Association of selected inflammatory biomarkers with cough reflex sensitivity in asthmatic children.

Bronchial asthma is the most common chronic respiratory disease of childhood. Cough is one of its defining symptoms. This study investigated the associations between selected inflammatory biomarkers and cough reflex sensitivity after capsaicin inhalation in children with mild and moderate well-controlled type 2 endotype asthma compared with non-asthmatic probands. Sensitivity to the cough reflex was measured by recording the cough response after capsaicin inhalation. The sandwich ELISA method was used to measure serum concentrations of the investigated potential inflammatory biomarkers (interleukin 13, interleukin 1beta, eosinophil-derived neurotoxin). The acquired data were statistically evaluated according to descriptive analyses for summarization and comparison between cough reflex sensitivity parameters and individual biomarker values in the observed and control groups modeled by a simple linear regression model. Statistical significance was defined as p<0.05. We showed a statistically significant association (p-value 0.03) between cough reflex sensitivity - C2 value (capsaicin concentration required for two cough responses) and interleukin 1beta serum concentrations in the asthma group compared with the control group of non-asthmatic children. Our results support the possibility of interleukin 1beta as a potential additive inflammatory biomarker used in clinical practice in children with asthma because of its correlation with the activity of the afferent nerve endings in the airways.

Biomarkers of Bronchial Asthma.

Asthma is a complex disease with a variable course. Efforts to identify biomarkers to predict asthma severity, the course of disease and response to treatment have not been very successful so far. Biomarker research has expanded greatly with the advancement of molecular research techniques. An ideal biomarker should be suitable to identify the disease as well the specific endotype/phenotype, useful in the monitoring of the disease and to determine the prognosis, easily to obtain with minimum discomfort or risk to the patient. An ideal biomarker should be suitable to identify the disease as well the specific endotype/phenotype, useful in the monitoring of the disease and to determine the prognosis, easily to obtain with minimum discomfort or risk to the patient - exhaled breath analysis, blood cells and serum biomarkers, sputum cells and mediators and urine metabolites could be potential biomarkers of asthma bronchiale. Unfortunately, at the moment, an ideal biomarker doesn't exist and the overlap between the biomarkers is a reality. Using panels of biomarkers could improve probably the identification of asthma endotypes in the era of precision medicine.

Cough Reflex Sensitivity in Asthmatic Children.

New knowledge about the neural aspects of cough has revealed a complex network of pathways that initiate cough. The effect of inflammation on cough neural processing occurs at multiple peripheral and central sites within the nervous system. Evidence exists that direct or indirect neuroimmune interaction induces a complex response, which can be altered by mediators released by the sensory or parasympathetic neurons and vice versa. The aim of this study was to clarify changes of cough reflex sensitivity - the activity of airway afferent nerve endings - in asthmatic children.25 children with asthma and 15 controls were submitted to cough reflex sensitivity measurement - capsaicin aerosol in doubling concentrations (from 0.61 to 1250 µmol/l) was inhaled by a single breath method. Concentrations of capsaicin causing two (C2) and five coughs (C5) were reported. Asthmatic children' (11 boys and 14 girls, mean age 9 ± 1 yrs) cough reflex sensitivity (geometric mean, with the 95 % CI) for C2 was 4.25 (2.25-8.03) µmol/l vs. control C2 (6 boys and 9 girls, mean age 8 ± 1 yrs) was 10.61 (5.28-21.32) µmol/l (p=0.024). Asthmatic children' C5 was 100.27 (49.30-203.93) µmol/l vs. control C5 56.53 (19.69-162.35) µmol/l (p=0.348). There was a statistically significant decrease of C2 (cough threshold) in the asthmatic patients relative to controls (p-value for the two-sample t-test of log(C2) for the one-sided alternative, p-value = 0.024). The 95 % confidence interval for the difference of the mean C2 in asthma vs. control, [1.004, 6.207]. For C5, the difference was not statistically significant (p-value = 0.348). There was a statistically significant decrease of cough reflex sensitivity (the activity of airway afferent nerve endings) - C2 value in the asthmatic children relative to controls.

Cough reflex sensitivity and fractional exhaled nitric oxide in children with asthma.

