For centuries, we have known that healthcare worker hand hygiene prevents transmission of pathogens between patients, reduces rates of healthcare-associated infections and saves lives. For decades, we have documented low rates of healthcare worker compliance with recommended hand hygiene practices, accepting them with a degree of resignation that might drive a modern-day Semmelweis to an asylum.

In recent years, however, as the patient safety movement has gained momentum, increasing calls for safer healthcare environments have come from patients, regulatory agencies, the media, politicians and even some healthcare epidemiologists. Since 2004, The Joint Commission has required US hospitals to demonstrate compliance with hand hygiene guidelines published by either the Centers for Disease Control and Prevention or the World Health Organization to be accredited.1 2

In this context, studies such as the one by Saint and colleagues3 seek to demonstrate both that hand hygiene can be improved and how it can be improved (see page 429). This is information we sorely need. Saint’s work might best be seen as a seductive “trailer” …