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

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 O’Fallon

Newer subdivisions and growing senior living communities in O’Fallon sit farther from the specialists who handle surgical complications. When an infected incision needs dressings that a nearby pharmacy does not stock, or a negative pressure pump with its canisters, waiting on an order can leave a gap. Gateway coordinates the clinician’s supply orders early and confirms a delivery address that works for a household where everyone is out during the day. For residents of senior living, we coordinate visit times with community staff so someone who knows the resident is present.

Two-story houses with the bedrooms upstairs are the norm in many O’Fallon subdivisions, which can be a problem after surgery or when a leg wound makes stairs risky. The city also has ranch-style villas, apartments, and a growing number of senior living, assisted living, memory care and skilled nursing communities. Gateway arranges partner clinician visits in all of these. For a house, we ask whether the patient is staying on the main floor. For a senior community, we coordinate with the wellness or nursing staff so they receive the treating clinician’s orders.

At home between visits

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

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 O'Fallon →

Getting care arranged in O’Fallon

To arrange wound follow-up after a surgical site infection in O’Fallon, call Gateway at 314-325-0126. Patients, family members and caregivers can call directly, and a referral is not required. We will ask where the patient lives, what has been done for the wound so far and which clinicians are involved. Gateway then confirms whether a partner clinician is available for that address and care setting, requests the relevant records and schedules the visit. At that visit the treating clinician examines the wound and decides on the plan. Our job from then on is the coordination: orders, supplies, follow-up visits and keeping the care team informed.

Say O’Fallon, Missouri when you call or leave a message, because there is also an O’Fallon in Illinois, and the region Gateway covers includes the Metro East. Give the street address, the ZIP code (63366 or 63368), a phone number and the name of the regular doctor. Gateway also arranges care in St. Peters, Lake St. Louis, Wentzville, Dardenne Prairie and Cottleville. O’Fallon is large, so the specific address matters when visit days are confirmed with a partner clinician.

  • County: St. Charles County, Missouri
  • ZIP codes: 63366, 63368
  • Nearby hospitals: Progress West Hospital in O'Fallon; Barnes-Jewish St. Peters Hospital; SSM Health St. Joseph Hospital in Lake Saint Louis (not affiliated with Gateway)
  • Nearby communities: St. Peters, Lake St. Louis, Wentzville, Dardenne Prairie, Cottleville
  • 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 O'Fallon page.

Common questions

Does Gateway arrange surgical site infection follow-up in nursing and rehabilitation facilities in O’Fallon?

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 O’Fallon.

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.

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

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.

What happens after I request wound care for someone in O’Fallon?

Someone from Gateway calls to collect the basics: the patient’s name, address, phone number, doctors and recent hospital stays. With permission, we request records and current orders. We then contact a partner clinician who sees patients in O’Fallon and confirm availability. You hear back with the next step. After the first visit, we coordinate any supplies or follow-up the treating clinician orders.

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.