A case study published by Rush-Copley, a 220 bed community hospital in Illinois, found improved "environmental hygiene" improves HCAHPS scores and decreases infection rates. The question is: how can this be accomplished? In this case study new cleaning products and a cleaning system were introduced, and environmental services personnel were given intensive training to become "Hygiene Specialists". They would introduce themselves as such to the patients, and describe to them how their room would be cleaned. After implementation, C. difficile rates decreased by 50%, and HCAHPS cleanliness scores increased from the 69th percentile to the 73rd percentile within a year.