What to know about surgical site infections

A surgical site infection is an infection that develops where a surgeon cut, in the days and weeks after an operation. Clinicians sort these infections by depth. Some stay in the skin and the fat just under the incision. Others reach the muscle layer and its covering. A third kind sits in the organ or space that was operated on, such as a joint or the abdomen. Depth matters because it shapes the treatment: a shallow infection may be handled by opening part of the incision and giving antibiotics, while a deep one can mean another procedure. Whatever the depth, the surgical team makes the diagnosis and directs treatment. Wound follow-up is what comes next, the regular checking and dressing of the incision while it recovers.

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.

Local context: University City

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

Homes in University City are mostly older: brick houses with front steps and second-floor bedrooms, two-family flats, and apartment and condominium buildings, some with elevators and some without. Senior apartments, assisted living and skilled nursing care are found within the city or a short drive away. Gateway arranges visits with partner clinicians in all of these places. When you call, mention details such as a buzzer entry, a walk-up floor or street-only parking, so the clinician knows what to expect on arrival.

When care happens 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.

In a facility

Assisted living and memory care raise different questions. Staff in these communities often cannot perform complex dressing changes, so the plan has to say who will: a home health nurse, a visiting clinician or, in some cases, family. A resident with dementia may not mention pain, may pull at a dressing, or may not remember instructions about the incision. The treating clinician takes this into account when choosing how the wound is a covered benefit and secured, and caregivers are asked to report behavior changes as well as wound changes. Gateway coordinates among the community’s staff, the home health agency and the family.

Signs to tell the clinician about

Some changes worth reporting come from the treatment, not the wound. Let the prescriber and the treating clinician know about:

  • Watery diarrhea, especially several times a day
  • A new rash, itching or hives
  • Vomiting that keeps you from taking the antibiotic
  • White patches in the mouth or other new irritation
  • Redness, warmth or drainage that returns after the antibiotic course ends

Report these promptly so the prescriber can decide what to do. Do not stop or restart a medicine on your own. Call 911 for swelling of the lips, tongue or throat, trouble breathing, or widespread hives with dizziness, which can signal a severe allergic reaction.

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 University City →

Getting care arranged in University City

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

A few things make a University City request go smoothly. Have the street address and unit number, a phone number that will be answered, the name of the regular doctor and any hospital paperwork. Tell us about stairs, locked entries and where a visitor can park. Gateway also coordinates care nearby in Clayton and Central County, Overland, the Central West End, Ladue and Creve Coeur. Availability is confirmed by location and care setting, so we will ask whether the patient is at home or in a facility.

  • County: St. Louis County, Missouri
  • ZIP codes: 63130
  • Nearby hospitals: Barnes-Jewish Hospital; SSM Health St. Mary's Hospital in Richmond Heights; Mercy Hospital St. Louis in Creve Coeur (not affiliated with Gateway)
  • Nearby communities: Clayton and Central County, Overland, Central West End, Ladue, Creve Coeur
  • 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 University City page.

Common questions

Does Gateway arrange surgical site infection follow-up in nursing and rehabilitation facilities in University City?

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 University City.

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.

Should I keep my surgeon appointments if a wound clinician is already visiting?

Yes. Wound visits add to the surgeon’s care and do not replace it. The surgeon decides about antibiotics, further procedures, closing the wound and when you can return to normal activity. The treating clinician’s notes can make those appointments more productive, because the surgeon sees how the wound has changed since the last check. If getting to the office is the obstacle, tell us when you call.

My father in University City no longer drives. Can primary care come to his house?

It can be arranged. Gateway connects people who cannot easily get to an office with partner clinicians who provide primary care follow-up at home. Call 314-325-0126 with his address and phone number. We will ask a few questions, confirm availability for his part of University City and request records from his current doctors.

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.