Aim. Ventilator-associated pneumonia (VAP) is a serious concern for patients in the Neuroscience Intensive Care Unit (NSICU). The risks to patients are significant and the monetary costs are astronomical. We review a multimodality approach that substantially reduced VAP rate in our ICU Methods. Data from all patients admitted to the NSICU between January 2005 and April 2010 were reviewed. All ventilated patients were treated according to a multimodality VAP assessment and prevention protocol, implementation of which began in August of 2008 and was completed by March 2009. Rates of VAP before, during, and after implementation of the protocol are compared. VAP rates are also compared to national rates as obtained from the National Healthcare Safety Network (NHSN). Results. In the pre-implementation period, the VAP rate was 11.6 per 1000 ventilator days. This rate was twice the national average. In the post implementation period, the VAP rate was 5.5/1000 ventilator days. VAP rate dropped precipitously after full compliance with the protocol was achieved. Conclusion. Although intubated patients in the NSICU are at high risk for VAP, a significant reduction in VAP-related morbidity and monetary costs can be obtained with multimodality prevention and testing protocols.