A hole in a toilet wall was one failing highlighted/Image from NHS Quality Improvement Scotland report
Health Secretary Nicola Sturgeon has demanded "urgent improvements" at Aberdeen Royal Infirmary.
It follows a Healthcare Environment Inspectorate report highlighting issues needing to be addressed, including cleanliness and infection control.
Ms Sturgeon said: "This report makes difficult reading. I am disappointed that so much room for improvement has been identified."
A follow-up inspection was said to already have found some progress.
Inspectors had found patients who should be in isolation being treated in general wards, and stains and spillages that had not been cleaned up.
Patient safety is at the core of our service, and remains the top priority for all our staff
NHS Grampian chief executive
They also found a lack of communication between management and ward staff about controlling infections.
Ms Sturgeon said: "Some of what the inspectorate has found is simply unacceptable. However, the whole purpose of the inspectorate is to shine a light on areas of weakness and then ensure that improvements are made.
"It is very welcome news that a follow-up unannounced inspection found that urgent action is already being taken and many concerns have already been addressed.
"I now expect NHS Grampian to implement all the inspectorate's recommendations urgently and in full."
NHS Grampian chief executive Richard Carey responded: "It is vitally important to this organisation that we learn from this inspection and act swiftly on its recommendations.
"We will therefore work closely with the inspectorate in implementing their recommendations on improving our infection control measures, and report regularly to our board on progress.
Aberdeen Royal Infirmary was said to have room for improvement
"The public will quite rightly seek reassurance that the hospital is as safe as possible. We intend to provide that reassurance not through words but by our actions, so that when next an inspection is carried out the inspectorate will report full compliance with their recommendations."
He added: "Patient safety is at the core of our service, and remains the top priority for all our staff."
The Scotland Patients Association told BBC Scotland it was pleased at the "robust" inspection.
A spokeswoman said: "It is the responsibility of all NHS staff to understand how not to spread infection and it is the responsibility of management to make sure that all procedures and protocols are adhered to.
"Patients need to feel safe when they have to go into hospital and reports such as this, which show there is still room for improvement, do not instil 100% confidence."
Royal College of Nursing Scotland director Theresa Fyffe said: "It is important that the Healthcare Environment Inspectorate continues to work in a spirit of partnership and improvement with healthcare staff and that all health boards learn from the reports published so far."