Objective To explore the indications and opportunities applicable for hand hygiene (HH) monitoring of cleaners in medical institutions through risk identification and clustering analysis method, provide tools and stan-dards for the monitoring of HH compliance of cleaners. Methods The workflow and behavior of 50 cleaners were observed anonymously by random sampling method, 10 experts were selected to judge the workflow, risk belts were defined with risk identification tools, HH indications were determined by cluster analysis. Results Risk scores of 17 types of work behavior of cleaners met the standard of cluster analysis and had HH indications, the highest risk score was mopping object surface of each bed, toilet, corridor, and so on in the ward one by one (4.50±0.53) as well as wiping the sink, handrail, wall, windowsill, and so on (4.50±0.53). Cluster analysis showed that tool preparation, cleaning and disinfection, personal protection, medical waste and environmental sorting were 5 main behavior nodes. After further inductive analysis, it is determined that HH indications of cleaners were "one before and five after", that is, before cleaning and disinfection, after preparing tools, after cleaning and disinfection, after taking off personal protective equipment, after transferring medical waste and after environmental sorting. Conclusion The establishment of "one before and five after" HH monitoring indication system for cleaners in medical institutions not only provides applicable quantitative reference indication for HH training of cleaners, but also provides a reference tool for monitoring and intervention of HH of cleaners.