Improving the quality of hand hygiene is a well-known challenge. A review of the literature shows compliance with hand hygiene to be below 50%. An evidence based clinical guideline concerning sufficient hand hygiene has been developed. Based on this guideline a campaign and an audit were carried out in 2004 at Aarhus University Hospital, Skejby Sygehus. Our initial monitoring system failed to demonstrate improvement in hand hygiene compliance. Therefore the purpose of this work is to demonstrate our latest attempt to train key hygiene nurses to do observation studies in their own wards. The educational program is demonstrated and the key nurse’s role as an observer is discussed.