What a surgical site infection is
A surgical site infection is an infection in the part of the body where an operation was done. It may involve only the skin at the incision, the tissue underneath or, less often, the deeper space the surgeon worked in. Most appear in the days and weeks after surgery.
Surgical site infection wound follow-up in St. Louis begins once the surgical team has made the diagnosis and started treatment. Treatment may include antibiotics, opening part of the incision so it can drain, or a return to the operating room. What remains is often an open or partly open wound that needs dressing changes and close watching while it heals.
If you are looking for help with this wound close to home, start with our overview of wound care in St. Louis.
Why an infected incision heals more slowly
Infection holds a wound in the early, inflamed stage of healing. New tissue does not build well until bacteria and damaged tissue are under control. If the surgeon opened the incision to drain it, the wound has to fill in from the bottom instead of knitting together edge to edge.
Other things can add time:
- Pockets or tunnels where fluid collects out of sight
- Stitches, mesh, a joint implant or other material near the infection
- High blood sugar, which weakens the body’s defenses against bacteria
- Poor circulation, swelling, smoking or low protein intake
- Bacteria that do not respond to the first antibiotic chosen
What the treating clinician tracks during follow-up
The surgeon or prescribing clinician directs the infection treatment. The treating wound clinician watches how the wound responds and reports back. At each visit the clinician typically reviews:
- Whether redness is spreading or shrinking
- Warmth, swelling and tenderness
- The amount, color, thickness and smell of wound drainage
- Wound size, depth and any tunneling, measured the same way each time
- Culture results, the antibiotic plan and how you are tolerating it
- Temperature and how you feel overall
If the signs point the wrong way, the clinician contacts the surgical team instead of waiting for the next scheduled appointment. Gateway’s part in infection monitoring and follow-up is to keep those messages, records and orders moving.
Infection follow-up at home and in facilities
Getting to appointments is hard when you are sore, tired and not yet driving. Gateway arranges visits from partner clinicians in private homes around St. Louis and the Metro East. Between visits, you, a caregiver or a home health nurse may be changing dressings as ordered. Knowing the signs of wound infection helps you describe exactly what you see.
In skilled nursing and rehabilitation centers, nurses change dressings and record temperatures every day. The treating clinician works with them and with the facility’s physician, so one plan is followed on every shift. When a person moves from hospital to facility to home, wound follow-up after hospital discharge helps keep antibiotic end dates, dressing orders and surgeon appointments from getting lost.
Where primary care fits in
Blood sugar often runs higher during an infection, which is one reason diabetes care matters during recovery. Antibiotics can also interact with other medicines, so a medication review with a primary care clinician is worthwhile. Take antibiotics as prescribed, and tell the prescriber about side effects instead of stopping on your own.
Changes to report right away
Contact the surgical team or the treating clinician about any of these:
- Redness that spreads, or red streaks moving away from the incision
- Thick, cloudy, yellow or green drainage, or more drainage than before
- A new or stronger smell
- Pain, swelling or warmth that increases
- Fever or chills
- An incision that opens, or a new soft, swollen area nearby
- Diarrhea, a rash or other problems after starting an antibiotic
Call 911 for confusion or unusual sleepiness, a racing heartbeat, fast or difficult breathing, fainting, or heavy bleeding. These can be signs that an infection is affecting the whole body.
How Gateway helps arrange follow-up
Patients and families can call 314-325-0126 without a referral or ask for a callback. Please leave medical details out of the web form. On the call, it helps to know the surgery date, the surgeon’s name and which antibiotic was prescribed.
Gateway requests the surgical records, coordinates clinician orders and supplies, schedules visits with a partner clinician, and passes updates to the surgeon’s office. Visit availability is confirmed by location and care setting. Surgical practices, hospitals and facilities can refer a patient online or by fax at 314-786-7966.
Common questions
Who treats the infection, the surgeon or the wound care clinician?
The surgical team usually leads. They know what was done in the operation and decide on antibiotics, drainage or further surgery. The treating wound clinician manages the open wound, watches how it responds and reports changes to the surgeon. If you are unsure whom to call about a new symptom, start with the surgeon’s office.
Why did the surgeon open my incision and leave it open?
An infected incision often holds fluid or pus beneath the skin. Opening it lets that fluid drain and allows the area to be cleaned. Stitching it closed right away could seal bacteria inside. The open wound is then dressed while it fills in with new tissue, and some are closed later. Ask your surgeon which plan applies to you.
Is some redness around a new incision normal?
A thin line of pink or red along a fresh incision is common early on and usually fades. Redness that widens, feels hot or hard, becomes more painful or comes with drainage or fever should be reported. Skin tone affects how redness shows, so also pay attention to warmth, swelling and tenderness.
Can a surgical site infection come back after antibiotics are finished?
It can. Bacteria sometimes remain in a pocket of fluid or around stitches or implanted material, and an open wound can become infected again. That is why follow-up continues after the antibiotic course ends. Report any return of redness, warmth, drainage, pain or fever. Do not take leftover antibiotics on your own.
Related pages
General information to help you talk with your own clinician. It is not medical advice, and the treating clinician makes every clinical decision. For a medical emergency, call 911.