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Item No.:
02
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Site:
Medical-Acute Gastroenteritis (AGE) Surveillance Log
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Violation:
The medical staff were using an older version of the AGE Surveillance Log, which had a different format and was missing data elements, such as patient ID and report to medical date/time.
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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-Clinical Specimen Collection
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Violation:
There were no clinical specimen collection containers for bacterial or viral analysis onboard, and no shipping boxes for specimens collected. Staff stated the supplies were ordered and they were awaiting delivery.
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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.:
06
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Site:
Potable Water-Microbiological Analysis
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Violation:
The ship began sailing in July and only began a contract for microbiological analysis for the potable water distribution system in August. Although samples were collected in August, there were no results on the ship from these samples.
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Recommendation:
Collect and analyze a minimum of four potable water samples per month for the presence of E. coli. Collect samples from the forward, aft, upper, and lower decks of the vessel. Change the sample sites each month so that all of the potable water distribution system is effectively monitored. Conduct follow-up sampling for each positive test result. Maintain sample results onboard the vessel for at least 12 months and ensure they are available for review during inspections.
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Item No.:
08
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Site:
Potable Water-Shore Connections
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Violation:
There were five separate reduced pressure assembly backflow preventers installed at the international connections for fire on the ship, but none had been pressure tested following installation. Staff stated the testing kit had been ordered.
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Recommendation:
Inspect and test backflow prevention devices requiring testing with a test kit after installation and at least annually. Maintain the test results showing the pressure differences on both sides of the valves for each device.
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Item No.:
08
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Site:
Food Service General-Ice Machines
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Violation:
The chilled water lines at all of the ice machines were not identified.
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Recommendation:
Uniquely identify all refrigerant brine lines in all galleys, pantries, and cold rooms to prevent cross-connections.
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Item No.:
16
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Site:
Buffet-Sailfish Bistro Buffet
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Violation:
The time control plan stated the breakfast service was 06:00 - 10:30. Containers of potentially hazardous foods, such as milk, scrambled eggs, etc., were not labeled with their 4-hour discard time. Staff stated the service period was actually 06:30 - 10:30. Also, the time control plan did not indicate the flow of hot potentially hazardous foods from cooking/hot holding to being placed on time control.
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Recommendation:
Update the time control plan to reflect the correct service set-up and discard times. 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): (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-Sailfish Bistro Buffet
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Violation:
Plates and bowls out for passenger self service were not inverted or covered.
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Recommendation:
During service, ensure the food contact portion of each self-service food dispensing utensil is covered or located beneath shielding. 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:
Buffet-Sailfish Bistro Buffet
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Violation:
The two platters of apples did not have serving utensils.
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Recommendation:
Provide food-dispensing utensils for each container displayed at a consumer self-service unit such as a buffet or salad bar.
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Item No.:
19
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Site:
Bar-Aqua Bar (Deck 10)
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Violation:
Plates out for passenger self service were not inverted or covered.
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Recommendation:
During service, ensure the food contact portion of each self-service food dispensing utensil is covered or located beneath shielding. 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:
Bar-Aqua Bar (Deck 10)
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Violation:
The two platters of sliced bread did not have serving utensils.
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Recommendation:
Provide food-dispensing utensils for each container displayed at a consumer self-service unit such as a buffet or salad bar.
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Item No.:
19
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Site:
Buffet-Crew Mess
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Violation:
Plates out for crew self service were not inverted or covered.
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Recommendation:
During service, ensure the food contact portion of each self-service food dispensing utensil is covered or located beneath shielding. Ensure that dishware, glassware, and utensils out for service are inverted or covered.
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Item No.:
20
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Site:
Preparation Room-Preparation Room (Deck 2)
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Violation:
The food contact area inside the potato peeler contained three slotted fasteners.
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Recommendation:
Use only low profile, nonslotted, noncorroding, and easy-to-clean fasteners on food-contact surfaces and in splash zones. Prohibit the use of exposed slotted screws, Phillips head screws, or pop rivets in these areas.
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Item No.:
21
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Site:
Bar-Aqua Bar (Deck 10)
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Violation:
The cords below the soda dispenser were draped across the counter, making cleaning difficult.
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Recommendation:
Shorten the length or elevate the cords from the counter.
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Item No.:
21
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Site:
Galley-Hot Section
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Violation:
The heat-resistant sealant around the grooved/flat grills was peeling, making cleaning difficult.
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Recommendation:
Remove the peeling sealant. Replace with a sealant that can withstand the repeated washing and sanitizing.
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Item No.:
21
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Site:
Dining Room-Ponce de Leon
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Violation:
The upper cabinets had exposed raw wood near the front edge. These cabinets contained cleaned glasses, some of which were inverted.
