BACKGROUND: Appropriately implemented, hand hygiene can prevent nosocomial infections, but there is a lack of research on the effect of specific nurse-patient ratios on hand hygiene compliance rates. Furthermore, there have been few studies of infection control practices in Jordanian hospitals. METHODS: One hundred registered nurses from a private health care setting in Jordan who worked in intensive care units and medical-surgical wards participated. Two methods, videotaping and self-report, were used to collect data on hand hygiene. Subjects also completed a questionnaire to assess hand hygiene behavior, attitudes, and beliefs. RESULTS: The overall hand hygiene compliance rate was 32%. Nurse-patient ratios affected hand hygiene before beginning patient care only. The lowest hand hygiene compliance rates were in intensive care units when the nurse-patient ratio was less than 1:2. Females had higher compliance rates than males. CONCLUSIONS: The observed low level of overall hand hygiene compliance, lower compliance rates in higher acuity settings, and gender-related differences in compliance are consistent with findings from previous studies of hand hygiene over the past 2 decades. © 2009 Lippincott Williams & Wilkins, Inc.