Introduction: Hand hygiene using an alcohol-based hand rub (ABHR) is the gold standard for preventing the cross-transmission of microorganisms, particularly those responsible for acute respiratory infections, gastroenteritis, and the spread of multidrug-resistant bacteria in nursing homes for the elderly (Ehpad) and medical-social facilities for people with disabilities. This surveillance is part of the objectives of the National Strategy 2022–2027¹ and aims to quantify compliance with hand hygiene in these facilities by tracking a proxy indicator—“Number of hand rubs performed by staff per day of a resident’s stay in a medical-social facility ” (= estimate via an indirect measure) based on annual consumption of hydroalcoholic products (HAP). Method: From March 1 to June 15, 2025, nursing homes and targeted facilities in the disability sector (EMS-H: EAM/FAM, MAS, IME, IEM, EEAP) in mainland France and overseas territories were invited to participate in the surveillance. Organizational information (facility status, availability of a hygiene team or expertise (EOH/EMH), most recent weighted average GIR [GMP]), annual PHA consumption (volume of PHA purchased in liters per year), and facility activity (total number of days of care) were collected for the year 2024. Data collection was conducted via a secure online data entry form. The number of hand rubs performed by staff; external staff, visitors, and residents per resident occupancy day was estimated using the following formula: (PHA volume [liters] × 1,000) divided by (annual number of occupancy days × 3 mL), based on the assumption that one hand rub required 3 mL of PHA. Statistical analysis was performed using the Wilcoxon test. Results: A total of 2,331 French nursing homes participated in the surveillance (representing 31.4% of nursing homes). For the year 2024, the estimated median number of FHA per resident accommodation day was 1.53 (interquartile range (IQR): 1.00–2.21). In terms of organizational structure, 62.4% of nursing homes were public facilities, 24.6% were nonprofit, and 13.0% were private. In 52.9% of nursing homes, a hygiene coordinator had been designated, and a hygiene team (EOH/EMH) was available in 89.7% of nursing homes. Significantly higher PHA consumption was observed in nursing homes with the following characteristics: public status (median: 1.66 FHA per resident-day vs. 1.21 for nonprofit nursing homes; p <0.001), presence of an in-house or mobile hygiene team (EOH/EMH) (median: 1.56 vs. 1.30 for others; p <0.001); a designated hygiene coordinator within the facility (median: 1.68 vs. 1.36 for others; p < 0.001); and a GMP ≥ 780 (median: 1.76 vs. 1.45 for nursing homes with a GMP < 700). In addition, a total of 293 EMS-H facilities participated in the surveillance (representing 7.8% of EMS-H facilities nationwide). For these EMS-H facilities, the estimated median number of FHA performed per resident-day was 1.27 (95% CI: 0.72–2.15) in 2024. In terms of organizational structure, 42.3% of nursing homes were public facilities, 57.0% were nonprofit, and 0.7% were private. In 55.0% of nursing homes, a hygiene coordinator had been designated, and a hygiene team was available in 74.4% of nursing homes. Significantly higher PHA consumption was observed in nursing homes with the following characteristics: public status (median: 1.60 FHA per resident-day vs. 0.95 for nonprofit nursing homes); p <0.001), a designated hygiene coordinator within the facility (median: 1.52 vs. 0.93 for others; p < 0.001) and support from a hygiene team (EOH/EMH) (median: 1.45 FHA per resident-day vs. 0.79 for others; p = 0.002). Conclusion: Following a significant increase between 2019 and 2020 in the use of PHA in French nursing homes, particularly linked to the COVID-19 pandemic, the decline observed since 2021 is confirmed in 2024. Regarding the objective of the 2022–2025 national strategy, extended to 2027, targeting at least 4 HWs per resident-day, 3.6% of nursing homes met this target in 2023. This figure remained stable in 2024. Despite the potential biases identified, the results of this surveillance demonstrate the need to intensify efforts to promote hand hygiene through FHA in long-term care facilities.