Warnings about substandard levels of hygiene and infection control have been issued to twenty-one NHS trusts, including four flagship foundation hospitals.

The Care Quality Commission (CQC), the new “super-regulator” for health and social care that started work on Wednesday, said that the trusts had failed to meet standards on cleanliness.

All 21 have had strict conditions placed on their registration with the commission, which is a legal requirement. Hospitals that fail to act to improve hygiene levels could be issued with warning notices and fines, or face prosecution or closure.

The CQC rulings, issued today, show that ten acute hospital trusts, six primary care trusts, four mental health care trusts and one ambulance trust have registration conditions as a result of failing to meet the criteria fully. The four trusts with foundation status — a supposed marker of excellence — are Kettering General Hospital, Leeds Partnerships, Medway and Alder Hey Children’s.

Fears over the regulation of foundation trusts were raised last month after it became clear that Mid Staffordshire NHS Foundation Trust had been awarded the status despite concerns over its death rates. The Healthcare Commission, the CQC’s predecessor, published a damning report on “appalling standards” of care at the trust. Between 400 and 1,200 more people died there than would have been expected between April 2005 and March 2008.

Today’s data shows that some trusts have been given a deadline for taking action to meet hygiene standards while others have conditions on their registration, such as the need to keep wards clean. Examples include ensuring that the decontamination of surgical equipment is satisfactory and developing tighter policies to tackle infections such as MRSA, Clostridium difficile and legionella.

Overall, 388 NHS trusts have been registered with the CQC, which replaces the Healthcare Commission, the Commission for Social Care Inspection and the Mental Health Act Commission.

As part of their assessment, trusts declared whether they were compliant with national hygiene standards. The CQC also looked at other information, including patient and staff surveys, hygiene inspections carried out by the Healthcare Commission and MRSA and C. difficile rates. Of the 21 trusts, 13 declared non-compliance with some of the criteria set down by the CQC for registration.

In another eight cases, the CQC had evidence that the trust had repeatedly failed to achieve required standards for infection control, had a high infection rate and/or was identified by the Healthcare Commission as having substantial problems that could risk patient safety.

The CQC defended its decision not to issue a hygiene warning to East Sussex Hospitals NHS Trust, which runs the Eastbourne hospital where a strain of C. difficile last month was linked to the deaths of 13 patients. It said that a warning had been considered, but the trust was handling the outbreak efficiently and appeared to have been victim of the small chance all hospitals have of such an incident occurring, rather than as a result of poor hygiene.

Over the next year, up to half of all NHS trusts providing acute, primary care, mental health and ambulance services will be inspected by the CQC.

Baroness Young of Old Scone, the chairwoman of the CQC, said that recent decreases in rates of MRSA and C. difficile reflected how infection control was improving nationally. “Most trusts have stronger systems to protect patients from infection than a few years ago, and trusts’ boards are taking the challenges seriously. We commend them for that,” she said.

She said that registration of NHS trusts based on healthcare-associated infection marked the first step in a new system to drive further improvement and ensure patients’ safety. “This was an opportunity for trusts to let the public know that they are taking effective action to tackle these infections. The overwhelming majority of trusts provided the assurance needed to register. We will closely monitor their performance to ensure they continue to meet the regulations and make improvements when required.”

Of the 21 trusts that had fallen below the CQC standards, she said: “We have placed rigorous conditions on these trusts’ registration and will monitor them closely.”

Hygiene warnings

— Alder Hey Children’s NHS Foundation Trust

— Barking, Havering and Redbridge University Hospitals NHS Trust

— Barnet, Enfield and Haringey Mental Health NHS Trust

— Barts and The London NHS Trust

— Coventry and Warwickshire Partnership NHS Trust

— Herefordshire PCT

— Isle of Wight NHS PCT

— Kettering General Hospital NHS Foundation Trust

— Leeds Partnerships NHS Foundation Trust

— Leeds Teaching Hospitals NHS Trust

— Lewisham PCT

— Manchester PCT

— Medway NHS Foundation Trust

— North Bristol NHS Trust

— Plymouth Hospitals NHS Trust

— Royal Surrey County Hospital NHS Trust

— Somerset PCT

— South West London and St George’s Mental Health NHS Trust

— United Lincolnshire Hospitals NHS Trust

— West Sussex PCT

— Yorkshire Ambulance Service NHS Trust

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