The reporting of healthcare-associated infections (HAIs), established by Decree No. 2001-671 of July 26, 2001, has been integrated into the public health alert system with the aim of optimizing HAI prevention efforts. Objectives - The objectives of this study were to describe the organization of internal and external reporting in healthcare facilities (HFs) in the Île-de-France region and to assess the motivations and challenges encountered in implementing this system. Methods - This was a self-reported survey of "reporting" officers at healthcare facilities in the Île-de-France region who had submitted at least one report to the Interregional Coordination Center for the Control of Nosocomial Infections in the Northern Interregion (CClin Paris-Nord) between February 1, 2004, and February 29, 2008, using a pre-designed questionnaire containing closed-ended questions on the organization of the reporting process and an open-ended question for suggestions on how to improve the system from those involved in reporting. The survey was conducted in 108 healthcare facilities in the Île-de-France region from May 20 to October 31, 2008, by a CClin intern. Results - The response rate was 60.1%. Regarding internal reporting, a specific form was available in 46.2% of healthcare facilities. In 86.2% of healthcare facilities in the Île-de-France region, there was a specific process for internal reporting of NI, and in 36.9% of cases, this process was computerized. The two main sources of internal reporting were the microbiology laboratory (84.6%) and the clinicians in charge of the cases (83.1%). External reporting was perceived by "reporting" managers as representing: (i) a useful tool for active participation in the health alert system (92.3%); (ii) support for implementing appropriate corrective measures (73.8%) or assistance with investigations (73.8%), primarily through the CClin; (iii) feedback to the networks of CClin correspondents. In 73.8% of cases, the “reporting” managers were satisfied with the feedback from the CClin, versus 29.2% who were satisfied with the feedback from the Ddass. The reporting of NI appears to have been established as a useful alert tool. However, there is still work to be done to make internal reporting channels truly operational. The development of a specific, accessible, and user-friendly IT tool for external reporting is underway. Furthermore, the role of the CClin is viewed as a positive asset. (R.A.)