The increasing incidence of hospital-acquired (nosocomial) infection is a disturbing phenomenon resulting in significant patient mortality and putting considerable strain on healthcare budgets and personnel. One particularly serious aspect of nosocomial infection is that of ventilator-associated pneumonia (VAP). This arises in patients who receive mechanical ventilation within the intensive care unit. The quoted incidence of VAP varies widely (5-67%) and the reported mortality of patients with VAP is in the range of 24-71%. This review will examine the many factors that account for these wide ranges reported, including the patient population under investigation, the causative organism, the method of diagnosis, interventions employed and preventative strategies. The use of bioactive and drug-impregnated biomaterials for endotracheal tube construction is discussed as novel approaches to the prevention of VAP.