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Item No.:
02
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Site:
Medical-Acute Gastroenteritis Surveillance Log
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Violation:
The AGE log did not have columns for time of first medical visit, passenger seating, fever temperature, and specimen requested. In addition, there were extra columns of information and some of the required columns were not in the correct order. According to the staff, the log was developed by the corporate office and cannot be changed on the ship.
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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.:
08
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Site:
Potable Water-Distillate and Permeate Striping
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Violation:
The distillate and permeate lines directed to the potable water system were not striped blue/gray/blue in accordance with ISO 14726.
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Recommendation:
Stripe or paint distillate and permeate lines directed to the potable water system in accordance with ISO 14726 (blue/gray/blue). Ensure no other lines have the above color designations. Stripe or paint these lines at 5 meters (15 feet) intervals and on each side of partitions, decks, and bulkheads, except where decor would be marred by such markings.
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Item No.:
08
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Site:
Galley-Garden Cafe Warewashing Aft
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Violation:
A large amount of detergent was covering and dripping from the backflow prevention device on the hood cleaning system, making it difficult to determine if it was working properly. The device was working properly during the inspection.
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Recommendation:
Ensure the backflow prevention device is maintained so that on inspection it can be determined if the device is working properly.
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Item No.:
10
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Site:
Housekeeping-Private Cabin Whirlpools
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Violation:
The documentation for the disinfection of private cabin whirlpools did not include the concentration of the disinfectant.
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Recommendation:
Clean and disinfect private whirlpool spas located in individual passenger cabins, including associated recirculation systems, between occupancies or weekly, whichever is more frequent. Ensure disinfection is accomplished with an appropriate halogen-based disinfectant at 10 ppm for 60 minutes, or an equivalent CT value.
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Item No.:
10
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Site:
Recreational Water Facilities-Automated Chart Recorders
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Violation:
There were no automated chart recorders or electronic data loggers installed on each RWF to record pH and halogen measurements. According to the staff, contractors were sailing on the upcoming cruise to install the new equipment.
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Recommendation:
Install chart recorders or electronic data loggers with security features that record pH and halogen measurements for each individual RWF. Ensure the sample line for the analyzer probe (monitoring) is either directly from the RWF or on the return line from each RWF and before the compensation tank. Install appropriate sample taps for analyzer calibration. Provide an audible alarm in a continuously occupied watch station to indicate low and high free halogen and pH readings in each RWF.
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Item No.:
10
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Site:
Recreational Water Facilities-Filter and Strainer Housings Disinfection
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Violation:
There were no records for the disinfection of the filter and strainer housings. According to the staff, the disinfection was conducted and new forms had been developed to document this information.
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Recommendation:
Clean, rinse, and disinfect the filter housing before the new filter media is placed in it. Ensure disinfection is accomplished with an appropriate halogen-based disinfectant. At a minimum, use a 50-ppm solution for 1 minute, or equivalent CT value. Maintain records on all inspection and cleaning procedures. Clean, rinse, and disinfect the hair and lint strainer and hair and lint strainer housing on all RWFs weekly. Ensure disinfection is accomplished with an appropriate halogen-based disinfectant. At a minimum, use a 50-ppm solution for 1 minute, or equivalent CT value. Maintain records on all inspection and cleaning procedures.
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Item No.:
10
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Site:
Recreational Water Facilities-Bather Loads
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Violation:
There was no documentation on the maximum bather load for each RWF.
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Recommendation:
Maintain documentation on the maximum bather load for each RWF. Ensure the maximum bather load is based on the following factor: one person per five gallons (19 liters) per minute of recirculation flow.
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Item No.:
10
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Site:
Recreational Water Facilities-Safety Signs
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Violation:
The safety signs for the RWFs did not include the following information: do not use these facilities if you are experiencing diarrhea, vomiting or fever; no children who are not toilet trained; and bather load number. In addition, the children's pool safety sign did not include the exact wording: ' take children on frequent bathroom breaks' or 'take children on frequent toilet breaks.' The whirlpool and hydropool safety signs did not include cautions against use by individuals on medication or who have diabetes, and did not include a caution against exceeding 15 minutes of exposure.
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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 #. For children's RWF signs, include the exact wording "TAKE CHILDREN ON FREQUENT BATHROOM BREAKS" or "TAKE CHILDREN ON FREQUENT TOILET BREAKS." In addition to the safety sign requirements in section 6.7.1.1.1, install a sign at each whirlpool spa and spa pool entrance listing precautions and risks associated with the use of these facilities. Include, at a minimum, cautions against use by the following: (1) individuals who are immunocompromised; (2) individuals on medication or who have underlying medical conditions such as cardiovascular disease, diabetes, or high or low blood pressure; and (3) pregnant women, elderly persons, and children. Additionally, caution against exceeding 15 minutes of exposure.
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Item No.:
10
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Site:
Recreational Water Facilities-Passenger Pools 1 and 2
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Violation:
There was no documentation that the main drain covers were certified for antientrapment. These pools had gravity drainage with two drains greater than 1 meter (3 feet) apart and no alarm.
