The implementation of a bundle to reduce ventilator-associated pneumonia (VAP) in a PICU did not significantly reduce the VAP rate after one year. VAP occurence in the pre-bundle group was 35 % compared to 31 % in the post-bundle group (p=0.651). VAP incidence rate was 18/1,000 ventilator days pre-bundle and decreased to 12/1,000 ventilator days post-bundle (p= 0.127). The study highlights that there is a need of large prospective multi-center studies with longer intervention duration in the future.