The individual, household and economic impact of Hospital Acquired Infections (HAIs) globally cannot be overstated; therefore, how healthcare workers perform and comply to hand hygiene practices is essential for mitigating its effects. The aim of this study was to understand the hand hygiene practices at Ruiru Sub-County Hospital, a level 4 facility in Kiambu County, Kenya. A cross-sectional descriptive study was done using a modified WHO hand hygiene questionnaire to assess knowledge, structural and individual factors that affect hygiene practices, and recommend potential interventions to improve hand hygiene; and a structured, unobtrusive observation of hand hygiene performance and compliance. Overall compliance rate with hand hygiene practices was found to be 54.1% among health care workers at the facility. The survey revealed acceptable training and knowledge standards among the healthcare workers but a disproportionate behavior gap. The significance of the study is to contribute to the revention and elimination of hospital acquired infections, which are increasingly becoming among the top global burden of disease. The effects of HAIs goes beyond the infected patient, but also affects the family and the economy,because of loss of productive lives through disability and death.