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Item No.:
01
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Site:
Medical-Gastrointestinal (GI) Illness Reporting
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Violation:
During the current (world) cruise, the medical staff made two required reports to the Vessel Sanitation Program upon arrival in New York on 10 June and San Francisco on 28 June, and in each case reported zero under gastrointestinal illness cases for both passenger and crew. The electronic gastrointestinal illness system revealed there was one reportable GI case in the crew on 1 June. Additionally, there was a reportable passenger GI illness case on 26 June and a reportable crew GI case on the same day.
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Recommendation:
The gastrointestinal illness report shall contain:
(1) The name of the vessel; (2) The ports of embarkation and disembarkation; (3) The dates of embarkation and disembarkation; (4) The total numbers of reportable cases of gastrointestinal illness among passengers and crew members, including those who have been disembarked or removed because of illness, even if the number is 0; and (5) The total number of passengers and crew members on the cruise.
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Item No.:
02
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Site:
Medical-Gastrointestinal (GI) Surveillance Log
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Violation:
The medical staff used an electronic system for recording gastrointestinal illness information including the symptoms, but the system could not produce or export a standardized gastrointestinal illness surveillance log. The system only displayed the various data elements from the standardized GI log when the box for diarrhea was checked. A person without diarrheal illness symptoms required a manual review of a handwritten medical record to see if they met the GI illness case definition.
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Recommendation:
Ensure that a standardized gastrointestinal illness surveillance log for each cruise is maintained daily by the master of the vessel, the medical staff, or other designated staff. The log shall list:
(1) All reportable cases of gastrointestinal illness; (2) All passengers and crew members who are dispensed antidiarrheal medication from the master of the vessel, the medical staff, or other designated staff.
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Item No.:
02
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Site:
Medical-Gastrointestinal (GI) Cases
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Violation:
The medical staff recorded two separate records in the electronic system for GI related patients (with or without diarrhea). Many under the non-diarrhea side were diagnosed as having gastroenteritis, but it was unclear what their specific symptoms were. Upon questioning, it was clear the medical staff were unclear about the VSP definition of a GI illness case, except the condition of 3 diarrheal episodes in 24 hours.
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Recommendation:
A reportable case of gastrointestinal illness shall be defined as:
(1) Diarrhea (three or more episodes of loose stools in a 24 hour period); 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 >38 °C (100.4 °F)); and (3) Reported to the master of the vessel, the medical staff, or other designated staff by a passenger or a crew member.
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Item No.:
02
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Site:
Medical-Gastrointestinal (GI) Illness Documentation
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Violation:
Numerous required fields in the GI illness records since the 3 April beginning of the world cruise were incomplete or completed incorrectly. A galley utility was logged into the electronic system on 26 April as a non-food handler, but in his medical record was listed as a waiter. In either assignment the VSP would define this individual as a food worker. Three of four passenger and crew cases from 26 April to 26 June had 3 or more diarrheal episodes but were listed as non-reportable, and there were no underlying medical conditions indicated. Time of symptom onset or last GI symptom was either not filled in or in one case the last GI symptom conflicted with a follow-up comment of asymptomatic on the same day. Similar findings of inaccurate GI data were noted in the previous VSP inspection of June 2010.
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Recommendation:
The log shall list:
(1) All reportable cases of gastrointestinal illness; (2) All passengers and crew members who are dispensed antidiarrheal medication from the master of the vessel, the medical staff, or other designated staff.
The gastrointestinal illness surveillance log entry for each passenger or crew member shall contain the following information:
(1) The first date of clinic visit or report to staff of illness; (2) The person's name, age and gender; (3) A designation as passenger or crew member; (4) Crew member position or job on the vessel, if applicable; (5) Cabin number; (6) Meal seating information; (7) Date and time of illness onset; (8) Illness symptoms, including the presence of the following selected signs and symptoms: numbers of episodes each of diarrhea and vomiting per day, bloody stools, fever, recorded temperature, abdominal cramps, headaches and muscle aches; (9) Notation on whether or not a stool specimen was requested and received; (10) Use of antidiarrheal medication; and (11) The presence of underlying medical conditions which may affect interpretation of acute gastrointestinal illness for example diabetic diarrhea, inflammatory bowel disease, gastrectomy or others.
