The new "super-regulator" for health and social care is flexing its extended powers after identifying 21 NHS trusts as having failed to meet hygiene standards.
The Care Quality Commission (CQC) warned that all trusts had to meet government standards on cleanliness as part of their registration with the new watchdog.
As a result of these failures, conditions have been placed on the registration of 10 acute hospital trusts, six primary care trusts, four mental healthcare trusts and one ambulance trust.
The conditions are legally enforceable and failure to act means that trusts could be issued with warning notices and fines, or face prosecution or closure.
Four of those identified as having failed to meet the standards are NHS foundation trusts - trusts that have a degree of managerial and financial independence from the Department of Health and are supposed to be a marker of excellence.
The figures have stirred up fears about the regulation of foundation trusts following concerns over the high death rate at Mid Staffordshire NHS Foundation Trust - which had also been awarded the status.
Between 400 and 1,200 more people died at the trust than would have been expected between April 2005 and March 2008. A report by the Healthcare Commission called the standards of care at Mid Staffs "appalling".