This multicenter registry style study compared hand hygiene (HH) compliance rates from direct observation to those reported using an electronic HH system capable of reporting at the group and individual level. Prior to system install, compliance rates at each site averaged between 87-92% using direct observation. Actual baseline compliance recorded by the automated system was 57% thus highlighting the inaccuracies of direct observation. Group monitoring followed by individual monitoring demonstrated greater improvement in HH compliance at all three sites than group monitoring alone and best targeted the lowest compliant caregivers, improving rates of this subgroup over 180%. An analysis by caregiver functional role (eg all nurses) demonstrates that individual reporting resulted in the greatest improvement in compliance and better equalized room entry and exit adherence. Overall, compliance has been sustained above 80% since month 3 of individual reporting.