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Item No.:
08
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Site:
Potable Water-Potable Water Tank Coating
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Violation:
During the 2011 dry dock, potable water tank 1 center and 3 port were partially re-coated with a two part epoxy product from Chugoku Marine Paint. Cleenkeep 201 blue base and Cleenkeep 201 hardener were applied, but the written record makes no mention that the painting took place. There were photographs showing the tank interiors after painting. In reviewing the product used, there was no documentation that it was independently tested or certified for use in potable water tanks.
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Recommendation:
Ensure that interior coatings on potable water tanks are approved for potable water contact, and all manufacturer's recommendations for application, drying, or curing are followed. Ensure written documentation for the coating used and recommendations followed are available for review during inspections.
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Item No.:
08
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Site:
Potable Water-Cross-Connection Control Program
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Violation:
The list of all backflow preventers on the vessel did not indicate the air-gap present on the mineralizer drain or the internal backflow preventers installed on the bulkhead mounted cleaning chemical dispensers in the deck 8 housekeeping chemical locker.
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Recommendation:
Ensure that the cross-connection control program includes at minimum: a complete listing of cross-connections and the backflow prevention method/device for each, so that there is a match to the plumbing system component and location, and an inspection frequency. Ensure that air-gaps are included in the listing.
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Item No.:
08
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Site:
Potable Water-Documentation of Inspection
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Violation:
There was no log documenting the inspection of the air-gaps or the non-testable backflow preventers installed throughout the vessel.
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Recommendation:
Ensure that a log documenting inspection and maintenance, in written or electronic form, is maintained and available for review during inspections.
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Item No.:
11
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Site:
Medical-Crew Gastrointestinal (GI) Case Isolation
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Violation:
On the current (world) cruise there was a galley utility/waiter GI illness case, a cruise director GI case, an electrical engineer GI illness case and a physician GI illness case, and in none of these was the ill crew member isolated until symptom-free for the minimum 24 hours for non-food employees and 48 hours for food employees. The section of the electronic log form indicating isolation was left blank in all four cases. The engineer and cruise director disembarked the vessel on the day after their symptoms began.
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Recommendation:
Ensure that symptomatic non-food employees meeting the case definition for AGE are isolated in cabin or designated, restricted area until symptom-free for a minimum of 24 hours. Ensure that symptomatic food employees meeting the case definition for AGE are isolated in cabin or designated, restricted area until symptom-free for a minimum of 48 hours.
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Item No.:
16
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Site:
Galley-Cold Galley
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Violation:
There were three sheet pans containing custard cups, chocolate cream cake, and chocolate iced puff pastry in the under counter reach-in refrigerator near the 3-compartment sink that were reportedly prepared on June 27, 2011 but had discard dates between July 3-5, 2011.
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Recommendation:
Ensure that refrigerated, ready-to-eat, potentially hazardous food: (1) Prepared on a vessel and held refrigerated for more than 24 hours is clearly marked at the time of preparation to indicate the date or day by which the food shall be consumed, which is 7 calendar days or fewer from the day the food is prepared with the day of preparation counting as day 1. (2) A container of refrigerated, ready-to-eat potentially hazardous food prepared and packaged by a food processing plant and held on the vessel after opening more than 24 hours is clearly marked, at the time the original container is opened, to indicate the date by which the food shall be consumed which is, including the day the original container is opened, 7 calendar days or fewer after the original container is opened. The day of opening is counted as day 1.
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Item No.:
16
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Site:
Galley-Aft Pastry
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Violation:
One tray of custard dessert prepared on the ship and in the walk-in cooler #21 was listed on the cooling log as being prepared on June 25, 2011 but the discard date on the item was labeled 'use by July 4, 2011'. The label for this dessert was corrected to indicate the proper discard date during the inspection.
