Ventilator-associated pneumonia (VAP) is associated with increased morbidity and mortality in PICU patients. The objectives of the study to examine the impact of adherence to VAP bundle on the incidence of VAP in our pediatric intensive care. A case control study was conducted in Abo EL reish EL moneira Hospital to all patients admitted and ventilated in the PICU through a year. The VAP rate decreased with compliance to ventilator bundle from 50 % to 14 %( P= 0.002). Initiation of VAP bundle is associated with a significant reduced incidence of VAP. VAP bundle is effective in VAP reduction when compliance is maintained.