Individual studies have suggested the utility of fractional exhaled nitric oxide (FeNO) measurement in detecting cough-variant asthma and eosinophilic bronchitis in patients with chronic cough. The aim of this study was to clarify a correlation of cough reflex sensitivity and fractional exhaled nitric oxide in asthmatic children. 25 children with asthma and 15 controls were submitted to cough reflex sensitivity measurement - capsaicin aerosol in doubling concentrations (from 0.61 to 1250 micromol/l) was inhaled by a single breath method. Concentrations of capsaicin causing two (C2) and five coughs (C5) were reported. Fractional exhaled nitric oxide (FeNO) measurement was included. Asthmatic children' (11 boys and 14 girls, mean age 9+/-1 years) and control group (unconfirmed diagnosis of asthma) (6 boys and 9 girls, mean age 8+/-1 years) were included into the study. FeNO vs. C2 in asthma (Spearman´s rank correlation: -0.146, p=0.49); FENO vs. C5 in asthma (Spearman´s rank correlation: -0.777, p=0.71). We found that there is no correlation between cough reflex sensitivity and fractional exhaled nitric oxide either in children with asthma or in the control group.

Cough reflex sensitivity after exercise challenge testing in children with asthma.

Bronchial challenge tests are commonly used in clinical medicine and research. The aim of this study was to clarify changes of cough reflex sensitivity before and after exercise challenge testing in asthma children. 42 asthmatic children were submitted to cough reflex sensitivity measurement - capsaicin aerosol in doubling concentrations (from 0.61 to 1250 micromol/l) was inhaled by a single breath method - before and after exercise challenge testing. Concentrations of capsaicin causing two (C2) and five coughs (C5) were reported. Children' (31 boys and 11 girls, mean age 14.05 ±â€¯2.08 yrs) cough reflex sensitivity (median, with the 95% CI) for C2 was before exercise challenge testing 9.77 (6.10-10.99) micromol/l vs. children' C2 after it 7.32 (6.10-14.65) (P = 0.58 for the Wilcoxon two sample paired test). Children' C5 was before exercise challenge testing 19.53 (14.65-80.57) micromol/l vs. C5 after it 39.06 (24.42-58.59) micromol/l (P = 0.09 for the Wilcoxon two sample paired test). We conclude that cough reflex sensitivity was not significantly changed after exercise challenge testing in children with asthma.

Training infection control and hospital hygiene professionals in Europe, 2010: agreed core competencies among 33 European countries.

The harmonisation of training programmes for infection control and hospital hygiene (IC/HH) professionals in Europe is a requirement of the Council recommendation on patient safety. The European Centre for Disease Prevention and Control commissioned the 'Training Infection Control in Europe' project to develop a consensus on core competencies for IC/HH professionals in the European Union (EU). Core competencies were drafted on the basis of the Improving Patient Safety in Europe (IPSE) project's core curriculum (CC), evaluated by questionnaire and approved by National Representatives (NRs) for IC/HH training. NRs also re-assessed the status of IC/HH training in European countries in 2010 in comparison with the situation before the IPSE CC in 2006. The IPSE CC had been used to develop or update 28 of 51 IC/HH courses. Only 10 of 33 countries offered training and qualification for IC/HH doctors and nurses. The proposed core competencies are structured in four areas and 16 professional tasks at junior and senior level. They form a reference for standardisation of IC/HH professional competencies and support recognition of training initiatives.

Development and assessment of national performance indicators for infection prevention and control and antimicrobial stewardship in European long-term care facilities.

BACKGROUND: Healthcare-associated infections in long-term care facilities (LTCFs) are of increasing importance. AIM: To develop consensus national performance indicators (NPIs) for infection control (ICPI) and antimicrobial stewardship (ASPI) in LTCFs, and assess the performance of 32 European countries against these NPIs. METHODS: Previously established European standards were the basis for consensus and the same iterative approach with national representatives from the 32 countries. A World Health Organization scoring system recorded how close each country was to implementing each standard. FINDINGS: The 42 agreed component indicators were grouped into six NPI categories: 'national programme', 'guidelines', 'expert advice', 'IC structure' (not present in the ASPI), 'surveillance' and 'composite'. 'Guidelines' scored the highest mean total possible score (60%, range 20-100%), followed by 'composite' (53%, range 30-100%), 'expert advice' (48%, range 20-100%), 'surveillance' (47%, range 20-83%), 'national programme' (42%, range 20-100%) and 'IC structure' (39%, range 20-100%). Although several scores were low, some countries were able to implement all NPIs, indicating that this was feasible. Most NPIs were very significantly related, indicating that they were considered to be important by the countries. 'Guidelines' and 'IC structure' were significantly related to European region (P ≤ 0.05). Accreditation/inspection was not evident in seven (22%) countries, nine (28%) countries had accreditation/inspection that included IC assessments, and seven (22%) countries had accreditation/inspection that included IC and antimicrobial stewardship assessments. Multi-variable analysis found that only the NPI and the ICPI 'expert advice' were associated with accreditation/inspection which included IC and antimicrobial stewardship. CONCLUSION: The identified gaps represent significant potential patient safety issues. The NPIs should serve as a basis for monitoring improvements over the coming years.

