ObjectiveTo understand the actual implementation of hand hygiene(HH)  of health care workers(HCWs), and provide evidence for improving HH management. MethodsHH performance appraisal began to implement in a hospital in 2016, at the same time, third party (healthcareassociated infection management professionals in other hospitals) was invited to carry out 4 times of anonymous survey on HH among HCWs in the hospital, change in HH compliance rate among HCWs was compared. ResultsHH compliance of HCWs surveyed by the third party was 60.68%, HH rates in the first half and second half year were 52.72% and 68.62% respectively, difference was statistically significant (P< 0.001). Compliance rate of HH in key departments (intensive care unit and neonatal department, 87.44%) was higher than surgical departments (64.71%) and internal medicine departments (53.74%), difference was statistically significant (both P<0.05). HH compliance rates of HCWs before and after contact with patients and after contact with the surrounding environment of patients were all low (53.59%, 58.07%, 43.97%, respectively). ConclusionHH surveyed by the third party can effectively reduce the Hawthorne effect during the observation process. HH performance appraisal can significantly improve the compliance of HH among HCWs.