About surgical site infections

The course of a surgical site infection usually has two parts. The first is short and intense: the incision becomes painful, red and swollen, often some days after you thought the hard part was over, and the surgical team steps in. The second part is slower. Once the infection is controlled, an incision that was opened has to fill with new tissue from its base upward, and that work goes on well after the last antibiotic dose. Drainage normally lessens, the wound gets shallower and the edges draw inward. Progress is not always even. A wound can stall, or a pocket can form under skin that looks closed. Some wounds are stitched shut later by the surgeon once they are clean.

What an assessment covers

A care plan for an infected surgical wound answers a few practical questions. How will drainage be handled so the surrounding skin stays dry? Does a deep area need to be filled lightly so it does not seal over at the top? How often should the dressing be changed, and by whom? The treating clinician chooses dressings to match the wound as it is today and expects to change them as it becomes shallower and drier. If the surgeon has ordered negative pressure wound therapy, the plan covers the device as well. Everything is written as orders that home health nurses, facility nurses or family can follow.

Local context: Affton

Many homes in Affton are older single-family houses with the bedroom and full bath upstairs, which matters after surgery. A person with an infected abdominal or hip incision may be living on the first floor for a while, and the dressing supplies, good light and a firm chair need to be there too. Long-time residents here often recover with a spouse of similar age as the main helper. If packing or changing a draining dressing is too much for that person, Gateway can ask the treating clinician about bringing in home health.

Most of Affton is single-family housing, often with a few steps up to the front door and a basement below, alongside duplexes, garden apartments and senior apartment buildings near the main roads. Assisted living, memory care and skilled nursing communities serve the area as well. Gateway arranges visits from partner clinicians in each of these settings. In a private home we work out timing with the family. In a facility we coordinate with the nursing staff so the visit, the orders and the supplies line up with the resident’s existing care plan.

Care at home

Home visits for an infected surgical wound are set at intervals the treating clinician chooses, and they often become less frequent as the wound settles. At each visit the clinician removes the dressing, examines and measures the wound, and redresses it. The dressing changes that fall between visits are done as ordered by a home health nurse, a caregiver who has been shown how, or you. Gateway schedules the visits, confirms the address and any access details, and sends the clinician’s update to the surgeon’s office, so your surgeon knows how the wound looks without waiting for your next appointment.

In a facility

In a rehabilitation setting, an infected incision has to share the day with therapy. Dressing changes work best when they are timed so a leaking or painful wound does not cut a session short, and therapists need to know about any movement limits the surgeon has set. Some residents are also receiving intravenous antibiotics through a long-term line, which facility nurses manage under the prescriber’s orders. The treating clinician watches how the wound responds and tells the attending physician and surgeon what it shows. Gateway helps keep track of the dates that matter, including antibiotic end dates, surgeon rechecks and the planned discharge.

Changes to report

Caregivers of older adults should know that infection does not always announce itself with fever. In a person who is frail or has dementia, report any of these to the treating clinician:

  • New confusion, restlessness or sleepiness
  • Refusing food or fluids
  • Guarding the surgical area or crying out when it is touched
  • A dressing that is suddenly wet, stained or strong smelling
  • A new fall or sudden weakness

After surgery on a leg or hip, also report new calf pain or swelling. Call 911 for chest pain, severe shortness of breath, a person who cannot be roused, or bleeding that will not stop.

Why primary care matters here

Rebuilding tissue in an open surgical wound takes protein, calories and fluid, at a time when appetite is often poor. Nausea from antibiotics, pain medicine and simply feeling unwell after an operation can cut intake for weeks. A primary care clinician can look at weight, eating and lab results where needed, and suggest practical steps or a dietitian referral. Tobacco is the other large factor. Nicotine narrows small blood vessels and reduces the oxygen reaching the incision, so support for cutting down or quitting is part of wound recovery. Arranging primary care with wound care keeps these conversations from being put off.

Primary care at home in Affton →

Getting care arranged in Affton

For a resident of a nursing home, assisted living or memory care community in Affton, a request for wound follow-up after a surgical site infection can come from the family, the resident or the facility’s nurses. Call 314-325-0126 and give us the facility name, the unit or room and the best nurse contact. Gateway speaks with the facility about its process for outside clinicians, confirms availability and coordinates a visit time that fits the resident’s day. After the visit, the treating clinician’s orders are given to facility nursing, and the family contact on file gets an update if the resident has agreed to that.

When you call 314-325-0126 about someone in Affton, have the street address, a phone number for the person who will be home, the name of the primary care doctor and any recent discharge papers nearby. Mention stairs, pets or a side-door entrance. Because Affton is compact and close to major roads, visits here can be planned alongside others in Mehlville, Crestwood, Shrewsbury, Webster Groves, South St. Louis and the rest of South County. Availability is confirmed for your address and care setting when you call.

  • County: St. Louis County, Missouri
  • ZIP codes: 63123
  • Nearby hospitals: Mercy Hospital South; SSM Health St. Mary's Hospital in Richmond Heights; St. Luke's Des Peres Hospital (not affiliated with Gateway)
  • Nearby communities: Mehlville, South County, Webster Groves, Crestwood, South St. Louis, Shrewsbury
  • Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

Other conditions and nearby communities

Read the full guide to surgical site infections, or see everything Gateway arranges on the mobile wound care in Affton page.

Common questions

Do I need a referral from my surgeon to start wound follow-up in Affton?

No. Patients, family members and caregivers can call Gateway directly, and surgical practices, hospitals and facilities can also refer. Once you call, we ask for the surgeon’s name and the hospital so the treating clinician can get the operative notes and current orders. Some health plans have their own referral or authorization rules, and those are checked along with your coverage before visits begin.

Who changes the dressing on the days between visits?

The treating clinician’s orders say how often the dressing is changed and who may do it. Depending on the wound and the setting, that may be a home health nurse, facility nursing staff, a family caregiver who has been taught, or the patient. If the wound is deep, in a spot you cannot see or reach, or simply more than you are comfortable with, say so. The clinician can adjust the plan.

How long will an infected surgical wound take to close?

No one can give an exact date. It depends on how deep and wide the opened area is, whether the infection is fully controlled, where on the body it sits, and your general health. A better question for the treating clinician is whether the wound is moving in the right direction: smaller measurements, less drainage and healthy tissue at the base from one visit to the next.

Does Gateway have a clinic in Affton where we can walk in?

No. Gateway does not run a walk-in clinic in Affton. We arrange for partner clinicians to see patients where they live, in homes and care facilities, and in some outpatient or office settings with clinical partners. Our administrative office in Chesterfield does not see patients. To start, call us or send the request form with a name and phone number only.

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.