Fewer than half the hospitals in England have good or excellent cleanliness ratings, the health minister Lord Warner said yesterday as he revealed measures to tackle superbugs.
Just three, all mental health units, were judged "unacceptable", but a further 24 were "poor", according to spot checks by teams including local health officials and patient representatives.
The figures for 1,184 hospitals were published as the Department of Health issued guidance on tackling super-bugs, of which the most notorious, MRSA, is blamed for 5,000 deaths a year.
Lord Warner said some NHS trusts might want to renegotiate cleaning contracts because of shortcomings.
Although ministers and health specialists caution against a simple causal link between cleanliness and infection, Lord Warner conceded: "It is improbable that a consistently dirty hospital has low cross-infection rates."
And the chief nursing officer, Christine Beasley, stressed that hospitals should be clean even if there was "zilch infection". It was a confidence issue for patients, she said.
The old green, amber and red classification system has been replaced with a five-point scale of excellent, good, acceptable, poor and unacceptable. A first round of inspections this year found 90 hospitals in the bottom two categories, so there had been some improvement. But 583 hospitals were still only acceptable, while 456 were good and 118 excellent.
Costs of hospital cleaning have been driven down in recent years, and the government believes trusts may have to spend more to raise standards. They say contracts must be driven by quality rather than price.
Although all three unacceptable units had contracted-out cleaning services, nine of the 24 poor hospitals had in-house arrangements.
The guidance advises on how regularly to clean 49 separate elements - from commodes and washbowls to clip boards, from drugs trolleys to entrance halls. Lord Warner said: "This means both hospitals and cleaning firms know what is expected."
The number of acceptable hospitals at present was "unfortunately large", and might mean many were "happy to be average", he added. Other simple measures are being introduced, such as making staff and visitors clean their hands with alcohol-based rubs.
Dave Prentis, the general secretary of the union Unison, said: "If you want cleaner hospitals _ you must have more cleaners. At the heart of the rise in infection rates is the fact that over the past 15 years, the number of hospital cleaners has been cut by more than half."
The Tories said they would shut "dirty MRSA-infected wards", and the Liberal Democrats blamed government targets for hampering infection control. A spokesman said: "Patients are shunted from ward to ward and there is not enough time to clean beds properly."
