Background: Hand hygiene is a vital aspect of infection control and as such requires monitoring. Assessing compliance with hand hygiene and providing healthcare workers with feedback on their performance is important in any hospital hand hygiene improvement program. Aim: to investigate the degree of conformance with hand hygiene by healthcare personnel in a private tertiary hospital. Methods: a structured observational study to monitor conformance with hand hygiene during provision of patient care in a private health care facility in south west Nigeria, before and after institution of a hand-hygiene improvement campaign. Results: A total of 311 healthcare workers were observed from June 2015 to June 2016 with 1476 opportunities for hand hygiene. Improvements in hand hygiene occurred with a 33 % increase in compliance after contact with body fluids, 18% after the removal of gloves, 39% after touching the patient, 27% before performing an invasive procedure and 30% before touching the patient. Preoperative Nurses were 7.48 times more likely than the general population to wash their hands before patient contact [CI=3.1-18.73, X2=25.38], Critical care Units Staff were 0.34 times more likely to comply after contact with body fluids [CI=0.16-0.75, X2=6.15]. Conclusion: Measuring hand hygiene compliance is a veritable tool in hand hygiene compliance. Sustained educational programs and reminders serve to improve hand hygiene.