OBJECTIVE: To evaluate the applicability of the HELICS program [part of the "Improving Patient Safety in Europe" program aiming at controlling nosocomial infections (NI) through surveillance] in European pediatric ICUs. DESIGN AND SETTING: A comparison of HELICS and pediatric definitions of the main NI was performed. The adaptability of the HELICS questionnaire for pediatric patients was examined. Then a European survey was carried out by e-mail questionnaire to analyze NI surveillance programs. PARTICIPANTS: Units affiliated with the European Society of Paediatric and Neonatal Intensive Care or the French Groupe Francophone de Reanimation et Urgences Pediatriques. MEASUREMENTS AND RESULTS: The main differences between adult and pediatric ICUs were the definition of ICU-acquired pneumonia, severity scores at admission, and scores of risk for NI. A total of 65 answers from 23 countries were collected. Among them 56 had a NI surveillance program that was of local origin for 64%. The most frequently collected NI were blood stream infections (91% of the units), catheter-related infections (88%), acquired pneumonia (86%), and urinary tract infections (77%). Definitions of NI had a local-based origin in 18% of cases, a regional-based or nation-wide origin in 21%, came from the Centers for Disease Control and Prevention in 38% and had multiple origins in 20%. Seventy-five percent of the units declared an interest in joining a European pediatric working group on NI within the European Society of Paediatric and Neonatal Intensive Care. CONCLUSIONS: The adaptation of the HELICS protocol for pediatric ICUs is necessary. Its application is largely wished and may be easily performed.