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.

How the care plan is built

Early on, the treating clinician and the surgical team agree on where the wound is headed. Some infected incisions are left to close on their own from the base. Others are kept clean until the surgeon can stitch them shut. A few need more surgery before either can happen. The goal shapes the plan: which dressings are used, how often the wound is measured and what the surgeon wants reported. The clinician also sets markers of progress, such as less drainage, a shallower base and healthy red tissue. When a wound misses those markers over several visits, the plan is reviewed with the surgeon instead of simply continued.

Local context: Arnold

Newer subdivisions and growing senior living communities in Arnold sit farther from the specialists who handle surgical complications. When an infected incision needs dressings that a nearby pharmacy does not stock, or a negative pressure pump with its canisters, waiting on an order can leave a gap. Gateway coordinates the clinician’s supply orders early and confirms a delivery address that works for a household where everyone is out during the day. For residents of senior living, we coordinate visit times with community staff so someone who knows the resident is present.

Housing in Arnold ranges from older ranch homes near the center of town to newer subdivisions, townhomes, apartment complexes and manufactured home communities. Hilly lots and sloped driveways are part of the landscape. The area also has senior apartments, assisted living and skilled nursing and rehabilitation centers. Gateway arranges partner clinician visits in all of these. For a home visit we ask about entry steps and where the patient rests. For a facility resident we coordinate with the director of nursing or the unit staff so orders reach the people carrying them out.

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

A common point where things slip for an infected surgical wound is the move out of a facility. Orders that were followed on every shift have to be handed to a family, a home health agency or another facility, and details go missing. Before discharge, Gateway works with the facility’s nurses and discharge planner to gather the current dressing orders, the most recent wound measurements, the antibiotic plan and the date of the next surgeon visit. Where availability allows, wound visits continue at the new address, so the person checking the wound already knows what it looked like the week before.

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

Blood sugar and infection push each other in the wrong direction. Infection and the stress of surgery tend to raise glucose, and high glucose makes it harder for white blood cells to do their work and for new tissue to form. People with diabetes often see their readings change during a surgical site infection, and some people learn they have diabetes only when an incision is slow to recover. A primary care clinician can review the readings and decide whether the diabetes plan needs attention during this period. Gateway can arrange primary care alongside wound visits, so the two clinicians share what they find.

Primary care at home in Arnold →

Getting care arranged in Arnold

For a resident of a nursing home, assisted living or memory care community in Arnold, 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.

Before you call about care in Arnold, write down the patient’s address and the nearest cross street, the best phone number, the insurance cards on hand and the name of the doctor who knows them best. If a home health agency is already involved, tell us that as well. Because Arnold sits at the top of Jefferson County, visits here can be planned together with nearby Imperial, Oakville, Mehlville and Fenton. Addresses farther into Jefferson County are welcome too, and availability is confirmed case by case.

  • County: Jefferson County, Missouri
  • ZIP codes: 63010
  • Nearby hospitals: Mercy Hospital South; Mercy Hospital Jefferson in Festus; SSM Health St. Clare Hospital in Fenton (not affiliated with Gateway)
  • Nearby communities: Jefferson County, Oakville, Imperial, Fenton, Mehlville
  • 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 Arnold page.

Common questions

Can a clinician come to a home in Arnold to check an infected surgical incision?

Gateway arranges home visits from partner clinicians for wound follow-up after a surgical site infection. Whether a visit can be set up at an address in Arnold depends on location and care setting, which we confirm when you call 314-325-0126. Gateway is not an emergency service. If your surgeon told you to go to the emergency department for certain symptoms, follow that instruction.

Is a surgical site infection contagious to the people I live with?

Ordinary contact such as sitting together or sharing a meal is generally not a concern. Bacteria can spread through direct contact with wound drainage or used dressings. The usual precautions are washing hands before and after touching the dressing, bagging used materials and not sharing towels. If the culture showed a resistant type of bacteria, or someone at home has a weak immune system, ask the treating clinician whether more steps are needed.

What does a wound culture tell the care team?

A culture is a sample from the wound sent to a laboratory to identify which bacteria are growing and which antibiotics work against them. Results usually take a few days. The prescriber may keep the first antibiotic or switch based on the report. A culture is read together with how the wound looks, because bacteria can be found on wounds that are not infected.

My mother is in a rehabilitation center in Arnold and will go home soon. Can follow-up continue at her house?

It can be requested. If a treating clinician is already seeing her in the facility through Gateway, tell us the planned discharge date and her home address so we can check availability there. If she is not yet a patient, you or the facility’s social worker can start the request. The clinician decides the plan of care in each setting, and we move the records with her.

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.