Introduction: Health care associated infections including COVID-19 are drawing attention from patients, insurers and Governments worldwide because of the magnitude of the problem i.e. morbidity, mortality and treatment, although these are preventable. Literature review shows there is very little published information on hand washing practices of health care workers in Kenya. This study provides important inputs for planning, policy making and informs future research areas and methods. Methods: A cross sectional study design was conducted in Matayos, Teso South and Teso North sub-counties of Busia County. The study covered 33 consenting health workers in 7 health facilities. An interview guide and observation checklist were used to collect data and to ascertain availability of hygiene and sanitation facilities. Thematic analysis was used to analyze qualitative data while quantitative data was analyzed using descriptive statistics. Results: That there was no policy on hand hygiene in 6 (86%) health facilities; awareness about hand hygiene was high; knowledge on critical moments for hand hygiene was unsatisfactory but nurses scored better. Only 44% respondents knew effectiveness of alcohol-based sanitizer; on disposal of waste, maternity wards ranked highest 6(87.7%) complying. Laxity in enforcing obligatory use of hand hygiene was high only 2(28.6 %.) of facilities complying. Respondents attributed reduction in diarrheal infections and improvements in sanitation during covid-19 pandemic to rigorous hand hygiene practices. Found that hand hygiene compliance by health care workers can reduce infections in health facilities. That lack of piped water, erratic supply of soap, sanitizers and dependency on external partners were perceived to be important barriers for the sustainability of hand washing practices. Conclusion: The hand hygiene initiative has occupied a new and important place in the minds of health workers, policy makers and communities due to its contribution in the prevention and control of one of the most serious diseases of the 21st century. The initiative has presented a compelling case for investment in preventive and promotive health and demonstrated the power of the old adage “prevention is better than cure”. Purposeful partnerships and collaborations are powerful tools to achieve common goals. The study also exposed various systemic weaknesses within the public health sector and the political leadership that needs to be addressed to ensure sustainability of hand hygiene.