Deep nasal inspirations increase the cough threshold in children with mild asthma.

Asthma is a chronic inflammatory disease characterized by bronchospasms accompanied with frequent coughing, the pathogenesis of which is not clear. In healthy adults deep inspirations (DIs) provide a protective effect against bronchoconstriction triggered by methacholine inhalation, which correlates with the number of accompanying cough efforts. The aim was to study the effect of deep nasal inspirations representing the voluntary equivalent of the sniff-like aspiration reflex on the capsaicin-induced cough in children with mild asthma. The cough reflex sensitivity to capsaicin was determined using a compressed air-driven nebulizer in 21 children (8 girls and 13 boys of median age 13.3 year) suffering from mild asthma (FEV(1)∼80%). The effect of five previous DIs through the nose was examined on the elicitability of two and five or more cough efforts (C2, C5). Under control conditions, the concentration of 20.86 (14.58-29.8) µmol/l of capsaicin provoked two cough efforts (C2). After five DIs similar reaction required significantly higher concentrations of capsaicin: 29.02 (18.88-44.6) µmol/l; P=0.016. Five or more cough efforts (C5) were not significantly changed after previous DIs 161.49 (77.31-337.33) µmol/l and without DIs 141.52 (68.77-291); P=0.54. A series of five deep inspirations decreases the cough reflex sensitivity to evoke two efforts (C2) in children with mild asthma. The inhibitory effect of similar DIs disappeared after repeated applications of increasing doses of capsaicin, aiming to evoke five or more cough efforts, suggesting a reflex character of protective effect of DIs.

Consumption of psychoactive substances among 535 women entering a Lyon prison (France) between June 2004 and December 2008.

BACKGROUND: In France, recent data on the consumption of psychoactive substances (PASs) among women entering prison are virtually nonexistent. The objective of this study was to describe the characteristics of female entrants at Montluc prison in Lyon (France) and to estimate their PAS consumption. METHODS: Between June 1, 2004 and December 31, 2008, of 841 women entering the Lyon correctional facility, 535 had an entrance interview, conducted by a nurse, during which a questionnaire was systematically proposed; 306 detainees did not have this interview and could not be included in the study because of an immediate transfer to another prison or emergency hospitalization. Socioeconomic and incarceration characteristics, PAS consumption, as well as consumption level (occasional, regular, abusive or dependence) and psychological distress of the 535 interviewed detainees were systematically noted. This psychological distress was defined by the presence in the entrant talks or behavior suggesting clinical symptoms such as anxiety, depression, delusion, delirium, and mood or behavior disorders. Descriptive analysis was undertaken with the Chi(2) test and Fisher's exact test for differences between the proportions observed. RESULTS: The average age of the 534 responding detainees was 31.5 years; 59.2% had had no ongoing professional activity in the 12 months prior to incarceration, and 21.6% had already been imprisoned before; 37.5% of the entrants reported dependence on tobacco and 13.7% on alcohol; 6.6% reported regular, abusive use or dependence on cannabis, 20.4% on psychotropic medications, and 7.7% on other drugs (heroin, cocaine, synthetic drugs) in the 6 months preceding their incarceration; 39.2% of the consumers at risk reported using at least two substances; 7.1% of detainees were on opioid substitution treatment. A multiple correspondence factor analysis was used to note specific characteristics of three groups of PAS consumers. CONCLUSIONS: More frequent among young women detainees, overall PAS consumption was quite close to that of male entrants, was greater than in the general female population, and was very often accompanied by psychological distress. Effective screening upon entry into detention should be carried out so that female consumers can be offered psychological and/or psychiatric care adapted to a prison environment.

Consensus standards and performance indicators for prevention and control of healthcare-associated infection in Europe.

