Staff at a West Yorkshire accident and emergency department have been criticised for failing to clean equipment between patients.
Inspectors from watchdog the Care Quality Commission (CQC) observed several instances of hygiene procedures not being followed at Pinderfields Hospital in Wakefield.
The trust which runs the hospital said patient demand was so high at the time that it had to declare a critical incident. Staff were working in "extremely challenging conditions", it said.
The CQC has told Mid Yorkshire Hospitals NHS Trust to make improvements following the inspections at Pinderfields and Dewsbury and District Hospital.
In a statement the watchdog said: "In the emergency department staff did not always clean equipment after patient contact.
"Inspectors saw a number of examples where staff did not clean equipment in between patients.
"We saw examples of equipment used to transfer patients by ambulance staff, and not being cleaned after use. There were also examples of monitoring equipment being used and not cleaned between patients."
The CQC inspected medical services, maternity and children's services, as well as A and E, at both Pinderfields and Dewsbury.
Its overall rating for the trust remained "requires improvement".
At both sites medical care dropped from "good" to "requires improvement", while urgent and emergency service remained as "requires improvement". Services for children and young people were once again rated "good".
Maternity at Dewsbury and District Hospital remained "good", while at Pinderfields Hospital the department improved from "requires improvement" to "good".
CQC head of hospital inspection Sarah Dronsfield acknowledged that staff were working hard "under sustained pressure".
She said bosses were trying to implement improvements, but added: "At the time of our inspection the improvements that had been put in place weren’t consistently embedded or having a significant positive impact on people’s experiences and more needs to be done, especially around managing patient flow through the hospitals.
"The trust must ensure that they make the necessary improvements and work closely with system partners to improve patient flow into and out of the hospitals. We will keep a close eye on progress and will return to ensure that the required improvements are made."
Trust chief executive Len Richards said the report showed there had been improvements "in the most challenging of circumstances" but staff were disappointed at the rating given by the CQC.
He added: "This inspection took place at a time when the number of patients coming through our doors was extremely high. In prioritising getting patients off ambulances so they could get back out on the road, our emergency departments were very congested, as were our medical wards.
"This clearly impacted on the demands on our staff and therefore the observations of the inspectors."
On the occasions when equipment was not cleaned, the trust said the emergency department was experiencing such high patient numbers it had to declare a critical incident and the demands on staff were "extremely challenging".
In a statement, it added: "Nevertheless, we are taking follow up action to ensure cleaning procedures are followed."
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