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Item No.:
02
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Site:
Medical-Clinical Specimens
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Violation:
The hospital did not have a supply of clinical specimen collection containers for bacterial agents.
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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).
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Item No.:
02
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Site:
Medical-Shipping Container
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Violation:
The hospital did not have the proper shipping box to properly submit clinical specimens to a laboratory. There were some pieces which were on board that make up the interior of the box, but no outer cardboard box with the appropriate labeling was available. The inspector provided some web resources for these supplies during the inspection.
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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-Distribution System
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Violation:
The far point potable water analyzer/recorder charts had a printed range of 0-50 ppm prior to 26 February 2013. The more recent charts have a recording range of 0-10 ppm. Staff presented the new charts which do have a 0-5 ppm recording range.
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Recommendation:
Ensure the halogen analyzer-chart recorder charts have a range of 0.0 to 5.0 mg/L (ppm) and have a recording period of (and limited to) 24 hours.
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Item No.:
06
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Site:
Potable Water-Bunkering and Production Charts
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Violation:
The calibration or calibration check was noted inconsistently on the potable water production and bunkering analyzer/recorder charts.
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Recommendation:
Calibrate at the beginning of bunkering or production when halogen and pH analyzer-chart recorders are used in lieu of manual tests and logs. Ensure the calibration is recorded on the chart.
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Item No.:
08
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Site:
Potable Water-Bunkering and Production Charts
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Violation:
The ship consistently produced and bunkered potable water at pH levels above 8. The charts showed that this occurred over several months.
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Recommendation:
After the free residual halogen level of at least 2.0 mg/L (ppm) and pH level not exceeding 7.8 have been reached, monitor the free residual halogen and pH at least hourly during the bunkering of potable water. After the free residual halogen level of at least 2.0 mg/L (ppm) and pH level not exceeding 7.8 have been reached, monitor the free residual halogen and pH at least once every 4 hours during the production of potable water.
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Item No.:
08
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Site:
Potable Water-Backflow Prevention Log
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Violation:
The entries for the backflow prevention device inspections in the crew and passenger cabin toilets and showers describe a dual check backflow preventer with an atmospheric vent. Upon inspection of both showers and toilets, there was an Oras model installed on the potable water supply to each toilet, but this is a single check valve, non-continuous pressure device. There was no approved backflow preventer installed on the shower potable water supply located in the corridor access hatch or on the flexible hoses in the cabin showers.
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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. Provide a comprehensive cross-connection control program. Protect the following connections to the potable water system against backflow with air gaps or mechanical backflow prevention devices: (3) cabin shower hoses, toilets, whirlpool tubs, and similar facilities.
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Item No.:
08
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Site:
Potable Water-Engine Room
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Violation:
The mineralizer backflush drain pipe was not included in the cross-connection control plan and was not being periodically inspected. Upon inspection, there was a hose connected to the discharge pipe which was hung on a railing with a spray nozzle attached. It was not clear if this was due to a leak in the mineralizer drain valve or if the wastewater was being used in a technical way. The drain line was supposed to drain through the air gap to the bilge.
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Recommendation:
Inspect backflow prevention devices periodically and replace any failed units. Provide a comprehensive cross-connection control program. Protect the following connections to the potable water system against backflow with air gaps or mechanical backflow prevention devices: (23) water softener and mineralizer drain lines, including backwash drain lines (install an air gap or a reduced pressure assembly); (24) high saline discharge line from evaporators (install an air gap or a reduced pressure assembly);
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Item No.:
08
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Site:
Galley-Palm Garden Pantry
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Violation:
There was no backflow prevention device on the potable water supply to the combination oven.
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Recommendation:
Provide a comprehensive cross-connection control program. Protect the following connections to the potable water system against backflow with air gaps or mechanical backflow prevention devices: (10) food service equipment.
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Item No.:
10
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Site:
Recreational Water Facilities-Swimming Pool
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Violation:
The rescue hook at the pool was telescoping and not long enough to reach the center of the deepest part of the pool from the side plus 2 feet.
