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Hand hygiene is considered a critical factor in the prevention of health care-associated infections, and there have been many studies on ways to measure hand hygiene compliance.Our objective was to evaluate the utility of estimating hand hygiene compliance using automated count technology versus direct human observation before and after a feedback intervention. We used a before and after quasi-experimental study over 30 weeks, in the setting of one 12-bed neurocare intensive care unit (NCICU) and one 15-bed cardiac intensive care unit (CCU) in a university, tertiary care hospital.We assessed hand hygiene through a quasi-experimental study comparing estimated compliance using automated count technology and direct observation by a secret shopper with a feedback intervention at month 3. We used Poisson segmented regression and χ2 tests to compare trends before and after the intervention.Over 30 weeks, we collected 424,682 dispenser counts and 338 hours of human observations that included 1,783 room entries. Electronic hand hygiene dispenser counts increased significantly in the post-intervention period relative to the pre-intervention period (average count/patient-day increased 22.7 in the NCICU and 7.3 in the CCU, both P < .001), but direct observation of compliance did not change significantly (percent compliant increased by 2.9% in the NCICU and decreased by 6.7% in the CCU, P = .47 and P = .07, respectively).Passive electronic monitoring of hand hygiene dispenser counts does not closely correlate with direct human observation and was more responsive than observation to a feedback intervention.