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 May 5 to September 7, 2021, nursing homes in mainland France and overseas territories were contacted to participate in the surveillance. Organizational information (private/public, availability of staff or infection prevention and control [IPC] expertise, most recent weighted average care level [GMP]), annual PHA consumption (volume of PHA in liters purchased per year, including or excluding donations received in 2020 in connection with the COVID-19 pandemic), and nursing home activity (total number of resident days) were collected for 2019 and 2020. The number of hand rubs performed per day per resident was estimated using the following formula: (volume of hand sanitizer [liters] × 1000) divided by (annual number of days of care × 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 1,767 French nursing homes participated in the study. The estimated median number of FHA performed per day per resident was 1.55 (interquartile range: 1.05–2.18) in 2019 and 2.99 (IQR: 2.10–4.23) in 2020. Among the 1,767 nursing homes that provided organizational data, 66.0% (n=1,167) were public facilities, 19.4% (n=342) were nonprofit, and 10.4% (n=184) were private. In 63.2% of nursing homes, a hygiene coordinator had been designated, and an infection control team was available in 84.7% of nursing homes. Significantly higher PHA consumption was observed in nursing homes with the following characteristics: private status (2020 median: 3.25 applications vs. 2.95 applications for nonprofit nursing homes; p