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Nursing Guide to MRSA: Nursing Diagnosis, Interventions, & Care Plans

Updated On 10 Minute Read

Methicillin-resistant Staphylococcus aureus (MRSA) is a strain of Staphylococcus aureus that has developed resistance to beta-lactam antibiotics, including methicillin, oxacillin, penicillin, and amoxicillin. MRSA is a significant cause of both healthcare-associated infections (HA-MRSA) and community-associated infections (CA-MRSA). It’s known for causing skin and soft tissue infections, bloodstream infections, pneumonia, and surgical site infections. 

Due to its resistance profile, MRSA poses a substantial challenge in clinical settings. Nurses are on the front lines of infection control and can help in the early identification, isolation, and prevention of transmission. 

Infection Control: Preventing the Spread of MRSA

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Etiology and epidemiology 

MRSA originates from the acquisition of the mecA gene, which encodes for an altered penicillin-binding protein (PBP2a). This protein has a low affinity for beta-lactam antibiotics, rendering standard treatments such as methicillin, penicillin, and amoxicillin ineffective.  

As a result, MRSA strains are more difficult to eradicate and often require targeted antibiotic therapy. The organism can colonize the skin, nares, and mucous membranes without causing symptoms, which allows asymptomatic carriers to unknowingly spread the bacteria to others. 

MRSA can survive on surfaces for extended periods and is particularly resilient in hospital environments. Its ability to form biofilms on indwelling medical devices further enhances its resistance and complicates treatment. 

Clinical presentation 

  • Red, swollen, painful skin lesions, often warm to the touch and mistaken for spider bites.
  • Formation of pustules, abscesses, or boils with purulent drainage that may contain necrotic tissue.
  • Fever, chills, and malaise in the presence of deeper or systemic infections.
  • Signs of sepsis in advanced cases, such as hypotension, tachycardia, altered mental status, and multi-organ involvement.
  • In indwelling device-related infections, symptoms may include erythema and tenderness around the insertion site, with purulent exudate. 

Transmission 

  • Direct skin-to-skin contact, particularly in settings of poor hygiene or crowding, is one of the common ways this condition is transmitted.
  • This spreads through contact with contaminated surfaces, such as linens, medical equipment, or athletic gear.
  • This can be transmitted through invasive procedures or the use of medical devices (e.g., central lines, endotracheal tubes, urinary catheters).
  • Airborne dispersal is rare but can occur during aerosol-generating procedures in healthcare settings. 

Risk factors 

  • Recent hospitalization, particularly in intensive care units (ICUs)
  • Residents in long-term care facilities
  • Immunocompromised state (e.g., chemotherapy, HIV, organ transplant recipients)
  • Presence of surgical wounds, burns, or chronic ulcers
  • Use of indwelling devices such as dialysis catheters or feeding tubes
  • Participation in contact sports, especially in teams that share equipment or have close physical interaction
  • Living in crowded or unsanitary environments (e.g., military barracks, shelters, correctional facilities) 

Prevalence 

MRSA is a major contributor to healthcare-associated infections in the U.S., including bloodstream infections, pneumonia, and surgical site infections. According to the Mayo Clinic, approximately 5% of hospitalized patients carry MRSA.  

Community-associated MRSA has significantly increased in prevalence over the past two decades and now accounts for a substantial proportion of skin and soft tissue infections in healthy individuals without traditional healthcare exposure. Public health initiatives focus on surveillance, decolonization, and antimicrobial stewardship to curb the spread of MRSA in both healthcare and community settings. 

Diagnostic tests 

  • Culture and sensitivity testing: This is the gold standard for confirming MRSA. It uses specimens from wound swabs, blood cultures, sputum, or urine, depending on the site of infection. Sensitivity profiles guide targeted antimicrobial therapy.
  • Polymerase chain reaction (PCR): Rapid diagnostic method that detects MRSA-specific genes (e.g., mecA gene), often used in urgent care and surgical settings to minimize delays in treatment initiation.
  • Nasal swab screening: This is routine in many hospitals upon admission for high-risk patients (e.g., ICU, dialysis, surgical wards) to identify carriers and guide infection prevention strategies.
  • Additional diagnostics: These may include imaging studies (e.g., ultrasound, CT scan) to evaluate abscesses, osteomyelitis, or deeper involvement, and inflammatory markers (e.g., CRP, ESR, procalcitonin) to assess severity and monitor treatment response. 

