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.

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: North County

With skilled nursing facilities and senior living communities close by, people in North County often spend the first weeks after an operation in rehabilitation and then return to a house they have lived in for decades. A surgical site infection can show up on either side of that move. Gateway arranges wound follow-up in the facility and at home, and carries the dressing orders, measurements and antibiotic dates across the transfer. Neighbors and adult children who help out can ask the clinician what a worrying dressing looks like.

Much of North County was built as subdivisions of brick ranch homes and bungalows, and those one-story houses suit home visits well. The region also has apartment complexes, senior apartment buildings, assisted living and a number of skilled nursing and rehabilitation centers. Gateway arranges partner clinician visits across all of them, from a house in Florissant to a nursing facility in Bridgeton. For a home visit, we ask where the patient is most comfortable being seen. For a facility, we ask which days work on the unit. The treating clinician handles the clinical side.

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

Many people who develop a surgical site infection are already in a skilled nursing or rehabilitation center, recovering from a joint replacement, a hip repair or abdominal surgery. There, facility nurses change the dressing and take vital signs, and the attending physician oversees medical care. The treating wound clinician adds a focused wound exam at each visit, writes or recommends orders according to the facility’s process, and talks with the nurses who see the incision every day. Gateway arranges those visits with the facility and routes the clinician’s notes to the surgeon, so the three teams are reading the same record.

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.

Primary care and overall health

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 North County →

How to get started in North County

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

North County covers many towns and ZIP codes, so start with the exact address and the municipality. Have the patient’s phone number, insurance cards and doctor’s name ready. If a relative on another street or in another town helps with care, give us that number too. Gateway arranges care in Florissant, Hazelwood, Ferguson and Bridgeton, and across the city line in North St. Louis. Because the region is spread out, each visit is confirmed by location and care setting.

  • County: St. Louis County, Missouri
  • ZIP codes: 63031, 63033, 63034, 63042, 63135, 63136, 63137, 63138, 63134
  • Nearby hospitals: Christian Hospital in North County; SSM Health DePaul Hospital in Bridgeton (not affiliated with Gateway)
  • Nearby communities: Florissant, Hazelwood, Ferguson, Bridgeton, North St. Louis
  • Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

More wound care in North County

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

Common questions

Will my insurance pay for wound follow-up visits in North County after a surgical site infection?

That depends on your plan, the treating provider and the care that is needed. You can ask us about Medicare, Medicare Advantage, Medicaid and commercial plans, and we help confirm participation and benefits with the treating practice before care starts. Have your insurance card nearby when you call. Decisions about what is paid for rest with your plan, not with Gateway.

Does Gateway arrange surgical site infection follow-up in nursing and rehabilitation facilities in North 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 North County.

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 it matter whether an address is in North County or in the City of St. Louis?

Not for requesting care. Gateway arranges visits on both sides of the city line, in North County and in North St. Louis. It does help to give the full address and ZIP code, because many North County mailing addresses say St. Louis. The exact location lets us match the patient with a partner clinician who sees people in that area.

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.