Ventilator-associated pneumonia (VAP) is common, costly and portends a poor prognosis. Given the limited supply of effective antibiotics to treat the antibiotic-resistant pathogens increasingly associated with VAP, increasing emphasis is being placed on VAP prevention. Such VAP-preventive strategies can be broadly classified as either pharmacologic or non-pharmacological. Pharmacologic interventions include attempts to reduce host colonisation, optimisation of comorbid conditions and avoidance of agents which promote infection. Non-pharmacologic efforts include education, prevention of cross-infections, minimising the duration of intubation, reducing colonisation of the endotracheal tube-associated biofilm, minimising aspiration, avoiding patient transport, and use of kinetic beds. In this review we assess the evidence supporting various VAP-preventive strategies within this framework.