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Recommendation:
Ensure nonfood-contact surfaces of equipment that are exposed to splash, spillage, or other food soiling or that require frequent cleaning are constructed of a corrosion-resistant, nonabsorbent, and smooth material.
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Item No.:
21
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Site:
Galley-Hot Section
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Violation:
The drain pipe on the left steam boiler was leaking, causing water to pool on the deck. The leak was corrected.
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Recommendation:
Ensure nonfood contact equipment is maintained in good repair and proper adjustment including: (1) Equipment maintained in a state of repair and condition that meets the materials, design, construction, and operation specifications of these guidelines.
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Item No.:
21
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Site:
Bar-Casino Bar
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Violation:
The electrical cord below the espresso machine was draped across the counter, making cleaning difficult.
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Recommendation:
Shorten the length or elevate the electrical cord from the counter.
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Item No.:
21
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Site:
Bar-Aft Bar (Deck 9)
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Violation:
The electrical cord for the hot display cabinet was draped across the counter, making cleaning difficult.
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Recommendation:
Shorten the length or elevate the electrical cord from the counter.
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Item No.:
21
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Site:
Pantry-Aft Bar
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Violation:
Plastic wrap was used as a temporary splash panel between the spray hose and the clean storage shelves. This plastic wrap was not durable or easily cleanable. Staff stated a new splash panel was scheduled to be delivered by the end of September.
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Recommendation:
Ensure nonfood-contact surfaces of equipment that are exposed to splash, spillage, or other food soiling or that require frequent cleaning are constructed of a corrosion-resistant, nonabsorbent, and smooth material. Design and construct nonfood-contact surfaces of equipment and utensils to be durable and to retain their characteristic qualities under normal use conditions.
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Item No.:
22
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Site:
Pantry-Casino Bar Pantry
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Violation:
The undercounter dishwash machine did not have a manufacturer's data plate.
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Recommendation:
Ensure a warewashing machine is provided with an easily accessible and readable data plate affixed to or posted adjacent to the machine that indicates the machine's design and operating specifications including the: (1) wash tank, rinse tank(s) if present, and final sanitizing rinse temperatures; (2) pressure required for the fresh water sanitizing rinse unless the machine is designed to use only a pumped sanitizing rinse; (3) conveyor speed in feet per minute or minimum transit time for belt conveyor machines, minimum transit time for rack conveyor machines, and wash and final sanitizing rinse times as specified by the manufacturer for stationary rack machines.
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Item No.:
22
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Site:
Galley-Dishwash Machine
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Violation:
The manufacturer's data plate on the conveyor dishwash machine was located at the top back of the machine, which was difficult to read.
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Recommendation:
Ensure a warewashing machine is provided with an easily accessible and readable data plate affixed to or posted adjacent to the machine that indicates the machine's design and operating specifications including the: (1) wash tank, rinse tank(s) if present, and final sanitizing rinse temperatures; (2) pressure required for the fresh water sanitizing rinse unless the machine is designed to use only a pumped sanitizing rinse; (3) conveyor speed in feet per minute or minimum transit time for belt conveyor machines, minimum transit time for rack conveyor machines, and wash and final sanitizing rinse times as specified by the manufacturer for stationary rack machines.
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Item No.:
22
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Site:
Galley-Potwash Area
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Violation:
The potwash area did not contain soiled storage shelves. Numerous soiled items were stacked high on deck stands, but some soiled items were stored on the deck below the wash compartment and near the sanitizing compartment of the three-compartment sink.
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Recommendation:
Ensure drainboards, utensils, racks, or tables large enough to accommodate all soiled and cleaned items that may accumulate during hours of operation are provided for necessary utensil holding before cleaning and after sanitizing.
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Item No.:
27
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Site:
Bar-Aqua Bar (Deck 10)
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Violation:
Below the soda dispenser, the counter was soiled with more than one day's worth of dust and debris.
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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 Section
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Violation:
The metal handle and the joint on the tilting pan was heavily soiled with debris.
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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:
Other-Corridor Near Dry Storage (Deck 2)
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Violation:
A deck stand containing boxes of newly received chef's hats, plastic wrap, and salt was stored in the corridor where work was being done on the air conditioning exhaust. The deckhead above this deck stand was open to pipes.
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Recommendation:
Store cleaned equipment and utensils, laundered linens, and single-service and single-use articles: (1) in a clean, dry location; (2) in a location where they are not exposed to splash, dust, or other contamination.
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Item No.:
29
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Site:
Bar-Aqua Bar (Deck 10)
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Violation:
At the front bar counter, the minimum water temperature at the handwash station was 123°F. The bar was open during the inspection.