ICD-10 code 

  • A49.02 — Methicillin-resistant Staphylococcus aureus infection, unspecified site
  • Other codes may apply depending on the specific site, such as:
    • J15.212 — Pneumonia due to MRSA
    • L02.92 — Cutaneous abscess due to MRSA

Nursing care plan 

Nursing care for patients with MRSA is centered around infection prevention, wound care, patient education, and psychosocial support. Given the contagious nature of the organism and the potential for serious complications, nurses must exercise diligence in implementing isolation protocols and ensuring adherence to antimicrobial therapy.  

Individualized care plans should be developed based on the location and severity of infection, comorbidities, and the patient’s psychosocial and functional status. As key members of the interdisciplinary team, nurses are also responsible for facilitating communication, supporting safe discharge planning, and reinforcing hygiene measures to prevent the recurrence or spread of MRSA. When conducting and implementing a care plan, consider these components: 

Nursing considerations 

  • Implement and reinforce standard and contact precautions, including the use of personal protective equipment (PPE) such as gowns and gloves, proper disposal of contaminated materials, and diligent hand hygiene before and after patient contact. Ensure signage is posted to alert all staff and visitors of necessary precautions.
  • Educate patient and family on hygiene and wound care practices, including daily bathing with antiseptic agents like chlorhexidine, proper handwashing techniques, and step-by-step instructions for dressing changes and safe disposal of dressings at home.
  • Monitor for signs of systemic infection or treatment complications, including vital sign trends, new or worsening fever, tachycardia, hypotension, changes in mental status, or signs of antibiotic toxicity such as rash or gastrointestinal upset.
  • Administer and monitor response to antibiotics by observing clinical improvement (e.g., reduction in erythema, drainage, or pain), documenting adverse drug reactions, and ensuring timely laboratory monitoring, especially for drugs with narrow therapeutic indices like vancomycin.
  • Support emotional needs and reduce isolation effects by providing frequent check-ins, offering resources such as social work or chaplaincy services, and facilitating safe visitation and virtual communication to prevent patient loneliness and anxiety. 

Assessment 

  • Inspect wounds or lesions for changes in size, color, amount and type of drainage, surrounding erythema, and signs of healing or deterioration. Note any new areas of breakdown, increased warmth, or odor that may indicate secondary infection.
  • Monitor temperature, heart rate, respiratory rate, and white blood cell count regularly to detect systemic signs of infection or sepsis. Record trends over time and escalate care if abnormal vital signs persist.
  • Assess pain intensity and quality using validated scales; evaluate for tenderness on palpation, the presence of fluctuance suggesting abscess formation, and note any increase in purulent drainage or local tissue inflammation.
  • Evaluate mental status and hemodynamic stability in systemic cases by performing frequent neurologic assessments, observing for confusion, agitation, or lethargy, and checking blood pressure and perfusion status. This is particularly important in older adults or immunocompromised patients who are at higher risk for sepsis. 

Nursing diagnosis/risk for 

  • Risk for infection transmission related to colonization or active MRSA infection, as evidenced by open wounds, use of invasive devices, or close contact with others in shared environments.
  • Impaired skin integrity related to purulent lesions, incision and drainage procedures, or frequent dressing changes, as evidenced by erythema, swelling, pain, or drainage at wound sites
  • Acute pain related to inflamed or infected tissues, surgical interventions, or wound care procedures, as evidenced by patient verbal reports, guarding behavior, or pain scale ratings
  • Risk for ineffective therapeutic regimen management related to complex antibiotic regimens, lack of understanding about MRSA precautions, or psychosocial stressors, as evidenced by questions about medications, inconsistent hygiene practices, or non-adherence history 

Interventions 

  • Maintain clean, dry dressings by performing routine wound assessments, ensuring appropriate technique during dressing changes, and using sterile or clean supplies depending on wound classification. Monitor for signs of maceration or infection.
  • Reinforce hand hygiene and PPE compliance for all individuals interacting with the patient, including staff, visitors, and the patient themselves. Provide visual reminders and support adherence through role modeling and coaching.
  • Administer medications as prescribed, ensuring correct timing, dosage, and route. Monitor for therapeutic effect and adverse reactions, especially with high-risk antibiotics such as vancomycin, and document findings clearly in the medical record.
  • Provide education on completing the full course of antibiotics, understanding potential side effects, and the importance of not sharing medications or stopping treatment prematurely. Use teach-back methods to confirm understanding.
  • Collaborate with infection control and the interdisciplinary team to coordinate care, reinforce policies on contact precautions, assess the need for decolonization, and contribute to ongoing surveillance and quality improvement efforts related to MRSA prevention. 

