We evaluated the adherence to handwashing and gloving practice among health care workers (HCWs) in 5 medical and 5 surgical wards of a 1250-bed hospital in Riyadh. Nurses, consultants, residents, interns, and medical students attending these wards were each unobtrusively observed for handwashing and gloving practice. Each HCW was observed only once for all handwashing and gloving opportunities during a single patient encounter. 312 handwashing opportunities for 230 HCWs were observed. The study population comprised 110 nurses, 76 residents, 23 medical students, 11 interns, and 10 consultants. Female subjects constituted 56.1% of the population. The ratio of handwashing sinks to beds was 1:6-7. The overall frequency of handwashing was 6.7% before patient contact and 23.7% after patient contact. Adherence to handwashing was 70.0% among medical students, 69.2% among interns, 18.8% among nurses, 12.5% among residents, and 9.1% among consultants. The duration of handwashing was suboptimal for all HCWs (average of 4.7 s). Adherence to wearing gloves for performing procedures was on average 75.5%. Poor adherence to handwashing is a worldwide problem. Strategies to improve hand hygiene practice should be multifaceted and should include increasing the availability and accessibility of handwashing sinks and alcohol-based hand rubs.