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Hand hygiene compliance was found to be low among Pakistani medical students.Hand hygiene awareness, attitudes, and peer pressure predict compliance.Public university students expressed superior hand hygiene awareness.Women expressed superior hand hygiene attitudes.Need for “role models” was rated as the most important intervention.Medical students in their clinical years play an important role in healthcare delivery, yet poor levels of hand hygiene (HH) compliance in this population raise the risk for propagating nosocomial infections. To date, there has been a lack of dedicated interventions showing sustainable improvements in HH in this population.A multicenter, cross-sectional study was conducted among 450 medical students in their clinical years (third to fifth years). A self-administered, pre-validated questionnaire based on the World Health Organization's “Knowledge” and “Perception” questionnaires was used to explore HH knowledge, attitudes, practices, and desired interventions.Self-reported HH compliance was found to be low (56.8%), and moderate HH knowledge (61.8%) was observed among all study respondents. Public university students expressed greater knowledge than students in private and semi-private universities. Superior HH practices were associated with better individual HH attitudes, positive perceived HH attitudes in other healthcare workers (HCWs), and higher HH knowledge scores. The highest-rated interventions for improving HH compliance included role-modeling by HCWs, display of “clear HH instructions,” and “ensuring availability of hand sanitizers.”Our results call for a multifaceted approach to improve HH compliance among medical students, by ensuring adequate HH supplies/hand sanitizers, providing HH training in curricula, and effecting a cultural change mediated by professional modeling and open communication.