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Nursing Guide to Staph Infection: Nursing Diagnosis, Interventions, & Care Plans

Updated On 8 Minute Read

Staphylococcus infections, commonly referred to as “staph infections,” are caused by the Staphylococcus genus of bacteria, most notably Staphylococcus aureus. These infections range from minor skin infections to life-threatening illnesses such as sepsis, osteomyelitis, and endocarditis. Staph bacteria are part of the normal flora of the skin and mucous membranes, but they can become pathogenic when they breach physical barriers through cuts, wounds, or invasive procedures. 

Nurses are central to the prevention, detection, and management of staph infections. Early recognition, adherence to infection control protocols, and patient education are necessary components of nursing care for affected individuals. 

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Etiology and epidemiology 

Staph infections are most often caused by Staphylococcus aureus, including methicillin-sensitive (MSSA) and methicillin-resistant (MRSA) strains of bacteria. These are commonly found on the skin and in the nasal passages of healthy individuals. 

Staph infections are among the most common bacterial infections worldwide. They account for a significant portion of hospital-acquired infections and are also one of the leading causes of many skin and soft tissue infections. Resistance patterns vary geographically, with MRSA being a major concern in many healthcare settings. 

Clinical presentation 

  • Localized erythema, swelling, warmth, and tenderness at the infection site, often indicating cellulitis or abscess formation 
  • Presence of pustules, furuncles, or carbuncles with purulent discharge, frequently seen in skin and soft tissue infections 
  • Fever, chills, generalized malaise, and fatigue, especially in systemic or invasive infections 
  • Signs of sepsis or systemic inflammatory response syndrome (SIRS), including hypotension, tachycardia, tachypnea, and altered mental status 
  • Joint pain and restricted mobility in cases involving osteomyelitis or septic arthritis 

Modes of transmission 

  • Direct skin-to-skin contact 
  • Contact with contaminated surfaces or equipment 
  • Invasive medical procedures (e.g., IV catheters, surgical incisions) 
  • Airborne transmission during aerosol-generating procedures (less common) 

Risk factors 

  • Open wounds or recent surgery 
  • Immunocompromised status 
  • Use of indwelling devices (e.g., catheters, prosthetic joints) 
  • Diabetes, chronic kidney disease, or other chronic illnesses 
  • Contact sports or crowded living environments 

Diagnostic tests 

  • Wound, blood, urine, or sputum cultures: This is essential for identifying the causative organism and determining antibiotic sensitivity. 
  • Gram stain and culture with antimicrobial susceptibility testing: This provides rapid presumptive identification and confirms antibiotic resistance patterns such as MRSA. 
  • Complete blood count (CBC) with differential: This may show leukocytosis or left shift, indicating an acute bacterial response. 
  • C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR): This is useful for tracking inflammation and disease progression. 
  • Imaging studies: 
    • Ultrasound: This identifies abscesses or fluid collections beneath the skin. 
    • CT or MRI: This is necessary for evaluating deeper infections such as osteomyelitis, septic arthritis, or deep soft tissue involvement. 
    • Echocardiography: This is recommended if endocarditis is suspected, especially in patients with bacteremia or prosthetic heart valves. 

These diagnostic measures guide the selection of appropriate treatment modalities and help monitor the response to therapy over time. 

ICD-10 code 

  • A41.01 — Sepsis due to methicillin susceptible Staphylococcus aureus 
  • A41.02 — Sepsis due to methicillin resistant Staphylococcus aureus 
  • L02.91 — Cutaneous abscess, unspecified 

Management 

Management of staph infections requires a multifaceted approach that integrates pathogen-specific antimicrobial therapy, supportive nursing care, and timely surgical intervention when necessary. Individualized treatment plans should consider the patient’s age, immune status, infection site, and comorbidities to ensure optimal outcomes. 

Pharmacologic treatment 

  • MSSA infections: These are typically treated with beta-lactam antibiotics such as nafcillin, dicloxacillin, cephalexin, or cefazolin, which are effective against non-resistant strains. Oral therapy may suffice for uncomplicated skin and soft tissue infections, while IV therapy is preferred for more serious or systemic infections. 
  • MRSA infections: For infections caused by methicillin-resistant strains, antibiotic options include clindamycin, doxycycline, trimethoprim-sulfamethoxazole (TMP-SMX), vancomycin, linezolid, or daptomycin. Intravenous vancomycin remains the standard for severe infections like bacteremia and endocarditis. Linezolid is particularly effective for pulmonary involvement, while daptomycin is favored for right-sided endocarditis. 
  • Antibiotic therapy must be tailored based on culture and sensitivity results to reduce resistance development and ensure efficacy. Close monitoring for adverse reactions and therapeutic levels (e.g., vancomycin troughs) is essential in hospitalized patients. 

Surgical treatment 

  • Incision and drainage of abscesses is often the first and sometimes only necessary treatment for localized purulent lesions, particularly in healthy individuals without systemic symptoms. 
  • Debridement of necrotic or infected tissue facilitates healing and reduces bacterial load in severe or non-resolving infections. 
  • Removal of infected indwelling devices such as central lines, urinary catheters, or prosthetic joints may be required to eradicate infection sources and prevent recurrence, especially in persistent bacteremia. 

