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What happens when some of the brightest minds in epidemiology and infectious disease convene to discuss and debate some of the toughest issues in environmental hygiene and infection prevention? The gathering raises more questions than answers but establishes a firmer footing in the research agenda to help further address current challenges. In May, the Society for Healthcare Epidemiology of America (SHEA) held its spring conference and included "Advancing Healthcare Epidemiology and the Role of the Environment" as one of several tracks exploring imperatives in epidemiology.