AbstractBackground: Ventilator associated pneumonia (VAP) is a type of lung infection that occurs in people who are on mechanical ventilation breathing machines in hospitals. As such, VAP typically affects critically ill persons that are in an intensive care unit (ICU). VAP is a major source of increased illness and death. Persons with VAP have increased lengths of ICU hospitalization and have up to a 20–30% death rate. The main aim of the study was to attain 0% of VAP rate in ICUs. The purpose of the study was to analyzing the standard practices in nursing care and to identify the faults in VAP bundle care checklist. Methods: We conducted a retrospective case note review of 29 electronic patient records out of a whole population size of 48 from 4 ICUS (NMICU, NSICU, CICU, COVID ICU). The sample was taken randomly from 4 main ICUS. This was done to ensure that patients had equal chance of selection and to reduce researcher bias. The information was extracted from the electronic patient notes on EMR system. The VAP bundle care checklist was audited by using VAP bundle checklist audit form. The audit form includes 5 parameters (Semi recumbent patient positioning, Ventilator weaning, PUD prophylaxis, DVT prophylaxis, Suction of secretions. Results: Most percentage distribution 10 (100%) belongs to the category of head elevation and suction, there was an equal distribution among sedation and DVT prophylaxis which was 9 (90%), the least percentage distribution7 (70%) belongs to the peptic ulcer in January month. Whereas February month, the largest category observed were in the category of head elevation, suction, peptic ulcer prophylaxis which consist 10(100%), 7(70%) were in sedation category. Followed by DVT prophylaxis 6(60%). In accordance with percentage distribution in March month, majority of compliance belongs to the category of head elevation 8(88.8%), 7(77.7%) of compliance were in the DVT prophylaxis category. 6(66.6%) in the category of sedation and 5(55.5%) were equally distributed to the category such as suction and peptic ulcer prophylaxis. The study results that overall percentage distribution of VAP bundle care parameters, 96.5% was noted in head elevation parameter and 86.2% in suction parameter. There was an equal distribution 75.8% in the category of sedation, DVT prophylaxis and peptic ulcer prophylaxis. Conclusions: Findings of this study are useful for the health care workers to improve the standard practices in nursing care and to reduce or prevent the nosocomial infections especially VAP in ICU patients. The study results are helpful to the infection control department with the support from higher administration of the organization to obtain the 0% in ventilator associated pneumonia rate in monthly indicator and to enhance the quality of care in the hospital by implementing the recommendations and action plan of this audit.