Hand hygiene is a method that removes or destroys microorganisms on hands. Globally, 12% of all hospital admission among children aged from 0 to 14 years are due to infections. Among these, respiratory infections and infectious intestinal disease are responsible for 48% and 29% of child death respectively. The aim of the study was to assess the effect of child to child approach on hand hygiene practice among primary school children. The objective of the study wasto evaluate the effect of child to child approach on hand hygiene practice among primary school children. The study was conducted among 70 primary school children between the ages of 8 to 11 years. Design used was pre - experimental one group pre-test post-test design. Subjects were selected by using non- probability convenience sampling. Pretest was conducted by assessing the practice score of children with observation checklist on hand hygiene practice. Student trainers for providing training were selected using simple random sampling (lottery method). Training was provided to students trainers. Their efficiency were ensured after post- test. Then the student trainers were provided training to the allotted study participants. Post test conducted after 14 days by using same tool. Results showed that the mean hand hygiene post-test practice score was significantly (12.5) higher than the mean hand hygiene pre-test practice score (6.5) was calculated by paired t test. The obtained?t? value of (-29.7) was significant (p<0.001).Hence the findings reveals that child to child approach is an effective strategy to improve the hand hygiene practice of primary school children.