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Item No.:
02
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Site:
Medical-Acute Gastroenteritis (AGE) Surveillance Log
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Violation:
The electronic AGE surveillance log was not identical in content or design to the standardized AGE log provided in section 13.2 of the 2011 VSP Operations Manual. The exact version of the VSP AGE log could not be exported either.
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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-Acute Gastroenteritis (AGE) Surveillance Log
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Violation:
The definition of a reportable case of gastrointestinal (GI) illness in the ship's AGE log and some other electronic documents was not current with the 2011 VSP Operations Manual definition.
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Recommendation:
Ensure a reportable case of AGE is a case reported to the master of the vessel, the medical staff, or other designated staff by a passenger or a crew member and meets the case definition based on the following symptoms: (1) Diarrhea (three or more episodes of loose stools in a 24 hour period or what is above normal for the individual. See section 4.1.2.1.3, illness symptoms); or (2) vomiting and one additional symptom including one or more episodes of loose stools in a 24-hour period, or abdominal cramps, or headache, or muscle aches, or fever (temperature of greater than or equal to 38C [100.4F]).
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Item No.:
08
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Site:
Potable Water-Inspection Record
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Violation:
There was an electronic listing of all backflow preventers and air-gaps onboard which included inspection results, date, and comments, but staff stated that these were done at one time and the only record maintained was for the single job. There was nothing recorded on the sheet for the inspection of each individual prevention device or method.
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Recommendation:
Ensure the cross-connection control program includes at a minimum: a complete listing of cross-connections and the backflow prevention method or device for each, so there is a match to the plumbing system component and location. Include air gaps on the listing. Ensure a schedule for inspection frequency is set. Maintain a log documenting the inspection and maintenance in written or electronic form, and ensure it is available for review during inspections.Record inspection results for each prevention device/method.
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Item No.:
16
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Site:
Galley-Consumer Advisory
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Violation:
The ala carte breakfast and dinner menus included animal-derived foods such as lamb, duck breast, steak, and eggs benedict. There was no consumer advisory on these menu's and no asterisk at the foods which are not fully cooked to coincide with an advisory. In the buffet menu there is a cold-smoked salmon and bagel dish offered for passenger self-service, but staff stated there is no sign posted at the buffet for that food with a consumer advisory.
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Recommendation:
If an animal food such as beef, eggs, fish, lamb, milk, pork, poultry, or shellfish that is raw, undercooked, or not otherwise processed to eliminate pathogens is offered in a ready-to-eat form or as a raw ingredient in another ready-to-eat food, ensure the consumer is informed by way of disclosure using menu advisories, placards, or other easily visible written means of the significantly increased risk to certain especially vulnerable consumers eating such foods in raw or undercooked form. Locate the advisory at the outlets where these types of food are served. Ensure that raw shell egg preparations are not used in uncooked products as described in section 7.3.3.2.3. Ensure that disclosure is made by one of the two following methods: (1) On a sign describing the animal-derived foods (e.g., ?oysters on the half-shell,? ?hamburgers,? ?steaks,? or ?eggs?); AND that they can be cooked to order and may be served raw or undercooked; AND a statement indicating that consuming raw or undercooked meats, seafood, shellfish, eggs, milk, poultry may increase your risk for foodborne illness, especially if you have certain medical conditions. Ensure the advisory is posted at the specific station where the food is served raw, undercooked, or cooked to order OR (2) On a menu using an asterisk at the animal-derived foods requiring disclosure and a footnote with a statement indicating that consuming raw or undercooked meats, seafood, shellfish, eggs, milk, or poultry may increase your risk for foodborne illness, especially if you have certain medical conditions.
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Item No.:
17
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Site:
Galley-Parasite Destruction
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Violation:
The wild, cold-smoked salmon provided in ready-to-eat form on certain buffet menu's is received frozen and stored frozen on board, but there is no documentation that this salmon was frozen to a temperatue and time necessary to kill parasites.
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Recommendation:
If raw, raw-marinated, partially cooked, or marinated partially cooked fish are served in ready-to-eat form, ensure: (1) The person in charge records the freezing temperature and time to which the fish are subjected and retains the records on the vessel for 90 calendar days beyond the time of service or sale of the fish; or (2) If the fish are frozen by a supplier, a written letter from the supplier which specifies the fish species involved and both the temperature to which the fish was frozen and the total time period at that temperature. If the supplier provides any of the same species to the vessel in a fresh state, ensure there is a designation on the outer packaging for the parasite-free fish.
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Item No.:
18
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Site:
Galley-Galley
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Violation:
Upon review of the menu's it was found that eggs benedict is served once weekly for breakfast. In questioning the staff it was determined that raw shell eggs are used in the preparation of the hollandaise sauce for this dish. No pasteurized egg or egg products are ordered for this vessel.
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Recommendation:
Substitute pasteurized eggs or egg products for raw shell eggs in the preparation of foods such as Caesar salad, hollandaise, or barnaise sauce, mayonnaise, eggnog, ice cream, and egg-fortified beverages or dessert items that are not cooked.
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Item No.:
20
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Site:
Galley-Galley
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Violation:
Several of the colored cutting boards were heavily scored and difficult to clean along the surface from the knife marks. A new set of cutting boards arrived in today's supply shipment.
