**4. Therapeutic issues**

#### **4.1. Prevention of respiratory contamination**

A particular issue of ventilator associated pneumonia (VAPs) is the risk of infection with multidrug-resistant strains and carbapenem-resistant bacilli too. Not surprisingly, severely injured patients—VAPs and burn patients—are most prone to infection with carbapenemresistant species. The chief question for carbapenem-resistant Gram-negative bacillary pneumonia is how to efficiently prevent them. First of all, could these infections be stopped? In the hospital environment, hand hygiene and alcohol-based disinfection remain, undeniably, the sanitation gold standard. Rigorous monitoring of patients at admission and an accurate history are early stages in identification of patients with documented multidrug-resistant strains for further isolation or, at least clustering separately to prevent the risk of cross-contamination [25, 26]. Respiratory contamination depends on so many circumstances, almost impossible to eliminate, that the specific strategies are designed in order to reduce VAP, rather than to eliminate such infections [27]. What else could be taken in consideration apart from already established strategies? As it was underlined in introduction, from the ancient times, people are aware of the so-called air purification performed intuitively by burning scented substances or widespread use of all sorts of perfumes, plant extracts, or spices.
