Programs to prevent health care–associated infections (HAIs) have been some of the most prominent successes of the patient safety movement. These programs—including the Keystone ICU program and a recent effort to prevent catheter-associated urinary tract infections—have emphasized improving safety culture along with specific technical interventions. Analyzing data from two AHRQ-funded programs to prevent HAIs, this study sought to examine the relationship between Hospital Survey on Patient Safety Culture scores and HAI rates. Interestingly, no association was found between safety culture scores and HAI rates at the hospital unit level, even though HAI rates consistently improved during the study period. The authors note two possible interpretations of these results: first, safety culture may not be a crucial component of programs to reduce HAIs; second, survey results may not be an accurate measure of safety culture (especially in this study, where survey response rates were low). Other studies have indicated a stronger relationship between safety culture and rates of other types of adverse events. Therefore, despite this study's results, establishing a safety culture remains important.