can serve as sources, or reservoirs, for the spread of bacteria from the hands of healthcare workers and visitors to patients. A number of compounds can decrease the risk of bacteria growing on surfaces including: copper, silver, and germicides. There have been a number of studies evaluating the use of no-touch cleaning systems particularly the use of ultraviolet C devices. One review was inconclusive due to lack of, or of poor quality evidence. Other reviews have found some evidence, and growing evidence of their effectiveness. Treatment Two of the bacteria species most likely to infect patients are the Gram-positive strains of methicillin-resistant Staphylococcus aureus, and Gram-negative Acinetobacter baumannii. While antibiotic drugs to treat diseases caused by methicillin-resistant Staphylococcus aureus are available, few effective drugs are available for Acinetobacter. Acinetobacter bacteria are evolving and becoming immune to antibiotics, so in many cases, polymyxin-type antibacterials need to be used. "In many respects it's far worse than MRSA," said a specialist at Case Western Reserve University. Another growing disease, especially prevalent in New York City hospitals, is the drug-resistant, Gram-negative Klebsiella pneumoniae. An estimated more than 20% of the Klebsiella infections in Brooklyn hospitals "are now resistant to virtually all modern antibiotics, and those supergerms are now spreading worldwide." The bacteria, classified as Gram-negative because of their color on the Gram stain, can cause severe pneumonia and infections of the urinary tract, bloodstream, and other parts of the body. Their cell structures make them more difficult to attack with antibiotics than Gram-positive organisms like methicillin-resistant Staphylococcus aureus. In some cases, antibiotic resistance is spreading to Gram-negative bacteria that can infect people outside the hospital. "For gram-positives we need better drugs; for gram-negatives we need any drugs," said Dr. Brad Spellberg, an infectious-disease specialist at Harbor–UCLA Medical Center, and the author of Rising Plague'', a book about drug-resistant pathogens. Hospital-acquired pneumonia (HAP) is the second most common nosocomial infection and accounts for approximately one-fourth of all infections in the intensive care unit (ICU). HAP, or nosocomial pneumonia, is a lower respiratory infection that was not incubating at the time of hospital admission and that presents clinically two or more days after hospitalization. Ventilator-associated pneumonia (VAP) is defined as HAP in patients receiving mechanical ventilation. The incidence of VAP is 10–30% among patients who require mechanical ventilation for >48 h. A standard treatment protocol is based on accurate diagnosis definitions, microbiological confirmation of VAP, and