Prevention of nosocomial infections constitutes a strategy to improve patient safety and quality of care in intensive care unit (ICU). Infection prevention measures, specifically targeting ventilator-associated pneumonia (VAP), have been purposed as quality of care indicators for ICU patients. We discuss some of the recent evidence on the prevention of nosocomial infections with a particular emphasis on VAP. Moreover, there are several pitfalls in considering VAP rate as a quality indicator that include difficulties with sensitivity, specificity of VAP diagnosis, variability in surveillance methods, differences in patient case-mix between hospitals, and the risk of underreporting or manipulating VAP rates. Because of these limitations, we recommend the use of specific process measures to reduce VAP as for interinstitutional benchmarking.