Effective hand hygiene practice in a clinical healthcare setting is the most effective means to prevent, control and reduce healthcare-associated infections. Despite the introduction of hand hygiene practices and targeted campaigns, surveillance to ensure implementation of these techniques remains limited. Surveillance is widely accepted as an essential component to infection control campaigns. Therefore, we sought to design and test an easy-to-use surveillance instrument for hospital hand hygiene developed and piloted for three months in nine hospitals in China. This paper presents the resulting hand hygiene surveillance instrument as well as explicit guidelines for its implementation.