Understanding 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.

What an assessment covers

At the bedside, the treating clinician builds a baseline that later visits are compared against. Typical parts of the exam include:

  • Length, width and depth of any open area
  • Tunnels or pockets under the skin edges
  • The color and type of tissue in the wound bed
  • How much drainage there is and what it looks like
  • The surrounding skin and any remaining stitches or staples

Each finding is recorded the same way every time, so a small change in size or a new pocket stands out. The care plan follows from what the exam shows and what the surgeon has ordered.

Wound follow-up after a surgical site infection in South County

With skilled nursing facilities and senior living communities close by, people in South 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.

Care settings in South County are varied. Affton and Lemay have small brick bungalows and older two-bedroom homes. Concord, Sappington and Mehlville are known for ranch houses. Oakville and Sunset Hills have newer and larger homes. Throughout the area there are condominiums, senior apartments, assisted living, memory care and many skilled nursing and rehabilitation centers. Gateway arranges partner clinician visits in all of them. We fit the request to the setting, whether that means a kitchen-table visit in Affton or a visit planned with the nursing staff at a facility.

At home between visits

Supplies are a common sticking point after a surgical site infection, because the dressings ordered for an open, draining wound are rarely what was sent home from the hospital. Gateway coordinates the clinician’s supply orders so the right materials come to the house, and follows up on refills as the wound’s needs change. It helps to pick one clean, dry spot for everything, away from pets and the bathroom floor, with a small trash bag for used dressings. If a negative pressure pump has been ordered, we coordinate the equipment and the canisters and dressings that go with it.

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.

Signs to tell the clinician about

An infection that was settling can flare again, and the first clues are not always at the incision. Tell the treating clinician or the surgical team promptly about:

  • A temperature above the level your surgeon told you to report
  • Shaking chills or drenching sweats
  • Pain that climbs after days of easing
  • Nausea, poor appetite or unusual tiredness that is new
  • Blood sugar readings running higher than usual, if you check them

Call 911 if the person becomes confused, is hard to wake, breathes fast or with effort, has a racing heartbeat, or faints. Those signs can mean the infection is spreading through the body.

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 South County →

How to get started in South County

Clinicians and facility staff referring a patient for wound follow-up after a surgical site infection in South County 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.

South County is a patchwork of small cities and unincorporated neighborhoods, and nearly all of them use St. Louis as the mailing city. When you call, give the ZIP code and a nearby main road so we place the address correctly. Have the patient’s phone number, doctor’s name and insurance cards with you. Gateway arranges care in Affton, Mehlville, Oakville, Crestwood, Sunset Hills and Fenton, among others. If you are helping two relatives in different parts of South County, tell us, and we will take both requests together.

  • County: St. Louis County, Missouri
  • ZIP codes: 63123, 63125, 63126, 63127, 63128, 63129
  • Nearby hospitals: Mercy Hospital South; SSM Health St. Clare Hospital in Fenton; St. Luke's Des Peres Hospital (not affiliated with Gateway)
  • Nearby communities: Affton, Mehlville, Oakville, Crestwood, Sunset Hills, Fenton
  • Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

More wound care in South County

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

Common questions

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

Who changes the dressing on the days between visits?

The treating clinician’s orders say how often the dressing is changed and who may do it. Depending on the wound and the setting, that may be a home health nurse, facility nursing staff, a family caregiver who has been taught, or the patient. If the wound is deep, in a spot you cannot see or reach, or simply more than you are comfortable with, say so. The clinician can adjust the plan.

Will my insurance pay for wound follow-up visits in South 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.

Can Gateway arrange in-home visits for someone in South County who uses a wheelchair and cannot manage stairs?

Yes. Limited mobility is one of the main reasons people ask for visits at home. Let us know that the patient uses a wheelchair, which rooms they can reach and whether a caregiver is present. That information goes to the treating clinician before the visit. If the clinician orders equipment or supplies, Gateway coordinates getting them to the South County address.

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.