Understanding surgical site infections

A surgical site infection is an infection that develops where a surgeon cut, in the days and weeks after an operation. Clinicians sort these infections by depth. Some stay in the skin and the fat just under the incision. Others reach the muscle layer and its covering. A third kind sits in the organ or space that was operated on, such as a joint or the abdomen. Depth matters because it shapes the treatment: a shallow infection may be handled by opening part of the incision and giving antibiotics, while a deep one can mean another procedure. Whatever the depth, the surgical team makes the diagnosis and directs treatment. Wound follow-up is what comes next, the regular checking and dressing of the incision while it recovers.

How the care plan is built

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.

Wound follow-up after a surgical site infection in the Central West End

In the Central West End, many people recover from surgery in apartments, upper flats and older multi-story homes. Stairs are hard with an abdominal or hip incision, and harder still with an infection, so each trip out to have a wound checked costs real effort. Visits at home spare those flights. When Gateway schedules a visit, we ask about buzzer codes, locked lobbies, elevators and where a clinician can park, and we ask where dressing supplies can be delivered so they do not sit unattended in a shared entryway.

Housing in the Central West End stacks up as much as it spreads out. There are doorman towers along Lindell Boulevard and Kingshighway, brick walk-ups and converted mansions on the side streets, newer apartment buildings near the medical campus, and senior apartments, assisted living and skilled nursing within the neighborhood or a short distance away. Gateway arranges partner clinician visits in all of them. For secured buildings we ask ahead about the front desk, entry codes and visitor parking. For facilities we coordinate with the nursing team on timing and orders.

When care happens at home

Supplies are a common sticking point after a surgical site infection, because the dressings ordered for an open, draining wound are rarely what was sent home from the hospital. Gateway coordinates the clinician’s supply orders so the right materials come to the house, and follows up on refills as the wound’s needs change. It helps to pick one clean, dry spot for everything, away from pets and the bathroom floor, with a small trash bag for used dressings. If a negative pressure pump has been ordered, we coordinate the equipment and the canisters and dressings that go with it.

In a facility

Assisted living and memory care raise different questions. Staff in these communities often cannot perform complex dressing changes, so the plan has to say who will: a home health nurse, a visiting clinician or, in some cases, family. A resident with dementia may not mention pain, may pull at a dressing, or may not remember instructions about the incision. The treating clinician takes this into account when choosing how the wound is a covered benefit and secured, and caregivers are asked to report behavior changes as well as wound changes. Gateway coordinates among the community’s staff, the home health agency and the family.

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.

How primary care fits in

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 the Central West End →

Getting care arranged in the Central West End

Clinicians and facility staff referring a patient for wound follow-up after a surgical site infection in the Central West End 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.

Calling about someone in the Central West End? Have the building name and unit number, how visitors get in, and whether there is a place to park or a loading zone out front. Share a phone number that will be answered on the day of the visit. Street parking and event traffic near the park can slow arrivals, so a visit window is more realistic than an exact time. Gateway also arranges care in nearby University City, Clayton, Downtown St. Louis and the north and south sides of the city.

More wound care in the Central West End

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

Common questions

Does Gateway arrange surgical site infection follow-up in nursing and rehabilitation facilities in the Central West End?

Gateway arranges wound visits in skilled nursing facilities, rehabilitation centers, assisted living and memory care, as well as private homes. In a facility, the treating clinician works with the nursing staff and the attending physician under the facility’s own procedures. Facility staff or family can contact us to ask whether a partner clinician is available at a particular building in the Central West End.

Can a clinician come to a home in the Central West End 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 the Central West End 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.

What is negative pressure wound therapy, and why might it be ordered?

It is a treatment in which a sealed dressing is connected to a small pump that applies gentle suction to an open wound. The suction draws fluid away and can help some wounds fill in. A surgeon or treating clinician may order it for a deep or heavily draining surgical wound once infection is under control. It is not right for every wound, and the ordering clinician decides.

I do not have a car in the Central West End. What if I need an appointment that cannot be done at home?

We can help with the arrangements. When a treating clinician orders something that has to happen in an office, an imaging center or a hospital, Gateway can coordinate transportation arrangements along with the appointment and the records. What is available depends on your situation and your plan’s benefits. Tell us about mobility needs, such as a wheelchair or a walker, when the trip is being planned.

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.