Early studies suggested that surface contamination had little impact on transmission of healthcare-associated infections, but recent research shows that important pathogens can contaminate hospital surfaces at levels sufficient for transmission, survive for long periods, and be transferred to healthcare workers. Evidence is growing that contaminated surfaces contribute to the epidemic and endemic spread of pathogens and improving environmental decontamination can help control outbreaks. Efforts to enhance environmental hygiene should focus on improving cleaning and disinfection methods and reducing pathogen shedding.