After the years of media scrutiny, policy statements, regulations, inspections and public outcry - not to mention the avoidable deaths and illnesses - it is hard to comprehend why many acute trust boards are failing to make hygiene standards a priority.
The revelation by the Healthcare Commission that some boards are not even analysing data properly shows many are complacent and ineffective on this issue.
When prime minister Gordon Brown promised nurses enhanced powers to report hygiene problems to boards, he presumably took it for granted that boards would act. The commission's spot checks now call this into doubt.
It is a question of leadership. Boards should be setting the pace for the entire organisation, driving standards of behaviour which minimise the risks to patients.
If they fail to take the issue of hospital-acquired infection seriously, the rest of the trust is in serious danger of following suit.