The World Health Organization (WHO) developed the Hand Hygiene Self-Assessment Framework (HHSAF) to evaluate hand hygiene resources, promotion, and practices in healthcare facilities as part of its global "Clean Care is Safer Care" initiative. The framework underwent rigorous usability and reliability testing across 26 facilities in 19 countries (usability phase) and 41 facilities in 16 countries (reliability phase). Usability results showed the tool was easy to use (89% agreement) and effective for assessing hand hygiene status. Reliability testing revealed moderate-to-high consistency (0.54–0.86) across its five components, though seven indicators required refinement due to poor reliability. Post-testing modifications improved clarity, ensuring the HHSAF’s alignment with WHO’s evidence-based Multimodal Hand Hygiene Improvement Strategy. The finalized tool aids facilities in identifying gaps, planning interventions, and tracking progress over time.