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Recommendation:
Ensure the pole of the rescue or shepherd?s hook is long enough to reach the center of the deepest portion of the pool from the side plus 2 feet. Ensure it is a light, strong, nontelescoping material with rounded, nonsharp ends.
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Item No.:
10
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Site:
Recreational Water Facilities-Swimming Pool
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Violation:
The pool safety sign was incomplete. The following required wording was absent: Do not use these facilities if you are experiencing diarrhea, vomiting, or fever and no children in diapers or who are not toilet trained.
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Recommendation:
Provide safety signs for all RWFs, except for baby-only water facilities. Ensure the signs, at a minimum, include the following words: (1) do not use these facilities if you are experiencing diarrhea, vomiting, or fever; (2) no children in diapers or who are not toilet trained; (3) shower before entering the facility; and (4) bather load #.
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Item No.:
13
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Site:
Preparation Room-Fish Preparation
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Violation:
A 20 x 8 inch plastic container of white fish was observed holding at temperatures between 47 - 50 F in the undercounter reach-in refrigerator. The container was completely full of the fish product and according to staff, the fish was prepared and placed in the plastic container at 0700 in the morning. The inspector found the fish holding at these temperatures at 1100. The fish was immediately discarded.
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Recommendation:
Ensure the supervisor or person in charge of food operations on the vessel monitors that: ; (7) Employees are using proper methods to cool potentially hazardous foods that are not held hot or are not for consumption within 4 hours.
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Item No.:
15
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Site:
Provisions-Produce Room
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Violation:
A lime was observed spoiled with a heavy amount of fuzzy white mold.
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Recommendation:
Ensure food is safe and unadulterated.
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Item No.:
16
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Site:
Food Service General-Time Control Plans
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Violation:
There were no time control plans for the Lido buffet, Main Galley, Dining Room buffet, or the Dining Room coffee station where time is used as a public health control. Staff stated that the set-up and discard time periods are less than 4 hours and that the food placed on time control is immediately discarded at the end of each service. The flow of food from when last in temperature control to placement in time control was not identified, nor were the compartments and work stations where food is on time control identified.
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Recommendation:
If time only-rather than time in conjunction with temperature-is used as the public health control for a working supply of potentially hazardous food before cooking, or for ready-to-eat potentially hazardous food that is displayed or held for service for immediate consumption, ensure the food (1) Has an initial temperature of 5C (41F) or less or 57C (135F) or greater before placement on time control. (2) Is not be placed on temperature control again. (3) Is marked or otherwise identified to indicate the time 4 hours past the point in time when the food is removed from temperature control (if the time between service set-up and closing is greater than 4 hours. and (4) Is discarded within 4 hours of placement on time control. 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:
Preparation Room-Fish Preparation
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Violation:
A 20 x 8 inch plastic container of white fish was observed holding at temperatures between 47 - 50 F in the undercounter reach-in refrigerator. The container was completely full of the fish product and according to staff, the fish was prepared and placed in the plastic container at 0700 in the morning. The inspector found the fish holding at these temperatures at 1100. The fish was immediately discarded.
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Recommendation:
Except during preparation, cooking, or cooling, or when time is used as the public health control, maintain potentially hazardous foods at 57C (135F) or above, except that roasts may be held at a temperature of 54C (130F); or 5C (41F) or less.
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Item No.:
21
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Site:
Galley-Hot Galley
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Violation:
The black plastic gasket to the door of the counter mounted oven was split and cracked.
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Recommendation:
Ensure nonfood contact equipment is maintained in good repair and proper adjustment including: (2) Equipment components such as doors, seals, hinges, fasteners, and kick plates are kept intact, tight, and adjusted in accordance with manufacturer's specifications.
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Item No.:
22
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Site:
Galley-Dishwash
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Violation:
The data plate for the rack-type dishwash machine indicated conveyor speed in racks/hour rather than a minimum transit time.
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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: ; (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.:
26
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Site:
Galley-Pastry/Bakery
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|
Violation:
There was dried dough residue on the mixing arm of the large deck mounted mixer.
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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.:
28
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|
Site:
Buffet-
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|
Violation:
Plates and bowls being stored at the buffet line were not inverted or protected.