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Recommendation:
Ensure surfaces such as cutting blocks and boards that are subject to scratching and scoring are resurfaced if they no longer can be effectively cleaned and sanitized, or discarded if they are not capable of being resurfaced.
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Item No.:
21
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Site:
Galley-Galley
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Violation:
There were gaps present around the pipes penetrating the side and floor panels inside the undercounter technical compartment for the sinks.
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Recommendation:
Close gaps with profiles or grommets.
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Item No.:
21
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Site:
Bar-Back Bar
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Violation:
There were difficult to clean gaps present between the back bar undercounter wine refrigerator, beer refrigerator and ice machine and the wood cabinets surrounding these pieces. Additionally, the ice machine was mounted on legs only 3 inches above the deck, making cleaning beneath very difficult.
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Recommendation:
Ensure nonfood-contact surfaces are free of unnecessary ledges, projections, and crevices, and designed and constructed to allow easy cleaning and to facilitate maintenance.
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Item No.:
21
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Site:
Galley-Hot Galley
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Violation:
There was a wide and deep 1inch channel for the Lang range grease pan housings which were difficult to access and clean.
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Recommendation:
Ensure nonfood-contact surfaces are free of unnecessary ledges, projections, and crevices, and designed and constructed to allow easy cleaning and to facilitate maintenance.
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Item No.:
21
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Site:
Galley-Hot Galley
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Violation:
The deep grease pan housing for the AccuTemp flat grill was difficult to access fully and clean.
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Recommendation:
Ensure nonfood-contact surfaces are free of unnecessary ledges, projections, and crevices, and designed and constructed to allow easy cleaning and to facilitate maintenance.
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Item No.:
21
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Site:
Bar-Self-Serve Beverage Counter
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Violation:
There were difficult-to-clean gaps present around the undercounter milk and beer refrigerator and the cabinet and bulkhead surrounding.
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Recommendation:
Ensure nonfood-contact surfaces are free of unnecessary ledges, projections, and crevices, and designed and constructed to allow easy cleaning and to facilitate maintenance.
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Item No.:
27
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Site:
Bar-Self-Serve Beverage Counter
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Violation:
There was heavy dust soil along the surfaces surrounding the undercounter milk and beer refrigerator.
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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:
There was old grease soil in the back sections of the AccuTemp flat grill grease pan housing.
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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 range grease pan housing was soiled in the rear section with old grease residue. Clearly staff have worked to reach all sections, but they are difficult to clean.
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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:
Bar-Back Bar
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Violation:
The wood panels beside the undercounter refrigerators and ice machine were soiled with dust 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.:
36
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Site:
Bar-Bar
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Violation:
The artificial light level at the back bar counter was below the minimum 220 lux.
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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-Galley
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Violation:
The artificial light level behind the steamer oven was below the minimum 110 lux. The artificial light level at the aft/starboard counter and at the dishwash machine were below the minimum 220 lux.
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Recommendation:
Ensure the light intensity is at least 110 lux (10 foot candles) at a distance of 75 centimeters (30 inches) above the deck when in use, in walk-in refrigerator units and dry storage areas, and in other areas and rooms during periods of cleaning. 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.:
39
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Site:
Galley-Galley
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Violation:
One large filth fly was observed on the galley dishwash counter.
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Recommendation:
Effectively control the presence of insects, rodents, and other pests to minimize their presence in the food storage, preparation, and service areas and warewashing and utensil storage areas aboard a vessel.
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Item No.:
40
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Site:
Integrated Pest Management-Pesticide Treatment Log
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Violation:
There was documentation that a contract pesticide fumigation was made throughout the ship, but there were no details of the pesticide used and no material safety data sheet (MSDS) for that pesticide.
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Recommendation:
Ensure the vessel's IPM Plan includes a record of pesticides used to control pests and vectors. Ensure that the record includes all pesticides currently onboard the vessel and those used in the previous 12 months.
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Item No.:
41
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Site:
Housekeeping-Bridge Deck Public Toilet
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Violation:
There was no handwashing sign posted at the handwashing sink. This was corrected during the inspection. There was no sign posted in the toilet room advising use of the paper towels to open the door and exit the toilet room.
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Recommendation:
Provide the passenger and crew public toilets with a handwashing station that includes: (1) Hot and cold running water; (2) Soap; (3) A method to dry hands; (4) A sign advising users to wash hands. 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.
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Item No.:
41
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Site:
Medical-Outbreak Prevention and Response Plan (OPRP)
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Violation:
The electronic OPRP has not been updated since 2010 to reflect the new requirements under the 2011 VSP Operations Manual. Specifically the OPRP did not provide the concentration and a proper contact time for the spray disinfectant Oxivir. The plan actually did not specify that product, but listed the accelerated hydrogen peroxide (no name given). A one minute contact time was listed for chlorine at 1,000 ppm or this product. The description of communicating an ongoing outbreak to oncoming passengers was described as may be necessary. There was no specific description of how the spray bottles of disinfectant were to be used and no description of procedures to protect passengers from dermal and respiratory exposures to disinfectants. Under crew there were some glove requirements for use, but no specific information to protect them from respiratory exposure. There was no information on procedures for response to vomit or fecal accidents.
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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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