Introduction: Hand hygiene using hand rubs is the gold standard technique 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. This surveillance aims to quantify adherence to hand hygiene in nursing homes using a proxy indicator based on annual consumption of hand sanitizer. Method: From March 1 to May 31, 2023, nursing homes in metropolitan France and overseas territories were contacted to participate in the surveillance. Organizational information (private/public, availability of infection prevention and control [IPC] staff or expertise, most recent weighted average care level [GMP]), annual HAP consumption (volume of HAP in liters purchased per year), and nursing home activity (total number of care days) were collected for 2021 and 2022. The number of hand rubs performed per day per resident was estimated using the following formula: (volume of hand sanitizer [liters] × 1,000) divided by (annual number of care days × 3 mL), based on the assumption that one hand rub required 3 mL of hand sanitizer. Statistical analysis was performed using the Wilcoxon test. Results: A total of 1,953 French nursing homes participated in the study (representing 26.1% of nursing homes). The estimated median number of FHA performed per resident day was 2.24 (interquartile range: 1.45–3.07) in 2021 and 1.94 (IQR: 1.29–2.65) in 2022. In terms of organization, 63.9% (n = 1,247) of the nursing homes were public facilities, 18.2% (n = 355) were nonprofit, and 14.1% (n = 275) were private. In 62.6% (n = 1,222) of the nursing homes, a hygiene coordinator had been designated, and a COVID-19 response team was available in 85.6% (n = 1,672) of the nursing homes. Significantly higher PHA consumption was observed in nursing homes with the following characteristics: public status (median 2022: 2.02 applications vs. 1.60 applications for nonprofit nursing homes; p < 0.01), presence of an in-house infection control team (median 2022: 1.96 vs. 1.68 for others; p < 0.01); a designated infection control officer within the facility (median 2022: 2.06 vs. 1.67 for others; p < 0.01); and a GMP ≥ 780 (median 2022: 2.15 vs. 1.76 for nursing homes with a GMP < 700). Conclusion: Following a significant increase between 2019 and 2020 in PHA consumption in French nursing homes amid the COVID-19 pandemic, the decrease observed in 2021 was confirmed in 2022. In 2021, 11.7% of nursing homes performed ≥ 4 hand hygiene actions (a target of the 2022–2025 national strategy) per resident-day, compared to 6.7% in 2022. Despite all potential biases, the results of this surveillance demonstrate the need to intensify efforts to promote hand hygiene through handwashing in nursing homes.