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A national survey was conducted to describe the coverage and characteristics of infection prevention and control (IC) programmes in Italy and to evaluate progress during recent years. All regions, with one small exception, participated and the response rate was 88%. Nearly all 278 respondent public health trusts reported having an IC committee, 80% of the 615 respondent hospitals to have instituted an IC team, and 79% to have an IC nurse. However, when the presence of truly operating IC bodies was considered, the pattern was different: only 27% of IC teams met at least monthly, and variation by region was extremely large [coefficient of variation (CV): 1.06]. The IC programme characteristics with the greatest variation by region included: availability of qualified nurses and IC doctors (CV: 1.55 and 1.39 respectively); integration of IC activities and clinical risk management (CV: 1.05); IC programmes also involving community services (CV: 0.98); training of personnel at induction (CV: 0.82); and availability of written policies for the control of multidrug-resistant organisms (CV: 1.08). A relevant and statistically significant North-South gradient showed Southern Regions averaging 23 points less than Northern Regions on the IC score. Compared with a similar survey conducted in 2000, the distribution of several activities by region had improved significantly. Despite the noteworthy improvement observed over time, the situation in Italy is still unsatisfactory, due to significant variation in the development of IC organisations and initiatives by region and by type of hospital.