The HEI report follows two visits to the Borders hospital
Healthcare inspectors have published a list of requirements to reduce the risk of infection to patients at Borders General Hospital.
It follows a visit to the site near Melrose at the beginning of March.
The Healthcare Environment Inspectorate (HEI) said it had found "poor infection control practices" which had raised "significant concerns".
However, a follow-up visit found NHS Borders staff had already taken action to address the issues.
The first inspection took place on 4 and 5 March.
HEI chief inspector Susan Brimelow said it had found "ineffective communication" between senior management, the infection control team and ward staff.
It also raised issues about infection control practices in the hospital.
Ms Brimelow said: "To ensure patient safety was not compromised, I asked the inspectors to make an unannounced inspection of specific areas of the hospital on 24 March.
"I was pleased to see that NHS Borders staff had taken immediate action around the concerns raised following the announced inspection and did not wait for the published report."
The report identifies 13 requirements and four recommendations for improvement at the BGH.
"We will be closely monitoring that NHS Borders deals with these matters as a priority over the coming months," said Ms Brimelow.
NHS Borders chief executive Calum Campbell said patient safety was its "number one priority".
He said: "All NHS Borders staff work hard to ensure we maintain the necessary standards of cleanliness and hygiene to minimise the risk of healthcare associated infection.
"We are committed to continually improving standards in this area.
"We recognise there are areas where we need to make further improvement and we have already put a comprehensive action plan in place to ensure we urgently implement the recommendations set out in the report."
He said that should quickly see "visible and sustainable improvements" to the service.
Health Secretary Nicola Sturgeon said the report was "disappointing" but she was heartened that improvements had been made.
She added: "It's plain that urgent improvements are necessary at Borders General Hospital and I expect this report to act as a catalyst for immediate change.
"I have asked my officials to provide all necessary support to ensure NHS Borders puts in place a robust infection control policy."