Hand hygiene rates remain disappointingly low among physicians and nurses, despite appropriate handwashing being an essential factor in preventing health care–associated infections (HAIs). This report, which used data for all hospitals in Ontario, demonstrates that overall hand hygiene rates (measured by direct observation) consistently increased in response to an extensive educational campaign. However, the rates of two key HAIs—Clostridium difficile diarrhea and methicillin-resistant Staphylococcus aureus infections—did not decrease as a result. At baseline, rates of the two HAIs were quite low, and hand hygiene rates were relatively high, meaning that additional improvement in HAI rates may have been difficult to achieve. In contrast, another study from a United States institution found that the rates of multiple HAIs consistently decreased over time as hand hygiene rates increased.