Hand hygiene (HH) is an important measure in infection prevention to decrease transmission of microbial pathogens; however, HH compliance by health-care workers (HCWs) remains suboptimal. One of the principal recommendations of current guidelines is that waterless, alcohol-based hand rubs are the preferred method for HH in most situations, due to the superior efficacy of these agents in rapidly reducing bacterial counts on hands and their ease of use. Improving HH compliance is a good quality indicator for hospital patient safety programs. Observers can follow HCWs to perform direct HH observations; however, HCWs may be prompted to clean their hands when observers are nearby, which does not represent real-world conditions. Moreover, having observers walk into patient rooms violates patient privacy and is time consuming. HH strategies using indirect metrics for surveillance (e.g., measuring the volume of HH products consumed) and the use of new technologies (e.g., electronic dispenser counters, radiofrequency, alcohol sensors, and video recording) will also be discussed.