What to know about 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.

How the care plan is built

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 Washington

Distance changes how you plan for a surgical site infection in Washington. Ask the surgical team in advance what they want reported by phone, which symptoms mean going to the nearest emergency department, and which hospital they prefer if you need to be seen. Keep the surgeon’s after-hours number with the dressing supplies. Gateway confirms whether a partner clinician is available for visits at your address before anything is scheduled, groups supply orders so fewer deliveries are needed, and passes each wound update to the surgeon’s office.

In Washington you will find older houses near the riverfront downtown, newer subdivisions on the edges of the city, apartments, and farmhouses and homes on acreage in the countryside beyond. Senior apartments, assisted living and skilled nursing facilities serve the city and the smaller towns around it. Gateway arranges visits with partner clinicians in these settings. Because Washington is farther out than most communities we coordinate, we confirm availability by address before anything is scheduled. Clear directions matter on rural routes, so we ask for them.

When care happens 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.

In a facility

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.

Changes to report

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.

Why primary care matters here

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 Washington →

Getting care arranged in Washington

For a resident of a nursing home, assisted living or memory care community in Washington, a request for wound follow-up after a surgical site infection can come from the family, the resident or the facility’s nurses. Call 314-325-0126 and give us the facility name, the unit or room and the best nurse contact. Gateway speaks with the facility about its process for outside clinicians, confirms availability and coordinates a visit time that fits the resident’s day. After the visit, the treating clinician’s orders are given to facility nursing, and the family contact on file gets an update if the resident has agreed to that.

Calling about someone in Washington? Have the full address ready, including a county road or highway number if the home is outside the city, plus landmarks that help a visitor find the driveway. We will also ask for a callback number, the doctor’s name and any recent hospital paperwork. Gateway coordinates care elsewhere in Franklin County and in Eureka and Wildwood to the east. Because of the distances involved, knowing the exact address early helps us confirm what can be arranged.

  • County: Franklin County, Missouri
  • ZIP codes: 63090
  • Nearby hospitals: Mercy Hospital Washington (not affiliated with Gateway)
  • Nearby communities: Franklin County, Eureka, Wildwood
  • Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

Related care in Washington

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

Common questions

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

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 Washington.

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.

How long will an infected surgical wound take to close?

No one can give an exact date. It depends on how deep and wide the opened area is, whether the infection is fully controlled, where on the body it sits, and your general health. A better question for the treating clinician is whether the wound is moving in the right direction: smaller measurements, less drainage and healthy tissue at the base from one visit to the next.

My mother was sent from Washington to a St. Louis hospital. Can follow-up happen back home?

That is a common situation. When she is discharged back to Washington, you or the hospital’s case manager can contact Gateway. We request the records from the hospital, coordinate orders with the treating clinician and arrange follow-up at her home or facility, subject to availability for her address. Routine checks then may not require another long drive.

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.