Objective To explore the application of hand hygiene (HH) smart cloud system based on Internet of things (IoT) technology in the monitoring of HH in neonatal department. Methods Staff in the neonatal department of a hospital were selected as the research objects. Data about HH compliance rate from May 2021 to June 2022 were collected using the HH smart cloud system and compared with data recorded using the "direct observation method" during the same period. The impact of the application of HH smart cloud system on staff's HH compliance and data authenticity were analyzed. Results After using the HH smart cloud system, HH compliance rate of medical staff was 89.76%, which was lower than 92.73% recorded using the direct observation method during the same period, with statistically significant difference (P < 0.001). When comparing the HH compliance rates obtained by the two monitoring methods for staff at different job positions, nurse's HH compliance rate monitored by the smart cloud system was lower than that observed directly, with statistically significant difference (P < 0.001). HH compliance rates monitored by the smart cloud system were lower than those observed directly before and after contact with patients, before clean aseptic procedures, differences were statistically significant (all P < 0.05). HH compliance rates monitored by HH smart cloud system during different working hours showed statistically significant differences (P < 0.01). Daily consumption of hand disinfectants monitored by HH smart cloud system was 39.16 mL per bed. Conclusion Using the HH smart cloud system to monitor the HH of medical staff can obtain real and effective data.