Background: The World Health Organization (WHO) Hand Hygiene Self-Assessment Framework (HHSAF) was conceived as a structured self-assessment tool to provide a situation analysis of hand hygiene resources, promotion and practices within healthcare facilities. Aim: To perform usability pretesting and reliability testing of the HHSAF. Methods: The HHSAF draft was developed in consultation with experts to reflect key elements of the WHO Multimodal Hand Hygiene Improvement Strategy. Forty-two facilities were invited to pretest the draft HHSAF and complete a feedback survey. For reliability testing, two users in each facility completed the HHSAF independently. The reliability of each indicator, component subtotal and the overall score were estimated using the variance components model. After each phase, the tool was re-examined and modified as appropriate. Findings: Twenty-seven indicators were selected during drafting. Twenty-six facilities in 19 countries completed pretesting (62% response rate), with total scores ranging from 35 to 480 (mean 262). The HHSAF took less than 2 h to complete for 21 facilities. Most agreed that the HHSAF was �easy to use� (23/26) and �useful for establishing facility status with regard to hand hygiene promotion� (24/26). Complete reliability responses were received from 41 facilities in 16 countries. Reliability for the total score for the HHSAF and the subtotal of each of the five components ranged from 0.54 to 0.86. Seven indicators had poor reliability; these were examined for potential flaws and modified accordingly. Conclusion: This process confirmed the usability and reliability of this tool for the promotion of hand hygiene in health care.