Supportive care 

  • Pain management includes both pharmacologic agents (e.g., NSAIDs, acetaminophen) and non-pharmacologic measures like cold compresses and elevation of affected limbs. 
  • Antipyretics such as acetaminophen or ibuprofen help control fever and improve patient comfort. 
  • Wound care involves regular sterile dressing changes, debridement when needed, and use of topical antimicrobials if indicated. 
  • Ongoing assessment for systemic involvement (e.g., hypotension, altered mental status, increased WBC count) is critical to detect complications like sepsis, osteomyelitis, or endocarditis, which necessitate escalation of care and specialist consultation. 

Nursing care plan 

Nursing care for patients with staph infections involves vigilant assessment, infection prevention, patient and caregiver education, and coordination with the healthcare team to ensure timely and effective treatment.  

Nurses are responsible for implementing safety precautions to prevent the spread of infection, managing wound care and symptoms, and reinforcing adherence to therapeutic regimens. Individualized nursing interventions are guided by the severity and location of infection, patient comorbidities, and the risk of systemic involvement. 

Nursing considerations 

  • Implement infection control measures including strict hand hygiene, use of gloves and gowns, and patient isolation as indicated to prevent nosocomial transmission of staphylococcal bacteria. 
  • Monitor wound progression for signs of improvement or deterioration, such as changes in color, size, exudate volume, or new areas of erythema; watch for systemic symptoms like fever, chills, or hypotension. 
  • Assess pain levels using a standardized pain scale, address discomfort promptly with prescribed analgesics, and support nutritional status by collaborating with dietitians to ensure adequate protein and caloric intake to support tissue repair. 
  • Coordinate timely culture collection before antibiotic initiation when feasible, and ensure administration of antimicrobials at scheduled intervals, documenting response and any adverse effects. 

Assessment 

  • Inspect the wound site for clinical indicators of infection such as erythema, swelling, increased warmth, purulent drainage, or foul odor; note changes in wound margins and presence of necrotic tissue. 
  • Monitor vital signs, including temperature, heart rate, and respiratory rate, to identify early signs of sepsis or systemic inflammatory response. 
  • Assess mental status, particularly in older adults, for subtle changes that could indicate systemic infection; evaluate hydration status by monitoring intake/output, skin turgor, and mucous membranes. 
  • Evaluate the patient’s understanding of wound care procedures and adherence to hygiene recommendations; assess for barriers such as health literacy, cognitive limitations, or lack of caregiver support. 

Nursing diagnosis/risk for 

  • Risk for infection transmission related to open wounds and direct contact with contaminated materials or surfaces. 
  • Impaired skin integrity related to localized infection, surgical incision, or delayed healing as evidenced by drainage and tissue inflammation. 
  • Acute pain related to infected tissues and dressing changes, as evidenced by verbal reports of discomfort and guarding behavior. 
  • Risk for delayed surgical recovery due to impaired wound healing or antibiotic resistance, especially in patients with comorbidities such as diabetes or immunosuppression. 

Interventions 

  • Educate patients and their caregivers on proper hand hygiene technique, the importance of daily hygiene, and step-by-step wound management procedures using clean or sterile supplies. 
  • Administer prescribed antibiotics, ensuring correct dosage and frequency; monitor for allergic reactions, gastrointestinal distress, or secondary infections such as Clostridioides difficile (C. diff). 
  • Maintain clean, dry wound dressings and use barrier creams or secondary dressings as needed to protect surrounding skin. Document dressing changes meticulously. 
  • Encourage increased fluid intake and balanced nutrition rich in protein, vitamin C, and zinc to enhance immune response and wound healing; involve family or nutrition services as appropriate. 

Expected outcomes 

  • Resolution or containment of infection evidenced by reduced drainage, normalized temperature, and improved wound appearance. 
  • Skin integrity maintained or restored with decreased risk of further tissue breakdown. 
  • Pain was effectively managed with reduced reliance on pharmacologic interventions over time. 
  • Patients and caregivers demonstrate verbal and practical understanding of infection control and home care requirements. 

Individual/caregiver education 

  • Importance of completing the entire course of prescribed antibiotics even if symptoms improve early 
  • Proper wound hygiene, including handwashing before and after dressing changes, and correct disposal of soiled materials 
  • Avoiding contact sports, pools, hot tubs, or shared personal items (e.g., razors, towels) during active infection to minimize spread 
  • Signs that require prompt medical evaluation include rapidly spreading redness, fever above 101°F, increasing pain, or foul-smelling discharge 
  • Strategies to prevent reinfection include regular laundering of linens, disinfecting high-touch surfaces, and using separate toiletries when possible 

FAQs

Resources 

References 

Jennifer Oh, BSN, RN

Jennifer Oh, BSN, RN

Jennifer Oh, BSN, RN, has worked in med-surg telemetry and case management in Temple, Texas. She enjoys the opportunity to help the patients and families and wants to share her insights and experience with other nurses to help them on their journey toward success in the field.