The hospital trust says it is "extremely concerned" by the strike
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About 150 hospital porters and cleaners in Greater Manchester were still refusing to work on Tuesday over a pay dispute.
Staff at the Royal Bolton Hospital say they are not currently paid a "decent living wage".
The action comes after a break down in negotiations with their employer, ISS Mediclean.
Bolton Hospitals NHS Trust said care in certain areas would be reduced at the hospital, adding it was "extremely concerned" by the strike.
ISS Mediclean said it provided a "near normal" portering service on Monday while critical areas - such as intensive care, theatres and patient movements - were not affected.
National guidelines
A spokesman said: "We will continue to work closely with the trust to ensure that disruption is kept to a minimum and that patient safety is not compromised.
"This still remains our priority."
The workers' union Unison has told the trust that its members will return to work in the event of a major incident.
The dispute arose after a pay claim was lodged to increase wages to £5 an hour for cleaners and £5.50 for porters.
Cleaning staff are currently employed by ISS Mediclean on £4.47 an hour and porters earn £4.61 an hour.
ISS Mediclean says it offered a 3.23% rise backdated to April, in line with national pay guidelines.
A further stoppage is scheduled to take place from 30 June.