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Recommendation:
Store clean equipment and utensils covered or inverted.
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Item No.:
28
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Site:
Galley-Dishwash
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|
Violation:
The edge of a large plastic hotel bin being used for soaking soiled dishware in a chlorine solution, was in direct contact with previously cleaned stacked plates. The bin was immediately moved,
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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.:
28
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|
Site:
Galley-Dishwash - Clean Staging Area
|
|
Violation:
Two racks of previously cleaned small plates and bowls were not being stored inverted or protected.
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|
Recommendation:
Store clean equipment and utensils in a self-draining position that allows air drying, and covered or inverted.
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Item No.:
28
|
|
Site:
Galley-Plating Station
|
|
Violation:
During cleaning operations, the top plates on the plate trolley at this station were not inverted or protected from possible contamination.
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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.:
28
|
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Site:
Galley-Dishwash
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|
Violation:
Condensate collecting on the deckhead above the clean landing side of the rack-type dishwash machine was dripping directly onto just cleaned dishes and coffee mugs which were exiting the machine.
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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.:
33
|
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Site:
Galley-Potwash
|
|
Violation:
There was a yellow, greasy residue on the exterior of the exhaust vent above the automatic potwash machine.
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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:
Galley-Hot Galley
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|
Violation:
Water was observed pooling on the deck and in-between recessed deck grouting below the soup kettles and under the preparation counter near the handwash station.
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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. Ensure decks, bulkheads, and deckheads in food preparation, warewashing, pantries, and storage areas are maintained in good repair.
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Item No.:
33
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Site:
Food Service General-Combination Ovens
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Violation:
Water lines to several of the combination ovens were draped on the deck and made cleaning difficult. The combination ovens were located in the Main Galley ( near the soup station and flat grill) and in the Palm Garden Pantry.
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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:
Food Service General-Decks
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Violation:
Deck tiles and deck grouting were cracked and pitted throughout several food service areas of the ship. This was especially the case in the following areas: Main Galley potwash, Main Galley soup stations, and the Main Galley Pantry. Areas of new deck tiles and grouting were observed in the Main Galley dishwash area.
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Recommendation:
Ensure decks, bulkheads, and deckheads in food preparation, warewashing, pantries, and storage areas are maintained in good repair.
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Item No.:
34
|
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Site:
Galley-Hot Galley
|
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Violation:
There was a steady water leak coming from a relief valve located on the backside of the left soup kettle. Water was pooling on the deck throughout this area.
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Recommendation:
Ensure a plumbing system in a food area is maintained in good repair.
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Item No.:
34
|
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Site:
Galley-Hot Galley
|
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Violation:
The hand sink drain line was directed to the scupper and water was able to collect and run on the deck throughout this area. The plastic drain line was also dripping from the connection point and appeared to be loosely connected.
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Recommendation:
Ensure a plumbing system in a food area is maintained in good repair.
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Item No.:
36
|
|
Site:
Dining Room-Coffee Station
|
|
Violation:
The lighting at the handwash station was less than the required 220 lux.
|
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Recommendation:
Ensure the light intensity is at least 220 lux (20 foot candles) at a distance of 75 centimeters (30 inches) above the deck in handwashing facilities.
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Item No.:
36
|
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Site:
Pantry-Palm Garden Bar
|
|
Violation:
The handwash station had less than the required 220 lux of light.
|
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Recommendation:
Ensure the light intensity is at least 220 lux (20 foot candles) at a distance of 75 centimeters (30 inches) above the deck in handwashing facilities.
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Item No.:
36
|
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Site:
Galley-Coffee Station
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Violation:
There was less than the required 220 lux at the coffee dispensing area.
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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 at consumer self-service areas.
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Item No.:
36
|
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Site:
Bar-Winestube Bar
|
|
Violation:
Lighting at the worker side bar counters could not be raised to 220 lux for cleaning.
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|
Recommendation:
In bars and dining room waiter stations, provide 220 lux (20 foot candles) light intensity during cleaning operations.
