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Item No.:
02
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Site:
Medical-Acute Gastroenteritis (AGE) Surveillance Log
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Violation:
Although many of the corrections required from the October 2012 VSP inspection findings were made, the AGE log did not have the patient ID column listed and the title 'Report to Medical' was not listed. For 'Report to Medical' the column for 'Date of Report' was present, but the time of report was absent.
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Recommendation:
Ensure the AGE surveillance log entry for each passenger or crew member contain the following information in separate columns: (1) Date of the first medical visit or report to staff of illness; (2) time of the first medical visit or report to staff of illness; (3) case identification number; (4) person's name; (5) person's age; (6) person's sex; (7) designation as passenger or crew member; (8) crew member position or job on the vessel, if applicable; (9) cabin number; (10) meal seating information; (11) date of illness onset; (12) time of illness onset; (13) illness symptoms, including the presence or absence of the following selected signs and symptoms, with a separate column for each of the following: (a) number of episodes of diarrhea in a 24-hour period; (b) number of episodes of vomiting in a 24-hour period; (c) bloody stools; (d) recorded temperature; (e) abdominal cramps; (f) headaches; (g) muscle aches; (14) entry (yes/no) for whether this was a reportable case; (15) entry (yes/no) for antidiarrheal medications sold or dispensed by designated medical staff; (16) presence of underlying medical conditions that may affect interpretation of AGE. Ensure the AGE surveillance log contains the above information in the exact order and is entered in the template in Annex 13.2.2. Ensure that the log data is exported in the exact order as in the example template in Annex 13.2.2 with analyzable formats such as Excel or Access. Ensure that any additional data fields are entered only outside of the form margins when exported to VSP.
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Item No.:
02
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Site:
Medical-Specimen Collection Containers
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Violation:
There was no supply of clinical specimen collection containers for bacterial analysis.
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Recommendation:
Ensure the medical staff maintains a supply of at least 10 clinical specimen collection containers for both viral and bacterial agents (10 for each), as well as a shipping container that meets the latest shipping requirements of the International Air Transport Association (IATA) and U.S. Department of Transportation for Biological Substances, Category B designated shipments (or higher). Ensure the vessel maintains the appropriate labels and markings required for shipping Biological Substances, Category B shipments. Ensure the vessel maintains appropriate refrigerant materials to keep clinical specimens cool. (see Annex 13.4 of the VSP 2011 Operations Manual.)
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Item No.:
05
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Site:
Potable Water-Far Point Distribution Analyzer - Calibration
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Violation:
The far point analyzer registered a free chlorine residual of 1.15 ppm. The manual measure made using the inspector's test kit was 1.61 ppm. The analyzer was immediately re-calibrated.
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Recommendation:
Ensure the free residual halogen measured by the halogen analyzer is within 0.2 mg/L (ppm) of the free residual halogen measured by the manual test.
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Item No.:
08
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Site:
Potable Water-Main Laundry and Deck 2 Laundry
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Violation:
There were noncontinuous pressure backflow prevention devices installed on each of the laundry washing machines, each of which was installed between two valves and under continuous pressure.
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Recommendation:
Install a continuous pressure-type backflow preventer when a valve is located downstream from the backflow preventer.
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Item No.:
08
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Site:
Potable Water-Brass Backflow Preventers
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Violation:
It could not be determined if the German model brass backflow prevention devices installed in the galley were continuous pressure devices. The literature provided was written only in German and no translation was possible on the day of inspection.
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Recommendation:
Determine whether these backflow prevention devices are continuous pressure devices. Install a continuous pressure-type backflow preventer when a valve is located downstream from the backflow preventer.
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Item No.:
16
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Site:
Pantry-Caledonian Bar
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Violation:
There was no posted time control plan for the milk used in the cappuccino machine.
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Recommendation:
Maintain a written time control plan(s) that ensures compliance with these guidelines on the vessel and make it available for review during inspections. Post a time control plan at each outlet where time control is used. Ensure plan(s): (1) Includes set-up and discard times for each outlet. (2) List refrigeration and hot holding units (compartments and cabinets) on time control (the physical units must also be labeled as such). (3) Describe or show the flow of potentially hazardous food from when last in temperature control to placement in time control and discard.
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Item No.:
16
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Site:
Buffet-Crew Mess
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Violation:
There was no time control plan posted in this area. The units where time control was used were marked as being on time control. A new time control plan was posted during the inspection.
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Recommendation:
Maintain a written time control plan(s) that ensures compliance with these guidelines on the vessel and make it available for review during inspections. Post a time control plan at each outlet where time control is used. Ensure plan(s): (1) Includes set-up and discard times for each outlet. (2) List refrigeration and hot holding units (compartments and cabinets) on time control (the physical units must also be labeled as such). (3) Describe or show the flow of potentially hazardous food from when last in temperature control to placement in time control and discard.
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Item No.:
19
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Site:
Buffet-Crew Mess
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Violation:
Two stacks of small plates out for self service were not inverted or covered.
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Recommendation:
Ensure that dishware, glassware, and utensils out for service are inverted or covered.
