METHODS: As part of a performance improvement project, we collected VAP data per 1000 ventilator days for the year 2009 and 2010. For the year 2011-2014 this was collected every quarter. Ventilator associated pneumonia was determined as the rate per 1000 ventilator days. In addition to the usual care that included head of bed elevation, hand hygiene, maintenance of closed respiratory circuit with inline suctioning, patient mobility, protocol based liberation and sedation, we introduced endotracheal tubes with a subglottic suctioning device (Mallinckrodt Taper Guard Evac Oral Endotracheal Tube) and Q4 chlorhexidine gluconate/biotene oral care kits in the 1st quarter of 2012. This included all endotracheal tubes that were placed in the institution except for outside hospital transfer and field intubation performed by EMS. The oral care was provided by the RN q4 hourly with medline CHG kits in all intubated patients upon admission to the ICU untill the day of liberation. The compliance of these two steps was monitored during daily interdisciplinary rounds. VAP was diagnosed by CDC/NHSN guidelines. This is prior to the change in VAE surveillance algorithm guidelines introduced in January 2015 by CDC/NHSN.