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Recommendation:
Ensure handwashing sinks are equipped to provide water at a temperature of at least 38°C (100°F) through a mixing valve or combination faucet. For handwash sinks with electronic sensors, and other types of handwash sinks where the user cannot make temperature adjustments, ensure the temperature provided to the user after the mixing valve does not exceed 49°C (120°F).
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Item No.:
33
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Site:
Buffet-Sailfish Bistro Buffet
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Violation:
Below the starboard handwash station, the deck/bulkhead coving was rough, making cleaning difficult.
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Recommendation:
Ensure decks, bulkheads, and deckheads in food preparation, warewashing, pantries, bars, and food and equipment storage areas are constructed and maintained for easy cleaning.
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Item No.:
33
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Site:
Pantry-Casino Bar Pantry
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Violation:
The electrical cables and water lines for the undercounter dishwash machine were draped across the deck, making cleaning difficult.
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Recommendation:
Shorten the length or elevate the electrical cables and water lines from the deck.
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Item No.:
33
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Site:
Pantry-Aft Bar
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Violation:
The electrical cables and water lines for the undercounter dishwash machine were draped across the deck, making cleaning difficult.
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Recommendation:
Shorten the length or elevate the electrical cables and water lines from the deck.
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Item No.:
36
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Site:
Buffet-Sailfish Bistro Buffet
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Violation:
The light intensity was less than 220 lux on the worker side of 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:
Buffet-Sailfish Bistro Buffet
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Violation:
The light intensity was less than 220 lux at the starboard handwash station.
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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:
Galley-Hot Section
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Violation:
The light intensity was less than 110 lux beside and between the convection ovens. The light intensity was less than 220 lux at the handwash station and at the two steam boilers.
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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. 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:
Dining Room-Ponce de Leon
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Violation:
The light intensity was less than 220 lux at all areas of the counter used for water pitchers and condiments.
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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.:
41
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Site:
Housekeeping-Outbreak Prevention and Response Plan (OPRP)
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Violation:
The written OPRP described steps at the green, yellow, and red level of management and response due to increasing AGE illness onboard, and stated that when a threshold was reached, the doctor would consult with the ship and corporate management to change the response level. There was no specific threshold or trigger noted for moving from green to yellow or even yellow to red.
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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: (1) Duties and responsibilities of each department and their staff for all the passenger and crew public areas; (2) Steps in outbreak management and control and the trigger for required action at each step. Ensure the triggers address a graduated approach to outbreak management in response to increasing case counts; (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); (4) Procedures for informing passengers and crew members of the outbreak. Ensure this section also includes procedures for notification of passengers embarking the vessel following an outbreak voyage or segment of a voyage; (5) Procedures for returning the vessel to normal operating conditions after an outbreak; (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-Outbreak Prevention and Response Plan (OPRP)
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Violation:
There were numerous statements in the OPRP about use of a Virox disinfectant, while others specified Oasis 146 (multi-quat sanitizer). Staff stated that Virox was not onboard and no longer used. There was no concentration specified for the Oasis 146, but a contact time on surfaces was listed as 5 minutes. It was not clear in reviewing the documentation for this product that it was ever tested for efficacy against calicivirus or other human norovirus surrogate. The documentation on the actual bottle described bacteria testing, but only stated viruses and fungi for disinfection, and specified for each that the product remain wet on surfaces for at least 10 minutes.
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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).
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Item No.:
41
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Site:
Housekeeping-Outbreak Prevention and Response Plan (OPRP)
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Violation:
The written OPRP did not include procedures to notify the passengers and crew of an AGE illness outbreak onboard. There were also no procedures to notify passengers boarding on the next voyage that an outbreak occurred on the previous voyage. There were no written procedures in the OPRP on returning the ship to normal operating conditions following and outbreak voyage.
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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: (4) Procedures for informing passengers and crew members of the outbreak. Ensure this section also includes procedures for notification of passengers embarking the vessel following an outbreak voyage or segment of a voyage; (5) Procedures for returning the vessel to normal operating conditions after an outbreak.
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Item No.:
41
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Site:
Housekeeping-Outbreak Prevention and Response Plan (OPRP)
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Violation:
The written OPRP included several areas with instructions for areas which did not exist on this vessel. They included, but were not limited to spa, salon, gym, crew gym, pool, duty free shop, and gift shop. Additionally, in all the food areas, including bars and beverage stations there was a procedure under a red level response to apply a 1,000 ppm chlorine disinfection on the food and non-food contact surfaces as part of an end of service disinfection each day in all back of house food areas.
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Recommendation:
Critically examine the OPRP and only areas which exist on the ship should be described. All reference to an end of the day 1,000 ppm chlorine disinfection must be removed, as such a procedure is only allowed in a case when a public vomiting takes place in a back of house food area.
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