Hand hygiene is a core practice for decreasing health care–associated infections, but achieving compliance has proven difficult. In this study, hand hygiene rates were about threefold higher when an auditor was present compared with hallway dispensers that were not visible by a direct observer. Since many publicly reported hand hygiene rates are based on direct auditor observations, this study suggests these metrics may be greatly inflated and unreliable. A prior WebM&M perspective reviewed recent strategies for promoting and monitoring hand hygiene.