The primary risk factor indicated by most epidemiological studies is the endotracheal tube. The endotracheal tube increase the risk for ventilator-associated pneumonia because it provides bacteria a direct, open passageway to the patients lungs and preventing natural reflexes of the person’s physiological systems (Mietto MD et.al, 2013). The ETT can prevent a patient’s natural defense mechanisms: such as coughing, the filtration of the upper airway, prevention of upper airway humidification, cause gastrointestinal reflux, and inhibiting airway reflexes. The ETT also acts as a potential reservoir for pathogens to form a toxic biofilm. Some non-modifiable risk factors associated with patients include those that are age 65 or older or patients
