Healthcare associated infections cause 75,000 to 80,000 deaths a year. Many are preventable with proper hand hygiene adherence (HHA). Worldwide, HHA range is between 40-60%, far below the 100% recommended. The purpose of this quantitative, cross-sectional, prospective study was to investigate any association between 15 demographic variables and HHA of ICU nurses. A convenience sample of 613 hand hygiene opportunities was collected by direct observation at each of 5ICUs (4 hospitals) in Texas for 8 consecutive hours each day for 3-5 days. The theoretical foundation guiding this study was the healthcare environment theory. The Statistical Package for Social Sciences software was used for descriptive and inferential analysis of data. An aggregated overall HHA rate of 64.09% was identified among all nurses, 66.88% among male nurses and 62.27% among female nurses. Number of children, age of the nurse, number of years of living in the U.S., and the number of years of active nursing practice were significantly associated with HHA (p = .000) using paired sample t-test. The potential social change impact of this study is identifying variables associated with HHA, identification and measurement of 4 barriers to HHA, measuring the Hawthorne Effect, identification of Low Gelers, High Gelers, and Super Gelers, average rate may not be indicative of what is happening in hospital, and call for standardization of surveillance methodology. Findings may lead to specific interventions to increase HHA among nurses with certain demographic characteristics.