Introduction: Hand Hygiene (HH) is the most cost effective measure to decrease health care associated infections (HAIs). Yet, staff adherence worldwide is around 40-60%. An-Najah National University Hospital (NNUH) is a tertiary care referral teaching hospital in the North of Palestine monitoring HH compliance by direct observation. This descriptive study aims at reporting the prevalence of HH across the institution during 2017-2018.Methodology: WHO HH Self-Assessment Framework was used for situation analysis and diagnostic tool for key issues requiring attention. A HH policy and intensive training to all staff were implemented. To monitor the improvements, the WHO toolkit for direct observation of HH compliance was used by IPCP team and anonymously by other trained observers. Compliance was assessed and reported on monthly basis. PDSA, root cause analysis and groups discussions were used as improvement tools. Training was reinforced by the use of ultraviolet light and fluorescent alcohol hand rub. Yearly, staff was engaged in HH day activities. Leadership support was constant by securing annual budget for the HH program and the enforcement of HH policy. Results: NNUH turns to be at an intermediate level of progress regarding the implementation of HH improvement strategies in 2017 and at advanced level in 2018. Formal HH team and patient and community engagement are still lacking as part of safety climate change. The overall compliance was 44%, (Range 31%-57%) for 2017 and 53% (Range 30%-72%) for 2018. The fluctuation of data across the months may be explained by factors such as: high turnover of staff, specially nursing and residents and the shortage of alcohol hand rub for a period of time. Personnel engagement is key factor for HH improvement. Conclusion: More efforts across the institution to increase the empowerment and commitment of the staff regarding HH concept are needed in order to.