyses the worms which are then expelled in the
faeces) and/or mebendazole (prevents sugar absorption
by the worms resulting in their death in a few days).
Piperazine is the most common drug used in the UK for
the treatment of threadworm infection, and may come
combined with a mild laxative to help clear the paralysed worms quickly.
A second dose is given 14 days later to ensure that any
worms that were unhatched at the time of the first dose
will be cleared from the system.
Strict hygienic measures should be taken to prevent
re-infection. It is best to treat the entire family on the
same day. For people who are unable or unwilling to
receive the drug treatment, such as pregnant mothers,
the infection can be cleared by strict hygiene combined
with mechanical removal (see other treatment options)
of the eggs throughout the day until all the worms die or
are cleared from the system.
Contraindications
A woman who is pregnant, planning a pregnancy or
breastfeeding should see her GP before embarking on a
treatment regimen, as should anyone who has a neurological disease.
Similarly, children under two years of age will need to
be seen by a doctor before they are treated with drugs.
Any patient who is suspected of having roundworm
infection or other secondary infestations should also be
referred to a GP.
Mebendazole is not for children under two. People
should not be treated with piperazine if they have
epilepsy, a gut blockage, liver disease or severely
decreased kidney function. Check that the patient is not
allergic to any of the components.
NT 21 October 2003 Vol 99 No 42 www.nursingtimes.net
pyjamas or pants in bed (clean ones
every night)
REFERENCES
● Change
underwear every day
● Disinfect
the toilet seat, toilet handle, and door
handle regularly
● Damp
dust and vacuum bedrooms daily
● Towels
should not be shared
Providing reassurance and advice
The nurse is probably the health professional best suited
to minimise the embarrassment of discussing ‘itchy bottoms’ and to ensure that the necessary hygienic practices
are effectively communicated to a family. Parents, especially parents new to this problem such as parents of
toddlers, can feel guilt and humiliation. They need to be
reassured that they are not failing as parents and are not
running a shamefully dirty household (Box 2).
Other treatment options
Mechanical removal of the eggs may be the only treatment option for some individuals. Measures to remove
eggs include (Ibarra, 2001):
● The application of tape or jelly around the anus at
night, followed by washing or wet-wiping the perianal
area after rising from bed and at three-hourly intervals
during the day;
● For babies, nappies should be changed and bottoms
cleaned every three hours. Frequency is important as the
larvae contained inside the eggs develop in 4–6 hours
and some may hatch and migrate back into the rectum.
● Combining these measures with good hygiene can end
the infection naturally after 2–3 weeks as the worms are
expelled or die over that period.
Preventing reinfection
Good hygienic practices are listed in Box 3. Drug treatment must be combined with strict hygiene measures to
prevent reinfection.
Ibarra (2001) stresses that threadworm infection
presents the opportunity for nurses to reinforce key personal hygiene measures. Not only will proper handwashing protect against threadworms, but also against a wide
range of other infections, including gastroenteritis. She
advocates that primary schools and nurseries should be
encouraged to supervise handwashing until children are
seven years old: ‘Good habits cheerfully established in
the early years will set a child up for life.’ ■
Ibarra, J. (2001) Threadworms: a
starting point for family hygiene. British
Journal of Community Nursing; 6: 8,
414–420.
Jacobs, A.H. (1942) Enterobiasis in
children: incidence symptomatology
and diagnosis with a simplified Scotch
cellulose tape technique. Journal of
Paediatrics; 21: 497–503.
Jones, J. (1988) Pinworms. American
Family Physician; 38: 159–164.
Herrström, P. et al (1997) Enterobius
vermicularis and finger sucking in young
Swedish children. Scandinavian Journal
of Primary Health Care; 15: 146–148.
Kropp, K.A. et al (1978) Enterobius
vermicularis (pinworms), introital
bacteriology and recurrent urinary tract
infection in children. Journal of Urology;
120: 480–482.
Russell, L.J. (1991) The pinworm,
Enterobius vermicularis. Primary Care;
18: 13–24.
Sun, T. et al (1991) Enterobius egg
granuloma of the vulva and
peritoneum: review of the literature.
The American Journal of Tropical
Medicine and Hygiene; 45; 249–253.
Mattia, A.R. (1992) Perianal mass and
recurrent cellulites due to Enterobius
vermicularis. The American Journal of
Tropical Medicine and Hygiene; 47;
6, 811–815.
This article has been double-blind
peer-reviewed.
For related articles on this subject
and links to relevant websites see www.
nursingtimes.net
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