Ventilator acquired pneumonia (VAP) is a hospital associated pneumonia that occurs in a patient who is being ventilated at the time of, or within 48 hours of, the onset of pneumonia . it is the 2nd most common nosocomial infection in the United States, accounting for 25% of infections in the ICU. The Mortality rates of VAP exceed the rate of death caused by infections associated with central line catheters, respiratory infections in non-ventilated patients, and even severe sepsis. Providence Medford Medical Center ICU has experienced two recent cases of confirmed Ventilator-acquired Pneumonia (VAP) between the months of May and July. These incidents occurred after an extended period of time with no cases of VAP. The purpose of this project was to Identify areas for quality improvement in the care of ventilated patients and to describe effective strategies for reducing the incidence of VAP.Review of core measures showed that the two areas with the greatest room for improvement were: consistently keeping the head of bed elevated to between 30-45 degrees to decrease the risk of micro-aspiration, and providing patients with regular oral care to prevent colonization by harmful pathogens. Recommendations were then made to Promote on-going staff education and monthly updates on VAP prevention efforts.