Patients with acute respiratory failure are predisposed to acquire nosocomial infection primarily because they may need ventilatory support, usually invasive mechanical ventilation. The presence of an endotracheal tube impairs natural defences of the respiratory tract and favours airways colonisation and lung infection. Cross transmission of microorganisms may also occur via contaminated hands of healthcare workers that manipulate invasive devices. Thus, avoiding the endotracheal tube and increasing hand hygiene compliance are major measures to prevent ventilator-associated pneumonia. The use of noninvasive ventilation has been shown to reduce the incidence of nosocomial infections and should be used whenever possible. Using hand rubbing with waterless alcohol-based products evidenced higher efficacy to reduce hand contamination as compared to conventional hand washing with soap. Due to its rapid activity and ease of access, hand rubbing constitutes a promising avenue for improving hand hygiene compliance and thus reducing cross infection.