Understanding 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

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.

Local context: St. Louis City

In the City of 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.

Almost every kind of housing is found in the City of St. Louis: single-family brick homes, two-family and four-family flats, downtown lofts, high-rise apartments, senior housing towers and large older homes divided into units. It also has many skilled nursing facilities, assisted living residences and rehabilitation centers. Gateway arranges partner clinician visits in all of these. For a high-rise, we ask about the front desk and where to park. For a flat, we ask which bell to ring. We collect those details so the treating clinician can focus on the patient.

Care at home

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

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.

What to report and when to call 911

Caregivers of older adults should know that infection does not always announce itself with fever. In a person who is frail or has dementia, report any of these to the treating clinician:

  • New confusion, restlessness or sleepiness
  • Refusing food or fluids
  • Guarding the surgical area or crying out when it is touched
  • A dressing that is suddenly wet, stained or strong smelling
  • A new fall or sudden weakness

After surgery on a leg or hip, also report new calf pain or swelling. Call 911 for chest pain, severe shortness of breath, a person who cannot be roused, or bleeding that will not stop.

Why primary care matters here

Surgeons follow a patient for a set period after an operation. Primary care stays on. That longer view matters when a surgical site infection is only one of several things going on: leg swelling from heart or vein problems around a lower-limb incision, poor circulation, a chronic cough that strains an abdominal wound, or weakness that keeps someone in bed and at risk for pressure injuries. A primary care clinician manages those conditions and coordinates with the surgeon about activity. For people who cannot easily get to an office, Gateway can arrange primary care visits in the same setting as the wound visits.

Primary care at home in the City of St. Louis →

Arranging wound follow-up after a surgical site infection in the City of 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 the City of 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.

An address that says St. Louis can be in the city or the county, so give the ZIP code and neighborhood when you call. Have a reliable phone number, the name of the patient’s doctor or health center, and any discharge papers. Gateway arranges care throughout the City of St. Louis, including Downtown, the Central West End, North St. Louis and South St. Louis, and in Clayton and Central County next door. Building access and parking affect visits here more than distance does, so tell us about entry doors, buzzers and elevators.

  • County: City of St. Louis, Missouri (an independent city)
  • ZIP codes: 63101, 63103, 63104, 63106, 63108, 63109, 63110, 63111, 63112, 63113, 63115, 63116, 63118, 63139, 63147
  • Nearby hospitals: Barnes-Jewish Hospital; SSM Health Saint Louis University Hospital (not affiliated with Gateway)
  • Nearby communities: Downtown St. Louis, Central West End, North St. Louis, South St. Louis, Clayton and Central County
  • 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 City of St. Louis page.

Common questions

Will my insurance pay for wound follow-up visits in the City of St. Louis 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.

Do I need a referral from my surgeon to start wound follow-up in the City of St. Louis?

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.

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.

Is care in the City of St. Louis arranged differently than in St. Louis County?

The process is the same. The city and county are separate governments, but Gateway arranges care by address and care setting on both sides of the line. What differs is practical: parking, building entry, stairs and whether the patient has a phone that is answered. Sharing those details at the start helps the partner clinician plan a visit in the City of St. Louis.

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.