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

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: Downtown St. Louis

People in Downtown St. Louis often had their operation at one of the large medical centers nearby, and the surgeon’s office may be only a short distance away. Close is not the same as easy when you cannot drive, the parking garage means a long walk, and an open incision is draining. Gateway arranges wound checks where you live and sends the treating clinician’s findings to the surgical team, so the surgeon has current information between in-person rechecks. We also request records from the hospital where the surgery was done.

Homes in Downtown St. Louis are almost all multi-unit: converted lofts, high-rise apartment towers, senior apartment buildings and a smaller number of condominiums. Skilled nursing and rehabilitation centers lie a short distance away in neighboring parts of the city. Gateway arranges partner clinician visits to all of these settings. Before a downtown visit we confirm how to get past the front door, whether a building manager needs notice, and where the clinician can leave a car. We also ask where supply deliveries should go, since packages are handled differently in each building.

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

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 Downtown St. Louis →

Arranging wound follow-up after a surgical site infection in Downtown St. Louis

Clinicians and facility staff referring a patient for wound follow-up after a surgical site infection in Downtown St. Louis 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.

Three things make a request for care in Downtown St. Louis go smoothly. First, the full address with unit number and ZIP code, whether 63101, 63102 or 63103. Second, access details: call box name, door code, front desk hours, guest parking or the nearest garage. Third, a phone that will be answered when the clinician arrives. Ball games, concerts and street closures can affect timing, so we plan around them where we can. Gateway also arranges care in the Central West End, North St. Louis, South St. Louis and across St. Louis City.

  • County: City of St. Louis, Missouri (an independent city)
  • ZIP codes: 63101, 63102, 63103
  • Nearby hospitals: SSM Health Saint Louis University Hospital; Barnes-Jewish Hospital (not affiliated with Gateway)
  • Nearby communities: St. Louis City, Central West End, North St. Louis, South St. Louis
  • Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

Related care in Downtown St. Louis

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

Common questions

Do I need a referral from my surgeon to start wound follow-up in Downtown St. Louis?

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.

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.

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.

Can staff at a senior apartment building in Downtown St. Louis contact Gateway for a resident?

Yes, with the resident’s agreement. Service coordinators, building managers and social workers in Downtown St. Louis can call us to start a request or help a resident make the call. We need the resident’s name and phone number to begin. Medical details should be shared by phone, not through the web form. The resident chooses who Gateway may talk to about scheduling and care.

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.