None of the State's 51 public hospitals received a top score in the latest national review of hospital hygiene published yesterday.
Seven hospitals were rated "good", the majority or 35 hospitals were rated "fair" and nine hospitals were ranked at the bottom of the league as "poor".
The review was carried out by the Health Information and Quality Authority (HIQA) and follows unannounced visits to hospitals earlier this year.
The organisation said it was disappointed most hospitals were only in the fair category and said this was due in many cases to a lack of emphasis at corporate management level on hospital hygiene.
The report noted that while good hygiene practice of front-line staff is vital, "high performance also depends on good leadership and effective management to ensure that efforts at governing, identifying, managing and reducing infection are sustained".
Jon Billings, HIQA's director of healthcare quality, said the overriding message to hospitals was that they can and should do better. He noted that while hand hygiene in most hospitals was now good, hospitals were falling down in a range of other areas.
Individual reports on hospitals showed many were not being properly cleaned. There was dust on beds, pipes and floors and at Our Lady's Hospital in Navan, for example, intravenous pumps were not clean, giving rise to a risk of cross-infection among patients.
The review did not look at infection rates in hospitals but Mr Billings said it was accepted there was a link between hygiene standards and healthcare-associated infections.
The HIQA report noted that good hygiene practice is a fundamental building block of safe, effective healthcare. "Our health and social care services must be delivered in appropriately clean settings so that our care reduces rather than increases the likelihood of infection," it said.
The hospitals that got a "good" rating were Tallaght, Beaumont, St James's, St Vincent's and the Rotunda in Dublin; St Luke's in Kilkenny and Naas General Hospital.
The nine hospitals that achieved a "poor" score were mainly smaller hospitals. They include Wexford General, Nenagh General, Roscommon County Hospital, Portiuncula in Ballinasloe, Navan hospital, Mallow General, St Michael's in Dún Laoghaire, St Mary's Orthopaedic Hospital in Cork and Our Lady of Lourdes in Drogheda.
St Mary's Orthopaedic Hospital in Cork did not submit any information regarding corporate management of hygiene and therefore got no rating on that aspect. The report said this was because there was confusion regarding who was responsible, and this was unacceptable.
Fewer than half the hospitals were found to have good arrangements in place for monitoring external cleaning contractors. Five had none at all.
HIQA stressed the findings could not be compared with the results of two previous hygiene audits commissioned by the HSE when hospitals such as Mallow fared very well as it assessed a wider range of areas in hospitals including theatres. It also placed more emphasis on corporate responsibility for hygiene.
The report makes several recommendations. One is that the HSE should establish a national set of indicators for monitoring hygiene, infection prevention and performance control.
It says focusing on hospitals is not sufficient to drive down healthcare-associated infections. There needs to be an integrated national plan that incorporates tackling the problem in all care settings including nursing homes and primary-care settings.