Healthcare-associated infection (HCAI) and related problems of antimicrobial resistance (AMR) place a considerable burden on healthcare delivery, patients, their families and carers, and the economy. Once considered a low priority, they are now recognized globally as major patient safety issues. The European Union's Directorate General for Health and Consumer Protection released a public consultation on strategies for improving patient safety by the prevention and control of HCAI, and increased standards of antimicrobial stewardship. They also specified that the 'Improving Patient Safety in Europe' research project they had funded would develop consensus standards and related performance indicators (SPIs) for the prevention and control of HCAI and AMR. This article describes how consensus was reached between 29 participating European countries, the detailed SPIs, and a reduced set of indicators ('13+13') that could be used internationally and nationally to stimulate and review improvement in HCAI prevention and control, and antimicrobial stewardship activities.

Automated detection of nosocomial infections: evaluation of different strategies in an intensive care unit 2000-2006.

The aim of this study was to evaluate seven different strategies for the automated detection of nosocomial infections (NIs) in an intensive care unit (ICU) by using different hospital information systems: microbiology database, antibiotic prescriptions, medico-administrative database, and textual hospital discharge summaries. The study involved 1,499 patients admitted to an ICU of the University Hospital of Lyon (France) between 2000 and 2006. The data were extracted from the microbiology laboratory information system, the clinical information system on the ward and the medico-administrative database. Different algorithms and strategies were developed, using these data sources individually or in combination. The performances of each strategy were assessed by comparing the results with the ward data collected as a national standardised surveillance protocol, adapted from the National Nosocomial Infections Surveillance system as the gold standard. From 1,499 patients, 282 NIs were reported. The strategy with the best sensitivity for detecting these infections using an automated method was the combination of antibiotic prescription or microbiology, with a sensitivity of 99.3% [95% confidence interval (CI): 98.2-100] and a specificity of 56.8% (95% CI: 54.0-59.6). Automated methods of NI detection represent an alternative to traditional monitoring methods. Further study involving more ICUs should be performed before national recommendations can be established.

[Use of the French medico-administrative database (PMSI) to detect nosocomial infections in the University hospital of Lyon]. / Intérêt de l'utilisation des données du Programme médicalisé des systèmes d'information (PMSI) pour la surveillance des infections nosocomiales aux Hospices Civils de Lyon.

BACKGROUND: Surveillance is an effective element in the fight against nosocomial infections, but the monitoring methods are often cumbersome and time consuming. The detection of infection in computerized databases is a means to alleviate the workload of health care teams. The objective of this study was to evaluate the performance of using discharge summaries in medico-administrative databases (PMSI) for the identification of nosocomial infections in surgery, intensive care and obstetrics. METHODS: The retrospective assessment study included patients who were hospitalized in general surgery, intensive care and obstetrics at different periods of time in 2006 and 2007 depending on the wards. Patients were monitored according to standard protocols which are coordinated at the regional level by the Southeast coordinating centre (CCLIN). The performance of identifying cases of nosocomial infection from discharge diagnoses coded by using the International Classification of Diseases (tenth revision) was evaluated by a study of sensitivity, specificity, positive and negative predictive values with their 95% confidence intervals. RESULTS: Using a limited number of diagnostic codes, the sensitivity and specificity were, respectively, 26.3% (95% CI 13.2-42.1) and 99.5% (95% 98.8-100.0) for the identification of surgical site infections. By expanding the number of diagnostic codes, the sensitivity and specificity were 78.9% (95% CI 65.8-92.1) and 65.7% (95% CI 61.0-70.3). The sensitivity and specificity for case identification of nosocomial infections in intensive care were 48.8% (95% CI 42.6-55.0) and 78.4% (95% CI 76.1-80.1), and were 42.9% (95% CI 25.0-60.7) and 87.3% (95% CI 85.2-89.3) for identification of postpartum infections. CONCLUSION: The PMSI is not a sufficiently efficient method in terms of sensitivity to be used in surveillance of nosocomial infections. A reassessment of the PMSI must be considered, with changes in coding of comorbidity that occurred in 2009.

A randomized trial of viral hepatitis prevention among underprivileged people in the Lyon area of France.

BACKGROUND: We compared the efficacy of two viral hepatitis B and C (VHBC) screening strategies, relative to no intervention, among underprivileged people (UP) living in shelters in the Lyon area. METHODS: Eighteen of 37 shelters were randomly sampled after stratification based on the accommodation capacity and the screening centres/shelters distance. Through randomization, the S0 strategy (no intervention), the S1 strategy [group information (GI) and referral for screening] and the S2 strategy (GI and in situ screening) were each applied in six shelters. A standardized questionnaire was offered to each participant. Follow-up of positive cases was organized via the reference centre of VHBC of Lyon. RESULTS: The screening completion rate (SCR) among 1276 included subjects in S0, S1 and S2 was 1.5, 42.8 and 59.7%, respectively (P < 10(-6)). This rate was higher in S2 regardless of the sociodemographic variable considered. Odds ratios (OR) of screening completion (SC) was significantly higher in S1 versus S0, OR = 49.8 [95% confidence interval (CI): 26.1-102.1], in S2 versus S0, OR = 98.5 (95% CI: 51.9-200.8) and in S2 versus S1, OR = 2.0 (95% CI: 1.3-2.9). Age, country of birth and professional inactivity were independently associated with SC. CONCLUSIONS: Health authorities must ensure widespread screening of UP, which is more effective when conducted in shelters than in screening centres.

