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 the treating clinician looks at

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.

Arranging this care in South St. Louis

In South St. Louis, many people recover from surgery in apartments, upper flats and older multi-story homes. Stairs are hard with an abdominal or hip incision, and harder still with an infection, so each trip out to have a wound checked costs real effort. Visits at home spare those flights. When Gateway schedules a visit, we ask about buzzer codes, locked lobbies, elevators and where a clinician can park, and we ask where dressing supplies can be delivered so they do not sit unattended in a shared entryway.

Brick defines the south side. There are bungalows and gingerbread-style houses in St. Louis Hills, narrow shotgun homes on The Hill, row houses in Soulard, and two-family and four-family flats nearly everywhere. Front steps are steep, gangways are narrow and parking is on the street. Senior apartment buildings, assisted living and skilled nursing facilities are spread through the neighborhoods as well. Gateway arranges partner clinician visits in each setting. Tell us if the patient lives in an upstairs flat or needs help getting to the door, so the visit is planned with that in mind.

Care at home

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.

For residents of nursing and senior living communities

A common point where things slip for an infected surgical wound is the move out of a facility. Orders that were followed on every shift have to be handed to a family, a home health agency or another facility, and details go missing. Before discharge, Gateway works with the facility’s nurses and discharge planner to gather the current dressing orders, the most recent wound measurements, the antibiotic plan and the date of the next surgeon visit. Where availability allows, wound visits continue at the new address, so the person checking the wound already knows what it looked like the week before.

What to report and when to call 911

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 South St. Louis →

Arranging wound follow-up after a surgical site infection in South St. Louis

You may already have a surgeon, a wound clinic or a home health nurse and still want help with wound follow-up after a surgical site infection closer to home in South St. Louis. That is a fine reason to call 314-325-0126. Tell us who is treating the wound now and what is not working, whether that is the travel, the gaps between appointments or unclear instructions. Gateway does not replace your current clinicians. We can arrange for a partner clinician to see the wound where you live and, with your permission, share notes with the offices already involved so the plans agree.

When you call, name the neighborhood as well as the address, since South St. Louis covers a lot of ground and several ZIP codes. Tell us about stairs, a locked gate or a doorbell that does not work, and give a phone number that will be answered. Gateway also arranges care in Downtown St. Louis, the Central West End and the rest of the city, and in nearby Affton, Shrewsbury and Maplewood. Street parking and one-way blocks are part of visiting here, and visit days are confirmed by location.

  • County: City of St. Louis, Missouri (an independent city)
  • ZIP codes: 63104, 63109, 63111, 63116, 63118, 63139
  • Nearby hospitals: SSM Health Saint Louis University Hospital; Barnes-Jewish Hospital; SSM Health St. Mary's Hospital in Richmond Heights; Mercy Hospital South (not affiliated with Gateway)
  • Nearby communities: St. Louis City, Downtown St. Louis, Affton, Shrewsbury, Maplewood, Central West End
  • 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 South St. Louis page.

Common questions

Can a clinician come to a home in South St. Louis 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 South St. Louis 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.

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.

Does Gateway help with dressing supplies for patients in South St. Louis?

When the treating clinician orders dressings or other supplies, Gateway coordinates getting them to the patient’s home or facility in South St. Louis. Which supplies are ordered is a clinical decision, and whether a plan pays for them depends on the plan, the treating provider and the care needed. Tell us if supplies from the hospital are running low so the clinician’s office knows before the visit.

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.