Ventilator associated pneumonia (VAP) is a serious and costly clinical problem. Specifically, receiving mechanical ventilation for over 24 hours increases the risk of VAP and is associated with high morbidity, mortality and medical costs. Cost effective endotracheal tubes (ETTs) that are resistant to bacterial infection could help prevent this problem. The objective of this study was to determine differences in the growth of Staphylococcus aureus (S. aureus) on nanomodified and unmodified polyvinyl chloride (PVC) ETTs under dynamic airway conditions. PVC ETTs were modified to have nanometer surface features by soaking them in Rhizopus arrhisus, a fungal lipase. Twenty-four hour experiments (supported by computational models) showed that air flow conditions within the ETT influenced both the location and concentration of bacterial growth on the ETTs especially within areas of tube curvature. More importantly, experiments revealed a 1.5 log reduction in the total number of S. aureus on the novel nanomodified ETTs compared to the conventional ETTs after 24 hours of air flow. This dynamic study showed that lipase etching can create nano-rough surface features on PVC ETTs that suppress S. aureus growth and, thus, may provide clinicians with an effective and inexpensive tool to combat VAP.