Over half of the nearly 2 million healthcare-associated infections can be attributed to indwelling medical devices. In this review we highlight the difficulty in diagnosing implantable device related infection and how this leads to a likely underestimate of the prevalence. We then provide a length-scale conceptualization of device related infection pathogenesis. Within this conceptualization we focus specifically on biofilm formation and the role of host immune and coagulation systems. Using this framework, we describe how current and developing preventative strategies target specific processes along the entire length-scale. In light of the significant time horizon for the development and translation of new preventative technologies, we also emphasize the need for parallel development of in situ treatment strategies. Specific examples of both preventative and treatment strategies and how they align with the length-scale conceptualization are described.