Healthcare associated infections are the most common complication of a person's hospital stay. Contemporary infection prevention and control programs are universally endorsed to prevent healthcare associated infections. However, western biomedical science on which contemporary infection prevention and control is based, is not the only way that staff and patients within healthcare settings understand disease causation and/or disease transmission. This results paper reports on one aspect of a study which ascertains perceptions of disease transmission and how these influence infection prevention and control practice at Atoifi Adventist Hospital Solomon Islands. Photovoice was used as the primary data collection method with staff and patients. The germ theory and hospital hygiene processes were only one of many explanations of disease transmission at the hospital. Many social, cultural and spiritual influences played an important role in how people understood disease to be transmitted. Although infection prevention and control models based on western science continue to form the premise of reducing healthcare associated infections in Solomon Islands and locations across the globe, local social, cultural and spiritual beliefs need to be considered when planning and implementing infection prevention and control programs to ensure success.