What to know about surgical site infections

Several common beliefs about infected incisions cause trouble. One is that an infection means the surgery failed or that someone was careless, when it is a recognized risk of any operation. Another is that the problem ends with the antibiotic prescription. The medicine fights bacteria, but it does not close a wound that had to be opened. People are also alarmed when the surgeon leaves the incision open, though that is usually deliberate. And many assume a wound that looks better on the surface is finished, when a deeper pocket may still be draining. The most useful habit is to describe exactly what you see to the clinician, without deciding first whether it is good or bad.

What an assessment covers

At the bedside, the treating clinician builds a baseline that later visits are compared against. Typical parts of the exam include:

  • Length, width and depth of any open area
  • Tunnels or pockets under the skin edges
  • The color and type of tissue in the wound bed
  • How much drainage there is and what it looks like
  • The surrounding skin and any remaining stitches or staples

Each finding is recorded the same way every time, so a small change in size or a new pocket stands out. The care plan follows from what the exam shows and what the surgeon has ordered.

Local context: Alton

People in Alton may have had surgery at an Illinois hospital or across the river in Missouri, and the wound follow-up has to connect with whichever team did the operation. Coverage adds a step. Illinois Medicaid plans, Missouri plans, Medicare Advantage and commercial insurance each work differently, and participation depends on the treating provider. Before a first visit for an infected incision, Gateway confirms which partner clinician can see you on the Illinois side and what your plan requires, then requests the surgical records from the hospital, whichever state it is in.

Much of the housing in Alton is older: large houses in the historic districts, frame houses on narrow lots, apartments in converted buildings and newer homes farther from the river. Many front doors are reached by a long flight of steps. The city and its neighbors also have senior apartments, assisted living, and skilled nursing and rehabilitation centers. Gateway arranges visits from partner clinicians in every one of these settings. We ask about steps, entrances and parking ahead of time, and in facilities we coordinate the visit and the resulting orders with nursing staff.

At home between visits

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.

Care in skilled nursing and assisted living

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.

Signs to tell the clinician about

Between visits, the dressing and the skin around it tell you a lot. Contact the treating clinician or the surgeon’s office if you notice:

  • Redness or darkening of the skin that extends past where it was yesterday
  • Drainage that soaks through sooner than it used to
  • Fluid that turns thick, cloudy or foul smelling
  • Skin edges that pull farther apart
  • A firm, tender or soft, swollen lump beside the incision

Call 911 for heavy bleeding that does not stop with firm pressure, if tissue from inside the body bulges through an open abdominal wound, or if the person becomes confused, faint or very short of breath.

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 Alton →

Getting care arranged in Alton

Clinicians and facility staff referring a patient for wound follow-up after a surgical site infection in Alton can call 314-325-0126 or fax 314-786-7966. Helpful to include: demographics and insurance, the working diagnosis, recent wound notes and measurements, current orders, the medication list and relevant test results. Please also tell us who should receive the treating clinician’s notes afterward. The online referral form takes contact details only, so clinical records should come by fax, not through the form. Gateway confirms that the referral arrived, checks availability for the patient’s address and lets your office know what has been scheduled.

When you call about care in Alton, mention right away that the address is in Illinois, and have the 62002 ZIP code, a phone number, the regular doctor and the insurance card on hand. Insurance plans and provider participation can differ on each side of the state line, so we check before scheduling. Availability is confirmed by location and care setting. Gateway also arranges care in Godfrey, the rest of the Riverbend, Edwardsville and elsewhere in Madison County.

Other conditions and nearby communities

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

Common questions

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

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.

What happens when the infection is near a joint replacement, mesh or other hardware?

Infection around implanted material is more serious, because bacteria can cling to surfaces that the body’s defenses and antibiotics reach poorly. The surgical team decides how to manage it, which may involve longer antibiotic treatment, a procedure to wash out the area, or removing or replacing the implant. Wound follow-up in this situation centers on close observation and prompt reporting, so the surgeon hears early about any drainage, opening or new pain.

Can I shower with an open surgical wound?

Follow the surgical team’s instructions, because the answer differs by operation, by wound and by dressing. Some people are cleared to shower with the wound covered or uncovered. Others are asked to keep the area dry. Soaking in a bath, hot tub or pool is generally off limits until the surgeon says otherwise. If you were not told, ask before your next dressing change, and ask what to do if the dressing gets wet.

What kinds of wounds can be seen at home in Alton?

Partner wound care clinicians commonly see pressure injuries, diabetic foot ulcers, venous and arterial leg ulcers, surgical wounds that are slow to close, and skin tears. The treating clinician assesses the wound and decides whether care at home is appropriate or whether a hospital or clinic setting is needed. Call 911 for heavy bleeding or for fever with confusion.

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.