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.

What an assessment covers

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 Jefferson County

In Jefferson County, the hospital where the surgery was done may be far away, and a recheck with the surgeon can take most of a day. That makes each home wound visit count for more. The treating clinician’s measurements and notes go to the surgical team, who can judge whether an in-person visit is needed sooner. Because deliveries take longer and stores carry less, Gateway plans dressing supplies ahead with the clinician’s orders, allowing for extra changes if drainage picks up before the next shipment.

Jefferson County has subdivisions and apartments in Arnold and Imperial, older homes in the river towns, manufactured homes, lake communities, and houses on acreage reached by gravel roads. Skilled nursing, rehabilitation and assisted living facilities are found mainly in the larger towns. Gateway arranges partner clinician visits in private homes and in facilities throughout the county. For homes, we collect directions and access notes. For facilities, we work with the nursing team so that wound orders, supply deliveries and visit days are understood by every shift.

At home between visits

Recovering from an operation at home already means lifting limits, less driving and a body that tires quickly. An infection adds surgeon rechecks, sometimes lab work, and a wound that has to stay dressed. Bringing wound visits to the house removes some of those trips. For appointments that still have to happen in person, such as a recheck with the surgeon, Gateway can help with transportation arrangements and send the latest wound notes to the office beforehand. If home health is already coming for therapy or nursing, we coordinate so the wound orders reach that agency and the two schedules do not collide.

For residents of nursing and senior living communities

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

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

A new antibiotic joins whatever else you take, and the combination deserves a look. Some antibiotics change how other medicines act, blood thinners among them, and some are cleared by the kidneys, which matters for older adults. Pain medicine after surgery can cause constipation and drowsiness, and steroids or other immune-suppressing drugs can slow wound healing. Sorting this out is primary care work. A primary care clinician can review the full list, including what the hospital added or stopped, and raise concerns with the surgeon or prescriber. When Gateway arranges both kinds of care, the wound clinician’s findings reach the clinician reviewing the medicines.

Primary care at home in Jefferson County →

How to get started in Jefferson County

Before anything is scheduled, Gateway checks two things for every request for wound follow-up after a surgical site infection in Jefferson County: 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.

When you call about care in Jefferson County, tell us the town and ZIP code first, since Arnold (63010) and De Soto (63020) are very different drives. Then give the street address, turn-by-turn directions if the home is rural, and a phone number that gets a signal there. Mention steep or unpaved driveways. Visits are planned by area, and Gateway arranges care in Arnold, Imperial, Festus and Crystal City as well as neighboring Fenton and Oakville. Bad weather on hill roads can occasionally move a visit, and we will call if it does.

  • County: Jefferson County, Missouri
  • ZIP codes: 63010, 63028, 63019, 63052, 63012, 63050, 63020, 63049, 63051
  • Nearby hospitals: Mercy Hospital Jefferson in Festus; Mercy Hospital South; SSM Health St. Clare Hospital in Fenton (not affiliated with Gateway)
  • Nearby communities: Arnold, Festus and Crystal City, Imperial, Fenton, Oakville
  • Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

Related care in Jefferson County

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

Common questions

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

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 Jefferson County.

Can I shower with an open surgical wound?

Follow the surgical team’s instructions, because the answer differs by operation, by wound and by dressing. Some people are cleared to shower with the wound covered or uncovered. Others are asked to keep the area dry. Soaking in a bath, hot tub or pool is generally off limits until the surgeon says otherwise. If you were not told, ask before your next dressing change, and ask what to do if the dressing gets wet.

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.

Can the clinician Gateway arranges work with a home health agency already visiting in Jefferson County?

Yes. Some patients already have a home health nurse or therapist coming to the house. Let us know the agency’s name. The treating clinician can write wound orders that the home health nurse follows between visits, and Gateway helps keep both sides informed about changes. The same applies in a facility, where the clinician works alongside the staff nurses and the attending physician.

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.