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Item No.:
36
|
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Site:
Food Service General-Lighting
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|
Violation:
There was less than the required 110 lux of light behind and around several pieces of deck and deck mounted equipment throughout the food service areas of the ship. These areas included: the left side of the combination oven in the hot galley, behind and around the ice machine in the Lido Galley, and behind and around the Coffee Station at the Lido Galley.
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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.:
37
|
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Site:
Galley-Potwash
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Violation:
Heavy condensate was collecting on the exhaust vent above the in-use automatic hood-type potwash machine. Condensate was dripping from the vent and landing on the clean staging tables and deck below. No clean equipment was impacted by the dripping condensate.
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Recommendation:
Ensure ventilation hood systems and devices operate effectively to prevent condensate from collecting on the bulkheads and deckheads.
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Item No.:
37
|
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Site:
Galley-Dishwash
|
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Violation:
Heavy condensate was collecting and dripping from the exhaust vent above the clean landing at the rack-type dishwash machine. The condensate was observed dripping directly onto just cleaned racks of dishes and coffee mugs that were exiting the machine. The inspector held a paper towel above the exhaust unit and it was evident that there was no suction. The soiled racks of dishes were sent to be re-cleaned and the crew directed all soiled dishes to be cleaned in adjacent crew galley until the problem could be resolved.
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|
Recommendation:
Ensure ventilation hood systems and devices operate effectively to prevent condensate from collecting on the bulkheads and deckheads.
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Item No.:
39
|
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Site:
Galley-Palm Garden Pantry
|
|
Violation:
Approximately, 4 small fruit flies were observed on the bulkhead and deckhead next to the grill and combination oven. The area was not in use at the time of the observation.
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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-Inspection Logs
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|
Violation:
There was no record of inspections of incoming shipments of foods and supplies.
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Recommendation:
Routinely inspect incoming shipments of food and all other supplies for evidence of insects, rodents, and other pests. Maintain a record of these inspections onboard the vessel and make the record available for review during inspections.
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Item No.:
41
|
|
Site:
Galley-Crew Public Toilets 2113, 2115, 2117
|
|
Violation:
There were no signs advising users to use a paper towel to open the door upon exiting.
|
|
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.
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Item No.:
41
|
|
Site:
Housekeeping-Public and Crew Toilets
|
|
Violation:
The public and crew toilets throughout the ship did not have signs posted inside advising users to take paper towels to open the toilet room door upon exiting. There was no sign advising hand washing in the men's toilet room just outside of the hospital.
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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.:
41
|
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Site:
Housekeeping-Outbreak Prevention and Response Plan (OPRP)
|
|
Violation:
There was not a complete written OPRP on board. There was a short instruction specific to the housekeeping staff on response once a trigger of 2% gastrointestinal (GI) illness was reached. The instruction specified use of 1,000 ppm chlorine for dishware retrieved from a GI ill guest cabin. The described disinfection chemicals were listed with concentrations, dilutions from the concentrate bottle, but no contact time on the surfaces. Reviewing the bottles revealed that the Mikro Quat had a quaternary ammonia concentration required of 700 ppm for a contact time of 10 minutes. The Incidin product had a 30 minute contact time at the 1% dilution, which was the dilution specified in the OPRP procedure, but at 2% dilution the contact time was 15 minutes. There was no procedure for informing guests and crew of an outbreak on the cruise, none for passengers embarking the ship following an outbreak cruise, and none for someone embarking following an outbreak segment. There were no procedures for returning the vessel to normal conditions following an outbreak, and no health and safety procedures to minimize respiratory or dermal exposures to passengers from the disinfectants used.
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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)
|
|
Violation:
There was a hit team checklist for outbreak GI cabins after debarking which detailed procedures for housekeeping infection control teams. There were parts of this checklist that were not applicable on this ship, such as fogging of cabins and steam cleaning. Staff did not have equipment to do these things, so this procedure should be reviewed and modified to include only what applies. Additionally, the procedure includes some chemicals such as Mikro Bac which are not carried on board. The chemicals which are mentioned, include the name and no concentration or contact times or name and concentrations, but no contact times.
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Recommendation:
Review current OPRP and modify so it is applicable to the procedures in place.
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