Hand hygiene is an important practice that prevents transmission of infections. This cross-sectional study directly observed and surveyed more than 160 physicians at a large university hospital to describe current practices and beliefs. Investigators discovered that adherence to hand hygiene averaged only 57% with wide variations across medical specialties. Whereas being a role model, having a positive attitude towards hand hygiene, and easy access to hand-rub solutions was associated with adherence, high workload and activities associated with high risk for transmission were risk factors for poor adherence. The authors discuss the challenges with promoting effective hand hygiene practices and suggest targeting high risk settings and reinforcing individual’s abilities to role model behaviors. The U.S Centers for Disease Control and Prevention provides guidelines, fact sheets, a press kit, and other tools to implement best practices.