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Item No.:
19
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Site:
Provisions-Fish Room
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Violation:
A stack of lemon sorbetto containers was stored on the deck near the door. This freezer was completely filled with food items and needed to be reorganized.
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Recommendation:
Protect food from contamination by storing the food: (4) At least 15 centimeters (6 inches) above the deck.
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Item No.:
20
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Site:
Galley-Potwash
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Violation:
On the clean storage racks, a large white cutting board was stained with a dark material.
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Recommendation:
Ensure materials used to make single-service and single-use articles do not impart colors, odors, or tastes to food and are clean.
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Item No.:
22
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Site:
Pantry-Outdoor Lido
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Violation:
The undercounter dishwash machine was posted out of order. This was written on the last inspection. Although parts were ordered to repair the machine, the parts received were not correct. A new work order was recently placed for a new machine.
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Recommendation:
Repair or replace the undercounter dishwash machine.
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Item No.:
26
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Site:
Galley-Potwash
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Violation:
On the clean storage racks, some of the pans had food debris on the inside.
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Recommendation:
Ensure food contact surfaces of equipment and utensils are clean to sight and touch.
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Item No.:
27
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Site:
Galley-Hot Galley
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Violation:
Next to undercounter refrigerator #134, the inside of the technical cabinet had an accumulation of dust and debris on the top and near the back.
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Recommendation:
Ensure nonfood-contact surfaces of equipment are kept free of an accumulation of dust, dirt, food residue, and other debris.
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Item No.:
27
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Site:
Galley-Hot Galley
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Violation:
The drip pan housing chute for the large flat grill was heavily soiled with dried grease and debris. The grill and housing had been previously cleaned.
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Recommendation:
Ensure nonfood-contact surfaces of equipment are kept free of an accumulation of dust, dirt, food residue, and other debris.
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Item No.:
27
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Site:
Galley-Hot Galley
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Violation:
Below the preparation counter containing the utility sink, the inside of the technical cabinet was soiled with dust.
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Recommendation:
Ensure nonfood-contact surfaces of equipment are kept free of an accumulation of dust, dirt, food residue, and other debris.
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Item No.:
27
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Site:
Pantry-Outdoor Lido
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Violation:
The top of the undercounter dishwash machine was soiled with dust.
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Recommendation:
Ensure nonfood-contact surfaces of equipment are kept free of an accumulation of dust, dirt, food residue, and other debris.
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Item No.:
28
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Site:
Galley-Potwash
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Violation:
On the clean storage racks, all of the hotel pans, bowls, and lids of various sizes were stacked wet, preventing proper air drying.
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Recommendation:
After cleaning and sanitizing, ensure equipment and utensils are air dried or adequately drained before contact with food.
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Item No.:
30
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Site:
Galley-Crew Toilet Room
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Violation:
Outside the galley, the toilet room used by food workers had the 'Wash Hands After Using Toilet' sign posted on the bulkhead next to the handwash station.
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Recommendation:
Ensure signs are conspicuously posted on the bulkhead adjacent to the door of the toilet, reading "WASH HANDS AFTER USING TOILET " in a language that the food employees understand.
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Item No.:
30
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Site:
Pantry-Outdoor Lido
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Violation:
At the entrance to the pantry, there was no waste receptacle for the handwash station. This was corrected.
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Recommendation:
Ensure a handwashing facility includes a sink, soap dispenser, single-use towels dispenser, and waste receptacle.
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Item No.:
30
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Site:
Pantry-Caledonian Bar
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Violation:
This bar pantry contained two handwash stations. The handwash station behind the entrance door did not have a paper towel dispenser or a waste receptacle. The handwash station at the preparation counter did not have a sign stating 'Wash Hands Often' or similar wording. Staff stated they were going to remove these two handwash stations, since they only used the handwash station on the other side of the door in the bar.
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Recommendation:
Ensure a handwashing facility includes a sink, soap dispenser, single-use towels dispenser, and waste receptacle. Post a sign over handwashing sinks stating "WASH HANDS OFTEN" in a language that the food employees understand.
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Item No.:
32
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Site:
Pantry-Crew Mess Dishwash
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Violation:
At the soiled landing of the dishwash area, the waste receptacle was half-full of food waste and was not covered. The area was not in operation during the inspection.
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Recommendation:
Cover receptacles and waste-handling containers when not in continuous use and after they are filled.
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Item No.:
33
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Site:
Dining Room-
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Violation:
There was no cabinet/deck coving along the worker side of the center area of the buffet line.
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Recommendation:
Cove all bulkhead/deck, equipment/deck, cabinet/deck, and deck sink coaming/deck junctures (including galleys, pantries, buffets, bars, waiter stations, dining room work counters, provisions, food storage rooms, equipment/utensil storage rooms, and toilet rooms intended for use by galley personnel).
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Item No.:
33
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Site:
Dining Room-
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Violation:
The deck was soiled with dust and debris below the portable sections of the buffet line. The area had been previously cleaned and was not in operation during the inspection.
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Recommendation:
Ensure decks, bulkheads, deckheads, and attached equipment in food preparation, warewashing, pantries, and storage areas are cleaned as often as necessary.
