Background: Hand hygiene is the simplest and most fundamental means to prevent care related infections. It is of great importance that the guideline of hand hygiene is followed for the patient’s sake. Unfortunately, healthcare workers perform hand hygiene too seldom. If the patient comes down with a care related infection, the suffering will increase. The nurse's role is therefore to prevent unnecessary suffering for the patient by following recommendations for hand hygiene. In order to get a broader understanding of the reasons why the compliance of hand hygiene is so low the theory of planned behaviour was used (TPB). This theory explains the human behavior. Aim: The aim of this study was to describe causes of not following recommendations for hand hygiene among health care workers. Method: This literature review was based on quantitative and qualitative scientific articles. Results: The findings indicated that there were several factors that influence the low compliance of hand hygiene recommendations. These were summarized as: workload and lack of time, skin irritation, attitudes and motivation, insufficient access to hand hygiene products, inappropriate glove use, lack of knowledge and unawareness.