Inspectors found two patient trolleys "heavily contaminated with blood and faeces" on a visit to Scotland's newest hospital.
The trolleys were in cubicles ready for the next patient in the immediate assessment unit (IAU) at Queen Elizabeth University Hospital in Glasgow.
The Healthcare Environment Inspectorate (HEI) team also found two of the seven communal patient toilets in the unit "heavily contaminated with faeces" on the walls, mirrors and basins.
Inspectors raised "significant concerns" about cleanliness in the emergency department, IAU and clinical decisions unit following their unannounced visit between December 12 and 15 last year.
By the time of their follow-up visit on January 16-17, inspectors found a number of improvements had been made.
Alastair McGown, senior inspector for Healthcare Improvement Scotland, said: "At our first inspection we noted the standard of environmental cleanliness in the majority of wards and staff knowledge of standard infection control precautions was generally good.
"However, we had significant concerns in the emergency department and immediate assessment unit, and the systems in place for monitoring cleanliness.
"We formally escalated these concerns to NHS Greater Glasgow and Clyde's (NHSGGC) senior management team at the time of our inspection and asked them to take remedial action without delay."
It was the first inspection of the 1,109-bed acute hospital, which opened in April 2015.
During their initial visit in December, HEI found a variety of patient equipment in the emergency department was contaminated with dust, debris or body fluids.
They found the majority of patient trolleys and transport chairs ready for use by the emergency department and IAU were dirty, and the majority of toilets in the atrium, mezzanine level one and the emergency department waiting area were contaminated with blood, faeces, urine or vomit.
In December there were no dedicated staff to clean the IAU, however by January the unit had dedicated domestic staff, while there had also been an increase in domestic staff provision in the emergency department.
But during the January follow-up visit, inspectors found a "significant amount" of patient equipment in the emergency department was contaminated with body fluids and dust.
HEI issued 10 requirements and three recommendations following its inspections.
NHSGGC said "significant changes" have already been made including more domestic time allotted to the emergency department and IAU, a programme of ongoing staff retraining across the service, and improved communication between domestic staff and clinical colleagues.
NHSGGC's nurse director Margaret McGuire said: "Recently an HEI inspection at the QEUH identified shortcomings in the cleanliness of equipment, general cleanliness in the emergency department and domestic record keeping.
"A more recent follow-up inspection identified that not all of the issues picked up on the first visit had been addressed.
"This is unacceptable and I want to publicly assure every one of our patients and their families that the issues raised are now being fully addressed and will be rigorously implemented and maintained going forward."
Dr Jennifer Armstrong, NHSGGC medical director, added: "Our staff take these inspection reports very seriously and have been working extremely hard to address the requirements made by the inspection team."
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