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Recommendation:
Ensure that refrigerated, ready-to-eat, potentially hazardous food: (1) Prepared on a vessel and held refrigerated for more than 24 hours is clearly marked at the time of preparation to indicate the date or day by which the food shall be consumed, which is 7 calendar days or fewer from the day the food is prepared with the day of preparation counting as day 1. (2) A container of refrigerated, ready-to-eat potentially hazardous food prepared and packaged by a food processing plant and held on the vessel after opening more than 24 hours is clearly marked, at the time the original container is opened, to indicate the date by which the food shall be consumed which is, including the day the original container is opened, 7 calendar days or fewer after the original container is opened. The day of opening is counted as day 1.
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Item No.:
16
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Site:
Buffet-Lido
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Violation:
A rice cooker was used to serve rice on the buffet line for lunch and staff reported that it was on time control. However, the rice was not listed on the time control plan or labeled with a discard time.
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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 that (1) The food is marked or otherwise identified to indicate the time that is 4 hours past the point in time when the food is removed from temperature control; (2) The food is cooked and served, served if ready-to-eat, or discarded, within 4 hours from the time when the food is removed from temperature control; and (3) The food in unmarked containers or packages or marked to exceed a 4 hour limit is discarded. Add cooked rice on the buffet line to the time control plan.
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Item No.:
17
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Site:
Galley-
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Violation:
Tomato chili in reach-in refrigerator # CRG-3 was cooked on the ship and according to staff was also cooled but the chili was not documented on a cooling log. The food item was labeled 'use by July 3, 2011'.
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Recommendation:
Ensure that logs documenting cooked, potentially hazardous food cooling temperatures and times from the starting points designated in 7.3.5.2.1 thru the control points at 2 and 6 hours are maintained onboard the vessel for a period of 30 days from the date the food was placed in the cooling process.
Ensure that logs documenting cooling of potentially hazardous foods prepared from ingredients at ambient temperatures, with the start time to the time when 5°C (41 °F) is reached are also maintained for a period of 30 days, beginning with the day of preparation.
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Item No.:
17
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Site:
Galley-Hot Galley
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Violation:
Several potentially hazardous food items in walk-in refrigerator #23 such as carrot soup, vegetable soup and curry soup were prepared on the ship and cooled; however the dates these items were cooked and cooled were not listed on the cooling log. These items were labeled 'use by July 3, 2011'.
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Recommendation:
Ensure that logs documenting cooked, potentially hazardous food cooling temperatures and times from the starting points designated in 7.3.5.2.1 thru the control points at 2 and 6 hours are maintained onboard the vessel for a period of 30 days from the date the food was placed in the cooling process.
Ensure that logs documenting cooling of potentially hazardous foods prepared from ingredients at ambient temperatures, with the start time to the time when 5°C (41 °F) is reached are also maintained for a period of 30 days, beginning with the day of preparation.
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Item No.:
20
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Site:
Pantry-Bistro Pantry
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Violation:
The half-height, single door, upright reach-in refrigerator was posted not in use and has been in that condition for months, according to staff.
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Recommendation:
Ensure that equipment for cooling and heating food, and holding cold and hot food, is sufficient in number and capacity to maintain specified potentially hazardous food temperatures.
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Item No.:
21
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Site:
Bar-Bistro
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Violation:
The two power cables below the WMF coffee machine were draped on the counter top making it difficult to clean.
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Recommendation:
Shorten or secure the power cables above the counter surface to ensure the area is easily cleanable.
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Item No.:
21
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Site:
Pantry-Vista Lounge
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Violation:
The exposed pipe insulation on the piping from the deckhead to the ice machine was not durable and the outer wrapping was damaged and falling apart, making cleaning difficult.
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Recommendation:
Ensure that 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. Ensure that nonfood-contact surfaces of equipment and utensils are designed and constructed to be durable and to retain their characteristic qualities under normal use conditions.
