{
  "abstract": "Russia’s full-scale invasion of Ukraine has transformed both the modern battlefield and the microbial environment surrounding the war-wounded. Explosive injuries, prolonged evacuation, and limited opportunities for early decontamination have contributed to an unprecedented rise in multidrug-resistant organism (MDRO) infections. This paper describes how routine infection prevention and control (IPC) and antimicrobial stewardship (AMS) systems have become inadequate under conflict conditions and how contamination evolves into colonization and then systemic infection as casualties move through the evacuation pathway.Building on the national IPC and AMS strengthening, we outline a complementary crisis intervention: the application of chemical, biological, radiological, and nuclear-inspired decontamination principles to routine trauma care. These measures incorporate structured early irrigation and debridement, antiseptic cleansing, removal of contaminated materials, and the use of dedicated decontamination spaces at hospital entry. They are designed to reinforce existing programs by reducing microbial burden at the earliest point of contact. Implementing this approach aims to disrupt MDRO acquisition and transmission, protect fragile healthcare infrastructure, and mitigate escalating biosecurity risks. Ukraine’s conflict experience has informed the development of this proposed concept, with formal implementation and impact evaluation planned as the next phase of work.LEVEL OF EVIDENCE: Level V (Current Opinion)",
  "authors": [
    {
      "affiliations": [
        "Antimicrobial Resistance and Infection Control, SI Center for Public Health of the Ministry of Health of Ukraine, Kyiv, Ukraine",
        "Pharmacy and Pharmacology, Griffith University - Gold Coast Campus, Southport, Queensland, Australia"
      ],
      "name": "Hailie Uren"
    },
    {
      "affiliations": [
        "University of Florida, Gainesville, Florida, USA",
        "Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA"
      ],
      "name": "B. Hudson Berrey"
    },
    {
      "affiliations": [
        "Central Research Scientific Institute of the Armed Forces of Ukraine, Kyiv, Kyiv City, Ukraine"
      ],
      "name": "Kostiantyn Gumeniuk"
    },
    {
      "affiliations": [
        "Orthopaedics and Traumatology, Shupyk National Healthcare University of Ukraine, Kyiv, Kyiv City, Ukraine"
      ],
      "name": "Volodymyr Kovalchuk"
    },
    {
      "affiliations": [
        "Institute of Molecular Biology and Genetics of the National Academy of Sciences of Ukraine, Kyiv, Kyiv City, Ukraine"
      ],
      "name": "Olena Moshynets"
    },
    {
      "affiliations": [
        "Defense Committees on Trauma, Joint Trauma System, JBSA Fort Sam Houston, Texas, USA",
        "Department of Surgery, San Antonio Military Health System, San Antonio, Texas, USA"
      ],
      "name": "Jennifer M. Gurney"
    },
    {
      "affiliations": [
        "Medical College of Wisconsin Department of Radiology, Milwaukee, Wisconsin, USA",
        "Radiology, Froedtert Hospital, Milwaukee, Wisconsin, USA"
      ],
      "name": "Douglas Davis"
    },
    {
      "affiliations": [
        "Normal Anatomy, Danylo Halytsky Lviv National Medical University, Lviv, Lviv Oblast, Ukraine",
        "Ukrainian-Polish Heart Center Lviv, Lviv, Ukraine"
      ],
      "name": "Uliana Pidvalna"
    },
    {
      "affiliations": [
        "Western Military Medical Clinical Center, Lviv Regional Military Administration, Lviv, Lviv Oblast, Ukraine",
        "Cardiovascular Surgery, Ukrainian-Polish Heart Center Lviv, Lviv, Lviv, Ukraine"
      ],
      "name": "Dmytro Beshley"
    },
    {
      "affiliations": [
        "Plastic Reconstructive Surgery, Ross Hall Hospital, Glasgow, Scotland, UK"
      ],
      "name": "Yvette Godwin"
    },
    {
      "affiliations": [
        "Department of Surgery and Cancer, Imperial College London, London, England, UK"
      ],
      "name": "Shehan Hettiaratchy"
    },
    {
      "affiliations": [
        "Infectious Disease Service, Walter Reed National Military Medical Center, Bethesda, Maryland, USA",
        "Center for Infectious Disease Research, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA"
      ],
      "name": "Roseanne A Ressner"
    },
    {
      "affiliations": [
        "Orthopaedics and Traumatology, Shupyk National Healthcare University of Ukraine, Kyiv, Kyiv City, Ukraine"
      ],
      "name": "Mykola L Ankin"
    },
    {
      "affiliations": [
        "Plastic Surgery, Oxford Medical Group, Kyiv, Kyiv, Ukraine"
      ],
      "name": "Solomiia Voitsekhovska"
    },
    {
      "affiliations": [
        "Joint Trauma System, Committee on Tactical Combat Casualty Care, Fort Sam Houston, Texas, USA"
      ],
      "name": "Frank Butler"
    },
    {
      "affiliations": [
        "Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA",
        "Surgery, University of Alabama at Birmingham Health System, Birmingham, Alabama, USA"
      ],
      "name": "John B Holcomb"
    }
  ],
  "title": "War against superbugs, stopping them before they stop us: a biological warfare approach to safeguard European biosecurity",
  "uid": "62975ae5-7be0-52f2-8737-32837d8e1771"
}