The article summarizes research findings on the mechanisms of contamination of blast injuries and firearm wounds in a surgical hospital setting and the development of postoperative purulent-inflammatory surgical site infections within the framework of scientific discussion. The aim of the study is to examine the conditions and specific mechanisms of infection in combat-related injuries and wounds during the treatment of casualties in a surgical inpatient facility. The research methodology was based on the analysis of scientific articles published between 2010 and 2025 and indexed in Ukrainian and international databases. Results. Systematization of literature data on infection of combat-related injuries and wounds during medical care, including surgical treatment in a hospital setting, shows that the mechanisms of contamination and the development of purulent-inflammatory surgical site infections (SSI) depend primarily on adherence to preventive measures and infection control. However, the implementation of these measures under conditions of active military conflict is complicated for multiple reasons. The prolonged military conflict has created extreme pressure on the medical infrastructure of both civilian and military healthcare services in Ukraine, owing to the increasing number of casualties and insufficient staffing and medical equipment in conflict zones. To ensure timely medical care for the wounded, effective evacuation routes from the battlefield were organized. At all stages of evacuation and medical care, there is a risk of additional wound contamination, which significantly complicates healing and increases the likelihood of infectious comorbid conditions. Damage to the anatomical integrity of tissues and organs due to blast or firearm injuries is accompanied by local and systemic reactions of the body and is characterized by a high level of microbial contamination, which predisposes to the development of purulent-inflammatory infection. It has been established that hospital-acquired strains of microorganisms resistant to multiple antimicrobial agents pose a particular threat to patient safety in a surgical inpatient setting. The study demonstrates that wound contamination and SSI development have specific characteristics. In hospital settings, purulent-inflammatory infection at the surgical site occurs when a source (reservoir) of pathogens, a mechanism of transmission, and a susceptible host are present. The entry point for microorganisms is the surgical wound created during treatment. Pathogens may enter the wound from endogenous sources (the patient’s own microbiota: nasopharynx, esophagus, stomach, biliary tract, skin, intestines, urinary tract, or pre-existing purulent foci) or from exogenous sources (primarily hospital-acquired strains). External sources of infection may include medical personnel, patients or caregivers who are carriers of SSI pathogens (especially MRSA), air, hospital environmental surfaces, contaminated medical instruments, dressings, equipment, and device surfaces. Conclusion. Infection of surgical wounds in victims of blast injuries and gunshot wounds in a hospital setting and the development of purulent-inflammatory SSI have their own characteristics, namely: 1) SSI occurs in the presence of a source (reservoir) of the infectious agent, the mechanism of its transmission, as well as a favorable organism; 2) the entrance gate for the penetration of microorganisms is a surgical wound created during the treatment of the patient; 3) infectious agents can enter the surgical wound from an endogenous source (the patient’s own microflora: nasopharynx, esophagus, stomach, biliary tract, skin, intestine, urinary system, existing foci of purulent inflammation) or from an exogenous source (mainly hospital strains of microorganisms); 4) external sources of infection can be medical personnel, patients and persons admitted to care for patients — bacterial carriers of SSI pathogens (especially MRSA); air; elements of the hospital environment; contaminated medical instruments, dressings, equipment and surfaces. Thus, knowledge of the mechanisms of wound infection and the development of SSI is extremely important for the implementation of effective prevention and infection control measures, which will help minimize the risks of infectious complications of surgical treatment of patients injured by blast injuries and gunshot wounds.

Organization: SI «Institute of Traumatology and Orthopedics of NAMS of Ukraine», Kyiv, Ukraine

Features of Postoperative Infections in Combat-Related Injuries and Wounds