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Item No.:
24
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Site:
Housekeeping-Outbreak Prevention and Response Plan (OPRP)
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Violation:
The written Gastrointestinal (GI) illness contingency plan specifies the use of 500-2,000 ppm chlorine solutions for morning and evening cleaning of room service and steward pantry ice machines and ice scoops. The plan specifies cabin glasses, cups, and ice buckets be sanitized with 500 ppm chlorine, and under additional procedures requires cutlery, plates, glasses, cups, and ice buckets to be bagged and sprayed with 1,000 ppm chlorine.
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Recommendation:
Ensure that a chlorine solution used as a sanitizing solution has a concentration between 50 mg/L (ppm) and 200 mg/L (ppm) [Food Areas].
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Item No.:
30
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Site:
Other-Crew Unisex Restroom Deck 4
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Violation:
The unisex restroom for the crew galley food workers did not have a tight-fitting door that was self-closing.
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Recommendation:
Ensure that toilet rooms are completely enclosed and shall have tight-fitting, self-closing doors which shall be kept closed except during cleaning or maintenance.
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Item No.:
33
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Site:
Preparation Room-Bakery
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Violation:
There were missing tiles under the Hobart floor mixer and recessed grout at the deck/bulkhead juncture throughout the bakery.
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Recommendation:
Ensure that decks, bulkheads, and deckheads in food preparation, warewashing, pantries, and storage areas are constructed and maintained for easy cleaning. Ensure that bulkheads and deckheads have smooth, hard finishes, and light colored surfaces.
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Item No.:
33
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Site:
Galley-Cold Galley
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Violation:
The electrical cord from the reach-in refrigerator in front of the dry storage area was plugged into the adjacent bulkhead blocking the cleaning locker and making the deck hard to clean. The cord was hanging loosely and not secured to the deckhead or bulkhead.
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Recommendation:
Ensure that decks, bulkheads, and deckheads in food preparation, warewashing, pantries, and storage areas are constructed and maintained for easy cleaning. The electrical cord for the reach-in refrigerator should be properly secured to the bulkhead to allow for easy cleaning on the deck.
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Item No.:
33
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Site:
Galley-Umihiko Deck 11
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Violation:
Several areas of the galley had recessed grout and tile, including at the deck/bulkhead juncture and in the dishwashing area.
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Recommendation:
Ensure that 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:
Dining Room-Four Seasons
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Violation:
Soft silicone was used as coving at the deck/cabinet juncture on all 16 waiter stations.
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Recommendation:
Ensure that bulkhead and deck junctures are coved (including galleys, pantries, deck/counter junctures at buffets, bars, waiter stations, and dining room work counters). Ensure that bulkheads and deckheads have smooth, hard finishes, and light colored surfaces. Use a hard sealant, semi-hard sealant, stainless steel strips, or similar materials for coving deck junctures.
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Item No.:
36
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Site:
Provisions-Cavier and Pickle Rooms
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Violation:
The lighting in the back of the Cavier Room #406 and in the Pickles Room #3 was less than 110 Lux. This was corrected during the inspection.
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Recommendation:
Ensure that 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.
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Item No.:
37
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Site:
Galley-Dishwashing Area
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Violation:
There was an excessive amount of condensation accumulating on the deckhead and bulkhead above the soiled side of the Hobart glass warewashing machine.
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Recommendation:
Ensure that ventilation hood systems and devices operate effectively to prevent grease and condensate from collecting on the bulkheads and deckheads and remove contaminants generated by equipment located under them.
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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 Gastrointestinal (GI) illness contingency plan listed a Microbac cleaner/disinfectant in numerous sections when the onboard cleaner disinfectant used in these instances was actually Microquat. The concentration of free chlorine for elevated GI illness response was less than 1,000 ppm for public area high touch surfaces, the grand spa dressing room, and vomit cleaning on hard surfaces. In each case above the range was listed as 500-2,000 ppm.
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Recommendation:
A minimum chlorine concentration of 1000 PPM should be used on all hard surfaces during a GI outbreak.
The written GI illness contingency plan should be reviewed and updated as often as necessary to ensure the plan is accurate.
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