About 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.

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.

Local context: Ladue

Many homes in Ladue 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.

Most of Ladue is single-family homes, many of them large, on private lanes or at the end of long driveways. Some families have hired caregivers in the home. Apartments and senior living are less common in Ladue itself than in the cities around it, where many longtime residents move for assisted living, memory care or skilled nursing. Gateway arranges partner clinician visits in both places. For a home, we ask about gate codes, the easiest entrance and who will meet the clinician. For a facility, we work with the nursing staff on timing and orders.

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

In a rehabilitation setting, an infected incision has to share the day with therapy. Dressing changes work best when they are timed so a leaking or painful wound does not cut a session short, and therapists need to know about any movement limits the surgeon has set. Some residents are also receiving intravenous antibiotics through a long-term line, which facility nurses manage under the prescriber’s orders. The treating clinician watches how the wound responds and tells the attending physician and surgeon what it shows. Gateway helps keep track of the dates that matter, including antibiotic end dates, surgeon rechecks and the planned discharge.

What to report and when to call 911

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.

Why primary care matters here

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 Ladue →

Getting care arranged in Ladue

If you have been managing a wound mostly on your own and are looking for wound follow-up after a surgical site infection in Ladue, you can call Gateway yourself at 314-325-0126. Tell us what the wound looks like now, what the last clinician said about it and what is getting harder to manage. It helps to know the patient’s insurance and the names of the doctors involved, but do not wait until you have everything. We check whether a partner clinician can see the patient at home or in their facility, and we tell you what we find. The treating clinician takes it from there, and you stay part of the conversation.

A few details make the first call go faster: the street address in Ladue with any gate or entry instructions, a daytime phone number, the regular doctor’s name and whether a private caregiver or home health agency is already involved. Gateway also arranges care in Clayton and Central County, Creve Coeur, Richmond Heights, Brentwood and University City. Ladue is in Mid County, close to the other cities on that list, though each visit is still confirmed by address and care setting.

  • County: St. Louis County, Missouri
  • ZIP codes: 63124
  • Nearby hospitals: Missouri Baptist Medical Center in Town and Country; SSM Health St. Mary's Hospital in Richmond Heights; Mercy Hospital St. Louis in Creve Coeur (not affiliated with Gateway)
  • Nearby communities: Clayton and Central County, Creve Coeur, Richmond Heights, Brentwood, University City
  • Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

Related care in Ladue

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

Common questions

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

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 Ladue.

How long will an infected surgical wound take to close?

No one can give an exact date. It depends on how deep and wide the opened area is, whether the infection is fully controlled, where on the body it sits, and your general health. A better question for the treating clinician is whether the wound is moving in the right direction: smaller measurements, less drainage and healthy tissue at the base from one visit to the next.

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

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.

If my husband moves from our Ladue home to assisted living nearby, does his wound care have to start over?

Not necessarily. Tell us about the move as early as you can. Gateway arranges care in private homes and in assisted living, memory care and skilled nursing settings in the cities around Ladue, and with permission we send records and current orders to the new setting. Whether the same treating clinician continues depends on the location and the facility, which we confirm for you.

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.