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Item No.:
33
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Site:
Preparation Room-Bakery
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Violation:
There were two large openings above the combination ovens where the ventilation pipes penetrated the deckhead.
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Recommendation:
Close the openings around the deckhead pipe penetrations.
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Item No.:
34
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Site:
Buffet-Crew Buffet Line
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Violation:
On the worker side of the buffet line, the handwash station bucket fill tap was leaking.
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Recommendation:
Ensure the plumbing system in a food area is maintained in good repair.
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Item No.:
34
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Site:
Pantry-Outdoor Lido
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Violation:
The utility sink faucet next to refrigerator #1 was leaking. Staff stated a work order had already been placed.
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Recommendation:
Ensure the plumbing system in a food area is maintained in good repair.
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Item No.:
36
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Site:
Dining Room-
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Violation:
The light intensity was less than 220 lux along the buffet line.
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Recommendation:
Ensure the light intensity is at least 220 lux (20 foot candles) on food preparation surfaces, and at a distance of 75 centimeters (30 inches) above the deck in food preparation areas, handwashing facilities, warewashing areas, equipment, and utensil storage, pantries, toilet rooms, and consumer self-service areas.
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Item No.:
36
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Site:
Preparation Room-Bakery
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Violation:
The light intensity was less than 110 lux between and behind the two combination ovens.
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Recommendation:
Ensure the light intensity is at least 110 lux (10 foot candles) behind and around mounted equipment, including counter-mounted equipment.
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Item No.:
36
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Site:
Galley-Crew Cook Area
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Violation:
The light intensity was less than 220 lux to the right of the tilting pans and less than 110 lux behind the combination ovens. During the inspection the right light bulb was not working. A crew member replaced the light bulb, which increased the light intensity to above the required level.
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Recommendation:
Ensure the light intensity is at least 220 lux (20 foot candles) on food preparation surfaces, and at a distance of 75 centimeters (30 inches) above the deck in food preparation areas, handwashing facilities, warewashing areas, equipment, and utensil storage, pantries, toilet rooms, and consumer self-service areas. Ensure the light intensity is at least 110 lux (10 foot candles) behind and around mounted equipment, including counter-mounted equipment.
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Item No.:
41
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Site:
Housekeeping-Outbreak Prevention and Response Plan (OPRP)
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Violation:
Although a number of changes were made to the written acute gastroenteritis OPRP since the October 2012 VSP inspection, some of the details were still incomplete. For disinfectants used there was sufficient detail for chlorine, but beside it and throughout the document the term 'virucidal disinfectant' was noted with no other description or detail of the concentration or contact time for application. In reviewing the various disinfectants stored in the outbreak storage locker, the disinfectants provided were specifically for bacteria, yeasts, and fungi. There was nothing indicating they were effective for viruses or caliciviruses. There were statements about fogging of areas throughout the plan in level 3 response, but no fogging chemical was specifically mentioned. In the hard surface cleaning section the term 'frequently' was used under level 3 rather than continuously. Although during fogging the plan made clear passengers were not to be present, there was no advisory about respiratory or dermal protection of passengers to the 1,000 ppm chlorine used to wipe or spray on nearly all the hand contact hard surfaces and furnishings in level 3. Lastly, the hit squad procedures listed an increase of chlorine concentration to 200 ppm for responses, but that is not an effective concentration for the type of body fluid responses this squad deals with.
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Recommendation:
Ensure each vessel has a written OPRP that details standard procedures and policies to specifically address AGE onboard. Include the following in the written OPRP: (3) Disinfectant products or systems used, including the surfaces or items the disinfectants will be applied to, concentrations, and required contact times. Ensure the disinfectant products or systems are effective against human norovirus or an acceptable surrogate (e.g., caliciviruses); (6) Procedures to protect the passengers and crew from exposure to disinfectants, if not already included in the vessel's safety management system. Ensure this protection includes: (a) Material safety data sheets (MSDSs); (b) Personal protective equipment for crew; (c) Health and safety procedures to minimize respiratory and dermal exposures to both passengers and crew.
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Item No.:
41
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Site:
Housekeeping-Crew Toilets
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Violation:
The crew public toilet on deck 2 and the bridge toilet did not have a sign posted to advise use of a paper towel to open the door on exit. The bridge toilet did not have a sign or pictogram at the handwash sink advising handwashing.
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Recommendation:
Post a sign advising users of toilet facilities to use hand towel, paper towel, or tissue to open the door unless the exit is hands free. Provide the passenger and crew public toilets with a handwashing station that includes: (4) A sign advising users to wash hands.
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Item No.:
43
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Site:
Ventilation-Heating, Ventilation, and Air Conditioning System
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Violation:
There was no written plan for the inspection and maintenance of the HVAC system. Ship staff stated that the maintenance frequency of every three months checking each fan unit air filter was part of the instruction given by the previous refrigeration engineer.
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Recommendation:
Ensure vessels have a plan to inspect and maintain HVAC systems in accordance with the manufacturer's recommendations and industry standards. Maintain the written inspection, cleaning, and maintenance plan for the HVAC system on the vessel and available for review during inspections. Ensure documentation of the inspection, cleaning, and maintenance plan is available for review during inspections.
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