Take a look at our tips on Safety In Rome . While we usually drink bottled water at meals as a matter of taste, we drink lots of tap water in the room. English, for many Italians, is a third language, not a second. Natives of Emilia-Romagna, for example, cannot easily understand a southern dialect, and vice versa, of course. English is understood and spoken moderately well in tourist areas in Rome and major cities.
Many waiters can give at least a sketchy description of selections in English.
However, more than in Northern Europe, you'll find a few words of the local language useful. The more off the beaten track, the more inexpensive the restaurant, hotel or shop, the more at least a little Italian will be helpful. You'll find your trip is much more enjoyable with these in your pocket or purse. See Language Skills for a longer discussion of the usefulness of a bit of language prep before your trip. We also have a very basic list of useful phrases .