Despite the primacy of the infection control program in many hospitals as the oldest and most established formalised quality and safety initiative, research into the critical and structural elements to optimally influence outcomes has been surprisingly sparse. Early studies focussed on the qualities of the individual infection control practitioner. The perception of skill, experience and thus expert knowledge by others is essential to influencing compliance. Attitudes and behaviours in practitioners that influence target groups frequently act through social opinion leaders and initiatives specifically directed to these individuals have been delineated. More recently, organisational context has been recognised as pivotal to an effective program. Governance structure, the overt and demonstrable support of senior administrative staff and the ability to drive executive decision making are now seen as essential components to an effective program. These findings do however, beg the question as to how successful programs are identified. Even with the development of numerous indicators allegedly reflecting acceptable levels of healthcare associated infection, this question is yet to be adequately answered.