Despite the tremendous effort put into the promotion of hand hygiene for decades, hand hygiene compliance among healthcare workers and patients remains suboptimal. A novel approach is required to identify and address the remaining gaps despite the World Health Organization's Five Moments for Hand Hygiene. Directly observed hand hygiene (DOHH) may fill this gap and ensure 100% hand hygiene compliance during crucial moments outside the WHO's Five Moments. The concept of DOHH was inspired by directly observed therapy for treating tuberculosis, where drug compliance is of utmost importance [ [1] Volmink J. Garner P. Directly observed therapy for treating tuberculosis. Cochrane Database Syst Rev. 2007; 4: CD003343 PubMed Google Scholar ] As the patient receives antituberculous medications under direct observation by a healthcare worker, the compliance of the patient can be ascertained. Similarly, when alcohol-based hand rub is delivered to the hands of healthcare workers and patients by a designated staff member at regular time intervals, their hand hygiene is under direct observation and compliance is ensured. Antituberculous medications are given once daily, while hand hygiene opportunities in healthcare workers and patients are numerous in clinical settings. Therefore, DOHH should be implemented in highly selected scenarios and moments as illustrated below.