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

Early on, the treating clinician and the surgical team agree on where the wound is headed. Some infected incisions are left to close on their own from the base. Others are kept clean until the surgeon can stitch them shut. A few need more surgery before either can happen. The goal shapes the plan: which dressings are used, how often the wound is measured and what the surgeon wants reported. The clinician also sets markers of progress, such as less drainage, a shallower base and healthy red tissue. When a wound misses those markers over several visits, the plan is reviewed with the surgeon instead of simply continued.

Local context: Metro East

Crossing a bridge for every wound check is a lot to ask of someone in the Metro East 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.

Care settings in the Metro East are as varied as the region. There are brick homes in older neighborhoods, farmhouses, subdivisions, apartments, mobile homes, senior living communities, memory care units, rehabilitation centers and skilled nursing facilities. Gateway arranges wound care and primary care visits with partner clinicians in all of these. We start by asking where the patient is living and who helps with daily care. Then we coordinate the visit with the household or the facility staff and make sure records and orders reach the treating clinician.

When care happens at home

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.

Signs to tell the clinician about

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 the Metro East →

Getting care arranged in the Metro East

Clinicians and facility staff referring a patient for wound follow-up after a surgical site infection in the Metro East 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.

Because the Metro East covers three counties, the first thing we ask for is the town and ZIP code. After that, have a phone number, the type of residence, the patient’s doctors and the dates of any recent hospital stay ready. Gateway arranges care in Belleville, Edwardsville, O’Fallon, Collinsville, Alton and Granite City, among other communities. Distances are long from one end of the region to the other, so availability is confirmed by location and care setting for each request.

  • County: St. Clair, Madison and Monroe counties, Illinois
  • Nearby hospitals: Memorial Hospital Belleville; Memorial Hospital Shiloh; HSHS St. Elizabeth's Hospital in O'Fallon, Illinois; Anderson Hospital in Maryville; Alton Memorial Hospital; OSF Saint Anthony's Health Center in Alton; Gateway Regional Medical Center in Granite City; Touchette Regional Hospital in Cahokia Heights (not affiliated with Gateway)
  • Nearby communities: Belleville, Illinois, Edwardsville, O'Fallon, Illinois, Collinsville, Alton, Granite City
  • Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

Other conditions and nearby communities

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

Common questions

Can a clinician come to a home in the Metro East to check an infected surgical incision?

Gateway arranges home visits from partner clinicians for wound follow-up after a surgical site infection. Whether a visit can be set up at an address in the Metro East depends on location and care setting, which we confirm when you call 314-325-0126. Gateway is not an emergency service. If your surgeon told you to go to the emergency department for certain symptoms, follow that instruction.

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.

Should I keep my surgeon appointments if a wound clinician is already visiting?

Yes. Wound visits add to the surgeon’s care and do not replace it. The surgeon decides about antibiotics, further procedures, closing the wound and when you can return to normal activity. The treating clinician’s notes can make those appointments more productive, because the surgeon sees how the wound has changed since the last check. If getting to the office is the obstacle, tell us when you call.

Can a hospital case manager and a family member in the Metro East both be involved in one request?

Yes, and it often helps. The case manager can send clinical records and orders, and the family can tell us about the home, the daily routine and who will be there for visits. Gateway keeps a single request for the patient and communicates with both. Hospitals and facilities can fax referrals to 314-786-7966, and families can call 314-325-0126.

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.