The lead paper, "Healthcare-Associated Infections as Patient Safety Indicators," written by Gardam, Lemieux, Reason, van Dijk and Goel, puts forward the design of healthcare facilities as one of many strategies to improve patient safety with respect to healthcare-associated infections. This commentary explores some of the issues in balancing infection prevention and control priorities with other needs and values brought to the design process. This balance is challenged not only by a lack of supporting evidence but also by the superficial nature in which infection prevention and control are often discussed within a design context. For the physical environment to support any patient safety initiative, the design of the processes must be developed in conjunction with that of the physical environment so that compliance can be natural and convenient. Finally, consideration is given to the value of documenting decision-making related to infection prevention and control in facility design and ongoing assessments of existing facilities.