A health watchdog found "poor" standards of cleaning with blood contamination in some wards on a recent hospital inspection.
Inspectors found blood contamination on wards including on an open bag of cotton wool, a refrigerator door and a patient drip stand at Raigmore Hospital in Inverness.
The Healthcare Environment Inspectorate (HEI) also found "significant" amounts of dust in wards at the hospital.
Its report also noted that compliance with standard infection control precautions were varied throughout the wards inspected.
HEI has now issued nine requirements which they expect NHS Highland to meet "as a matter of urgency".
These include ensuring that the patient environment is cleaned as often as specified in NHS guidelines and that there is enough cleaning equipment for domestic staff to use.
HEI officials carried out an unannounced inspection visit at the hospital on June 26 and 27. They published their report on Wednesday.
During their visit, the team noted that some patient equipment was dirty, with five of the nine commodes inspected "visibly stained or soiled", despite being marked as clean and ready for use.
HEI chief inspector Susan Brimelow said: "We found that NHS Highland is complying with some of the standards to protect patients, staff and visitors from the risk of acquiring an infection.
“However, we found that the standard of cleaning in the wards we inspected was poor and compliance with standard infection control precautions was varied.”
Labour health spokeswoman Jackie Baillie said the report was "deeply concerning" and said NHS Highland “should take this as a wake-up call”.
NHS Highland said that the hospital is using a new cleaning regime with a chlorine-based disinfectant, which means it is taking longer to do the actual cleaning, impacting on other tasks such as dusting.
It said that this has now been addressed by increasing the number of hours allocated to cleaning.
Una Lyon, lead nurse for the hospital, said: "The senior management team is obviously very concerned about the findings from the HEI report, which highlights areas where practice has fallen below the standard we would expect, and this is unacceptable.”
The health board has created an action plan to address the issues raised by the HEI with “immediate action” being taken where nessecary.
Theresa Fyffe, director of the Royal College of Nursing Scotland, said that senior charge nurses need the resources and the authority to get things done to ensure wards are clean and safe for patients.
She said: "It's not good enough to make them accountable for all that happens on their ward, but take away the means by which they can do their job effectively in areas such as domestic cleaning.
"How can they possibly be held to account for inconsistent and fragmented cleaning services, when they have no control over how many cleaners there are or when they work?"
A Scottish Government spokesman said that the public must have “complete confidence in the cleanliness of hospitals” and that the health board's improvement plan was welcomed.
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