CONTEXT: In the wake of a growing burden of health care associated infections (HAIs), health-care workers (HCWs) are advised to revert to simple tools like hand hygiene (HH). AIMS: The aim of this study is to explore the existing knowledge, attitudes and practices with regard to HH, the total HH compliance and the various barriers to HH in our hospital so as to plan the strategies for bridging these gaps, thus improving patient care. SETTINGS AND DESIGN: A cross-sectional study was conducted among 300 HCWs of Jubilee Mission Medical College and Research Institute, Thrissur, belonging to six different categories, for a period of 2 months. MATERIALS AND METHODS: Knowledge, attitude and practices were evaluated using a validated WHO HH questionnaire, a self-structured attitude questionnaire and an observation checklist based on the concept of Five Moments of HH by WHO, respectively. Total compliance and the profile of missed opportunities were also assessed. STATISTICAL ANALYSIS USED: SPSS was used for data analysis. RESULTS: The knowledge on HH was good (190 out of 300, 63.3%), attitudes were poor with nursing staff having significantly better attitude than doctors (P < 0.05). In the observational study, physicians and nursing staff had better practice. Lack of time was the major barrier pointed out. The overall compliance was 46% among the HCWs of whom only 16% had proper HH practice. Rest of the 30% performed HH, but the technique was wrong. CONCLUSIONS: The study highlights the need for reinforcing the existing HH training programmes to address the gaps in knowledge, attitude and practice and thereby improving the level of HH compliance and enhancing patient safety.