Expected outcomes 

  • Resolution or reduction of infection demonstrated by improved wound appearance, normalized temperature, and decreased inflammatory markers
  • Intact skin at wound site with minimal scarring or secondary complications
  • Adherence to infection control measures observed and documented during hospitalization
  • Patient and caregivers verbalize understanding of MRSA management, prevention strategies, and discharge instructions, supported by consistent adherence to hygiene and wound care protocols 

Management 

Treatment depends on the seriousness and anatomical location of the MRSA infection, as well as the patient’s overall health status, immune function, and the presence of comorbidities. Effective management requires a combination of pharmacologic and non-pharmacologic strategies, with close monitoring for complications. 

Pharmacologic treatment 

  • Mild to moderate skin and soft tissue infections (SSTIs): Oral antibiotics such as clindamycin, doxycycline, or trimethoprim-sulfamethoxazole (TMP-SMX) are commonly prescribed. These agents are generally effective against community-acquired MRSA strains and may be used empirically while awaiting culture results.
  • Severe infections: In cases involving bacteremia, endocarditis, pneumonia, osteomyelitis, or deep abscesses, intravenous antibiotics are required. Vancomycin remains the mainstay of therapy, but alternatives like linezolid (especially for lung infections), daptomycin (for right-sided endocarditis and bacteremia), and ceftaroline (a fifth-generation cephalosporin with MRSA coverage) are also used based on sensitivity results and patient-specific factors.
  • Tailor therapy: Always adjust antibiotic choice and duration based on culture and sensitivity findings. Monitor for antibiotic side effects, such as nephrotoxicity with vancomycin or myelosuppression with linezolid. 

Surgical treatment 

  • Incision and drainage (I&D): The primary intervention for MRSA-related abscesses. In many cases, I&D alone may be sufficient for smaller, localized infections without systemic symptoms.
  • Debridement: Removing necrotic tissue is critical in managing extensive soft tissue infections, osteomyelitis, or infected surgical wounds. It reduces the bacterial load and enhances antibiotic penetration. 

Infection control 

  • Contact precautions: Patients with active MRSA infections, especially in hospital or long-term care settings, should be placed under contact precautions, including gown and glove use by staff.
  • Hand hygiene: Rigorous hand hygiene with soap and water or alcohol-based hand rubs is the most effective measure for preventing MRSA transmission.
  • Environmental disinfection: High-touch surfaces, shared equipment, and patient care areas must be disinfected routinely using Environmental Protection Agency (EPA) registered, hospital-grade disinfectants effective against MRSA.
  • Decolonization strategies: In recurrent cases or outbreaks, decolonization protocols may be used, including the application of mupirocin ointment in the nares and daily chlorhexidine baths or washes to reduce colonization and risk of reinfection or transmission. 

Individual/caregiver education 

  • Avoid sharing personal items (e.g., towels, razors, clothing) to prevent cross-contamination.
  • Keep wounds covered with clean, dry bandages and change them as instructed by healthcare providers.
  • Practice proper hand hygiene before and after touching the wound or wound care materials, using soap and water or alcohol-based sanitizer.
  • Complete full antibiotic course even if symptoms improve and report any side effects or allergic reactions to the prescribing provider.
  • Conduct environmental cleaning at home, especially for high-touch surfaces (e.g., doorknobs, remote controls, bathroom fixtures), using disinfectants effective against MRSA. 

FAQs

Resources 

References 

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Mary Lynch, MSN, RN

Mary E. Lynch, MSN, RN, is a multidisciplinary healthcare leader with over 20 years of experience spanning financial analytics, clinical care, and healthcare education. After nearly a decade in the accounting and finance sectors, Lynch followed her passion for maternal health and pivoted into nursing, specifically postpartum care. She spent over 10 years supporting new moms, babies, and their families through one of life's most vulnerable transitions. Her deep clinical foundation now fuels her work as a Curriculum Designer at Relias.