Understanding surgical site infections

Every incision breaks the skin, the body’s main barrier against bacteria. Surgical teams lower the risk with skin cleansing, sterile technique and, for many operations, an antibiotic given shortly before the first cut. Even so, some bacteria reach the wound, most often from the patient’s own skin or, in bowel surgery, from the gut. Whether they take hold depends on how many there are and how well the tissue can defend itself. Tissue with poor blood flow, a collection of blood or fluid under the skin, or foreign material such as mesh gives bacteria a place to settle. Careful practice lowers the risk but cannot remove it, which is why the first weeks after any operation call for a close eye on the incision.

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: Granite City

Crossing a bridge for every wound check is a lot to ask of someone in Granite City with an open, draining incision. When the surgeon is in Missouri, home or facility visits on the Illinois side can reduce those trips, with the treating clinician’s findings sent to the surgeon between rechecks. Home health agencies and supply vendors also differ by state and by plan. Gateway confirms the treating provider and your coverage first, whether that is Illinois Medicaid or a Missouri-based plan, so dressing orders and any pump or equipment go through channels your plan recognizes.

Much of Granite City is made up of modest frame and brick houses on small lots, some with steps up to the front door. Apartments, senior housing, assisted living, and skilled nursing and rehabilitation facilities are found in the area too. Gateway arranges visits in all of these settings with partner clinicians. If steps, a narrow doorway or a second-floor unit make leaving home hard, say so when you call, because that is the situation home visits are meant for. In facilities, we coordinate with staff about the visit time, the resident’s chart and current orders.

When care happens at home

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.

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

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 Granite City →

Getting care arranged in Granite City

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

Calling about care in Granite City? Have the address and ZIP code (62040), a working phone number, a list of medications and the names of any doctors or specialists, including those across the river in Missouri. Gateway also arranges care in Collinsville, Edwardsville, Glen Carbon, Alton and the Riverbend, and elsewhere in Madison County. Scheduling depends on the care setting and where in the area the patient lives, so we confirm availability before a visit is set.

More wound care in Granite City

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

Common questions

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

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 Granite City.

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.

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.

Can I request care in Granite City if I have not seen a doctor in a long time?

Yes. You do not need a current doctor or a referral to call Gateway. Tell us what is going on and what medications you take, even if the list is short or out of date. The treating clinician begins with an assessment and decides what is needed from there. If older records exist at a hospital or a former doctor’s office, we can ask for 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.