Introduction: Hand hygiene using hand rubs is the gold standard technique for preventing 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 11 to June 30, 2022, 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 PHA consumption (volume of PHA in liters purchased per year), and nursing home activity (total number of resident days) were collected for 2020 and 2021. 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 1,733 French nursing homes participated in the study. The estimated median number of FHA procedures performed per resident day was 2.99 (interquartile range: 2.05–4.08) in 2020 and 2.42 (IQR: 1.62–3.31) in 2021. In terms of organizational structure, 65.7% (n=1,138) of the nursing homes were public facilities, 18.8% (n=325) were nonprofit, and 12.0% (n=208) were private. In 66.7% of nursing homes, a hygiene coordinator had been designated, and an infection control team was available in 85.5% of nursing homes. Significantly higher PHA consumption was observed in nursing homes with the following characteristics: private status (median 2021: 2.56 applications vs. 2.18 applications for nonprofit nursing homes; p <0.01), presence of an in-house infection control team (2021 median: 2.46 vs. 2.06 for others; p <0.01); a designated infection control officer within the facility (2021 median: 2.56 vs. 2.12 for others; p < 0.01); and a GMP ≥ 780 (2021 median: 2.70 vs. 2.16 for nursing homes with a GMP < 700). Conclusion: Following a significant increase in PHA consumption in French nursing homes between 2019 and 2020 amid the COVID-19 pandemic, a decrease was observed in 2021. In 2020, nearly 50% of nursing homes performed 3 hand hygiene procedures per resident-day, compared to 31% in 2021. Despite all potential biases, the results of this surveillance demonstrate the need to intensify efforts to promote hand hygiene through hand hygiene procedures in nursing homes.