The burden of healthcare­associated infections in European long­term care facilities.

Since 2006, several projects have been initiated in Europe to describe the distribution and characteristics of infection control programs in long‐term care facilities and to quantify the burden of infections, antimicrobial resistance, and antimicrobial use in long‐term care facilities. This article summarizes the results and activities that are underway.

Methicillin-resistant Staphylococcus aureus (MRSA) in Europe: which infection control measures are taken?

BACKGROUND: The prevalence of hospital-acquired Methicillin-resistant Staphylococcus aureus (MRSA) infections shows a huge variety across Europe. Some countries reported a reduction in MRSA frequency, while in others countries increasing MRSA rates have been observed. To reduce the spread of MRSA in the healthcare setting, a sufficient MRSA management is essential. In order to reflect the MRSA management across Europe, MRSA prevention policies were surveyed in ten countries. MATERIALS AND METHODS: The survey was performed by questionnaires in European intensive care units (ICUs) and surgical departments (SDs) in 2004. Questionnaires asked for availability of bedside alcohol hand-disinfection, isolation precautions, decolonization and screening methods. The study was embedded in the Hospital in Europe Link for Infection Control through Surveillance (HELICS) Project, a European collaboration of national surveillance networks. HELICS was initiated in order to harmonize the national surveillance activities in the individual countries. Therefore, HELICS participants developed surveillance modules for nosocomial infections in ICUs and for surgical site infections (SSI). The coordination of this surveillance has now been transferred to the European Centre for Disease Prevention and Control (ECDC). RESULTS: A total of 526 ICUs and 223 SDs from ten countries sent data on organisational characteristics and policies, demonstrating wide variations in care. Substantial variation existed in availability of bedside alcohol hand-disinfection, which was much higher in participating ICUs rather than in SDs (86 vs. 59%). Surveillance cultures of contact patients were obtained in approximately three-fourths of all SDs (72%) and ICUs (75%). Countries with decreasing MRSA proportions showed especially strict implementation of various prevention measures. CONCLUSION: The data obtained regarding MRSA prevention measures should stimulate infection control professionals to pursue further initiatives. Particularly, the vigorous MRSA management in countries with decreasing MRSA proportions should encourage hospitals to implement preventive measures in order to reduce the spread of MRSA.

Quality assessment in surgical care departments: proposal for a scoring system in terms of structure and process.

OBJECTIVE: To build a score able to reflect and rank surgical departments according to a definition of "quality" in terms of structure and process. METHODS: Collaborative design of a quality score in the framework of the French clinical research project NosoQual. Feasibility and observational study in 46 surgical departments visited between November 2002 and March 2003 according to standardised procedures. A bibliographic review followed by expert consultations, a field test, analysis and a final reconsideration leading to the definition of a consensual score. RESULTS: 138 variables comprised the score. They were classified into seven dimensions, each representing a different aspect of quality of care in surgery. According to the threshold and weight attributed to every variable, scores were calculated for each department. The average level of achievement of the scores varied from 42% to 71% of theoretical maxima. The variability of the scores related to the seven dimensions was larger and more significant than the one expressed by the overall score (coefficient of variation=0.1). CONCLUSION: This analytical work contributed to the design of a quality score for surgery. However, the progress of the score should continue to take into account all the obstacles that were observed and to meet the high requirements of the actual patient safety issue.

[Prevalence of nosocomial infections in 27 hospitals in the Mediterranean region]. / Prévalence des infections nosocomiales dans 27 hôpitaux de la région Méditerranéenne.

