What to know 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 the treating clinician looks at

The first visit starts with the story of the operation. The treating clinician wants to know what procedure was done and when, whether mesh, hardware or a joint implant was placed, and what the surgical team has done about the infection so far. That includes whether the incision was opened, whether a culture was taken, which antibiotic was prescribed and when it is due to end. Gateway requests the operative and discharge records so the clinician is not relying on memory alone. With that background, the clinician examines the wound and sets a dressing plan that fits the surgeon’s instructions.

Arranging this care in Florissant

Many homes in Florissant 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.

Single-story ranch houses are the typical Florissant home, which helps patients who cannot manage stairs. The city also has garden apartments, condominiums, senior apartment communities, assisted living, and skilled nursing and rehabilitation centers. Gateway arranges partner clinician visits in every one of these settings. A request can come from a homeowner, a relative or a facility’s nursing office. We then match the visit to the setting: a time of day that suits a family caregiver at home, or a time that works with medication passes and therapy in a facility.

At home between visits

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.

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.

Primary care and overall health

Surgeons follow a patient for a set period after an operation. Primary care stays on. That longer view matters when a surgical site infection is only one of several things going on: leg swelling from heart or vein problems around a lower-limb incision, poor circulation, a chronic cough that strains an abdominal wound, or weakness that keeps someone in bed and at risk for pressure injuries. A primary care clinician manages those conditions and coordinates with the surgeon about activity. For people who cannot easily get to an office, Gateway can arrange primary care visits in the same setting as the wound visits.

Primary care at home in Florissant →

Getting care arranged in Florissant

Before anything is scheduled, Gateway checks two things for every request for wound follow-up after a surgical site infection in Florissant: whether a partner clinician serves that address and care setting, and what the patient’s plan requires from the treating provider. Neither is assumed. If both line up, we arrange the visit and gather records. If something stands in the way, we say so, and our guide to following up on a request explains what to ask next. Gateway coordinates the care and does not make clinical decisions. Those belong to the treating clinician who sees the wound. Start by calling 314-325-0126, or ask a family member to call for you.

Florissant is big enough that location within the city matters. Tell us the ZIP code, the nearest major road and whether the home is north toward the Missouri River or south near Interstate 270. Have the patient’s phone number, the doctor’s name and the name of a second contact. Ask us about timing if a caregiver is only there at certain hours. Gateway also arranges care in Hazelwood, Ferguson, Bridgeton and the rest of North County, and visits in Florissant are planned with those areas.

  • County: St. Louis County, Missouri
  • ZIP codes: 63031, 63033, 63034
  • Nearby hospitals: Christian Hospital in North County; SSM Health DePaul Hospital in Bridgeton (not affiliated with Gateway)
  • Nearby communities: Hazelwood, Ferguson, North County, Bridgeton
  • Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

More wound care in Florissant

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

Common questions

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

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 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.

Does Gateway arrange surgical site infection follow-up in nursing and rehabilitation facilities in Florissant?

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 Florissant.

Can a skilled nursing or assisted living facility in Florissant request visits for a resident?

Yes. Facility staff in Florissant can refer by phone or fax, and one request can cover a single resident or start a conversation about regular visits for several. We ask for the resident’s information, the reason for the request and the best nursing contact. The treating clinician works alongside the facility’s own team and attending physician, and visit notes are shared with them.

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.