A multicentre study was conducted in 27 hospitals in Algeria, Egypt, Italy, Morocco and Tunisia to evaluate the prevalence and characteristics of the nosocomial infections. The study population (4634 patients) was relatively young, mean age 41.1 (standard deviation 23.4) years. The prevalence of nosocomial infections was 10.5%; this was higher in non-teaching centres and moderate-sized hospitals. Overall, urinary tract infections were the most common. Paediatric departments rated particularly high (11.3%). The most commonly isolated organisms were: Escherichia coli (17.2%), Staphylococcus aureus (12.5%), Pseudomonas aeruginosa and Klebsiella pneumoniae (9.2% each). On the day of the study, 40.7% of the patients were under treatment with antibiotics, with nearly half for an empirical indication. Nosocomial infection was significantly associated with mechanical ventilation, hospitalization > or = 8 days, presence of a central or peripheral catheter), urinary catheter, diabetes and age.

Prevalence of nosocomial infections in 27 hospitals in the Mediterranean region

A multicentre study was conducted in 27 hospitals in Algeria, Egypt, Italy, Morocco and Tunisia to evaluate the prevalence and characteristics of the nosocomial infections. The study population [4634 patients] was relatively young, mean age 41.1 [standard deviation 23.4] years. The prevalence of nosocomial infections was 10.5%; this was higher in non-teaching centres and moderate-sized hospitals. Overall, urinary tract infections were the most common. Paediatric departments rated particularly high [11.3%]. The most commonly isolated organisms were: Escherichia coli [17.2%], Staphylococcus aureus [12.5%], Pseudomonas aeruginosa and Klebsiella pneumoniae [9.2% each]. On the day of the study, 40.7% of the patients were under treatment with antibiotics, with nearly half for an empirical indication. Nosocomial infection was significantly associated with mechanical ventilation, hospitalization ? 8 days, presence of a central or peripheral catheter], urinary catheter, diabetes and age

Reducing surgical site infection incidence through a network: results from the French ISO-RAISIN surveillance system.

Surgical-site infections (SSIs) are a key target for nosocomial infection control programmes. We evaluated the impact of an eight-year national SSI surveillance system named ISO-RAISIN (infection du site opératoire - Réseau Alerte Investigation Surveillance des Infections). Consecutive patients undergoing surgery were enrolled during a three-month period each year and surveyed for 30 days following surgery. A standardised form was completed for each patient including SSI diagnosis according to standard criteria, and several risk factors such as wound class, American Society of Anesthesiologists (ASA) score, operation duration, elective/emergency surgery, and type of surgery. From 1999 to 2006, 14,845 SSIs were identified in 964,128 patients (overall crude incidence: 1.54%) operated on in 838 participating hospitals. The crude overall SSI incidence decreased from 2.04% to 1.26% (P<0.001; relative reduction: -38%) and the National Nosocomial Infections Surveillance system (NNIS)-0 adjusted SSI incidence from 1.10% to 0.74% (P<0.001; relative reduction: -33%). The most significant SSI incidence reduction was observed for hernia repair and caesarean section, and to a lesser extent, cholecystectomy, hip prosthesis arthroplasty, and mastectomy. Active surveillance striving for a benchmark throughout a network is an effective strategy to reduce SSI incidence.

National influences on catheter-associated bloodstream infection rates: practices among national surveillance networks participating in the European HELICS project.

This study was performed to evaluate associations between organisational characteristics, routine practices and the incidence densities of central venous catheter-associated bloodstream infections (CVC-BSI rates) in European intensive care units (ICUs) as part of the HELICS project (Hospitals in Europe Link for Infection Control through Surveillance). Questionnaires were sent to ICUs participating in the national nosocomial infection surveillance networks in 2004. The national networks were asked for the CVC-BSI rates of the ICUs participating for the time period 2003--2004. Univariate and multivariate risk factor analyses were performed to identify which practices had the greatest impact on CVC-BSI rates. A total of 526 ICUs from 10 countries sent data on organisational characteristics and practices, demonstrating wide variation in care. CVC-BSI rates were also provided for 288 ICUs from five countries. This made it possible to include 1383444 patient days, 969897 CVC days and 1935 CVC-BSI cases in the analysis. Adjusted logistic regression analysis showed that the categorical variables of country [odds ratio (OR) varying per country from OR: 2.3; 95% confidence interval (CI): 0.5-10.2; to OR: 12.8; 95% CI: 4.4-37.5; in reference to the country with the lowest CVC-BSI rates] and type of hospital 'university' (OR: 2.08; 95% CI: 1.02-4.25) were independent risk factors for high CVC-BSI rates. Substantial variation existed in CVC-BSI prevention activities, surveillance methods and estimated CVC-BSI rates among the European countries. Differences in cultural, social and legal perspectives as well as differences between healthcare systems are crucial in explaining these differences.