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Recommendation:
For RWFs with gravity drainage and multiple drains (2 or more drains greater than 3 feet apart), provide either a standard design (not compliant with ASME A112.19.8) drain cover and an alarm, or an ASME A112.19.8 compliant antientrapment/antientanglement drain cover. Ensure the alarm is audible and sounds in both a continuously manned space and at the RWF. Ensure this alarm is for all draining: accidental, routine, and emergency.
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Item No.:
20
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Site:
Galley-Garden Cafe
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Violation:
A threaded fastener with difficult to clean features was in the food contact area of the toaster oven.
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Recommendation:
Ensure multiuse food-contact surfaces 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.:
20
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Site:
Galley-Garden Cafe Main Service Line
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Violation:
The steel shell in the back of the pizza oven was separating from the baking stones, creating a gap. The oven was not in use at the time of the inspection.
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Recommendation:
Ensure multiuse food-contact surfaces are: (1) Smooth; (2) Free of breaks, open seams greater than 0.8 mm (1/32 inch), cracks, chips, inclusions, pits, and similar imperfections; (3) Free of sharp internal angles, corners, and crevices; and (4) Finished to have smooth welds and joints.
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Item No.:
20
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Site:
Galley-Cold
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Violation:
Two slotted fasteners were in the food splash zone of the deck mounted mixing machine.
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Recommendation:
Ensure multiuse food-contact surfaces 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.:
20
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Site:
Galley-Bistro Pastry
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Violation:
Two slotted fasteners were in the food splash zone of the deck mounted mixing machine.
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Recommendation:
Ensure multiuse food-contact surfaces 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.:
22
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Site:
Galley-Garden Cafe Warewashing Mid-Ship
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Violation:
The final rinse spray nozzles were not functioning on the in-use glasswash machine. The spray nozzles were fixed and began operating properly.
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Recommendation:
Maintain warewashing equipment in good repair and proper adjustment, including being maintained in a state of repair and condition that meets the standards of the materials, design, and construction of these guidelines.
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Item No.:
26
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Site:
Galley-Garden Cafe Main Service Line
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Violation:
Refractory was in the back of the pizza oven between the steel shell and the baking stones and on the baking stones in two oven compartments. The oven was not in use at the time of the inspection.
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Recommendation:
Ensure materials used in the construction of multiuse utensils and food-contact surfaces of equipment do not allow the migration of deleterious substances or impart colors, odors, or tastes to food and are safe under normal use conditions.
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Item No.:
27
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Site:
Galley-Garden Cafe Warewashing Aft
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Violation:
There was a large amount of detergent spilled inside the hood cleaning cabinet, including on the bottom of the cabinet, the piping, and the backflow prevention device.
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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:
Buffet-Garden Cafe Starboard Beverage Station
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Violation:
A residue from the coffee machine was covering the outside of the machine's waste line inside the technical compartment.
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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.:
29
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Site:
Galley-Garden Cafe Warewashing Aft
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Violation:
Soiled trays were stored on top of the handwashing sink behind the soiled end of the flight type conveyor warewash machine, making the sink inaccessible. The trays were removed.
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Recommendation:
Ensure handwashing facilities are used for no other purpose and are accessible at all times.
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Item No.:
30
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Site:
Galley-Ladies Toilet Room
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Violation:
The door for the ladies food employee toilet room behind the crew galley was not self-closing.
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Recommendation:
Ensure toilet rooms are completely enclosed and have tight-fitting, self-closing doors which are kept closed except during cleaning or maintenance.
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Item No.:
30
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Site:
Galley-Bistro Entrance
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Violation:
The door of the unisex food employee toilet room was not self-closing.
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Recommendation:
Ensure toilet rooms are completely enclosed and have tight-fitting, self-closing doors which are kept closed except during cleaning or maintenance.
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Item No.:
37
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Site:
Galley-Warewashing
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Violation:
Excessive condensation was collecting on the deckhead above the glasswash machine and was dripping onto the machine.
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Recommendation:
Ensure exhaust ventilation hood systems in food preparation and warewashing areas--including components such as hoods, fans, guards, and ducting--are designed to prevent grease or condensation from draining or dripping onto food, equipment, utensils, linens, and single-service and single-use articles.
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Item No.:
41
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Site:
Housekeeping-Spa
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Violation:
There were toilets inside the men's and women's changing rooms, and the exits were not hands free. There were no signs posted at the exits advising users to use hand towel, paper towel, or tissue to open the doors. In addition, there were no waste containers near the doors.
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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 a waste container near the door.
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Item No.:
41
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Site:
Housekeeping-Public Toilet Rooms
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Violation:
In the crew and passenger public toilet rooms without hands-free exits, there were no signs posted advising users to use hand towel, paper towel, or tissue to open the doors.
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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.
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Item No.:
41
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Site:
Housekeeping-Outbreak Prevention and Response Plan
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Violation:
The written outbreak prevention and response plan did not include procedures for informing passengers and crew members of an outbreak or returning the vessel to normal operating conditions after an outbreak.
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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; or (5) Procedures for returning the vessel to normal operating conditions after an outbreak.
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Item No.:
42
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Site:
Children Area-Written Illness Exclusion Policy
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Violation:
The written illness exclusion policy did not include a requirement for written clearance from the medical staff before a child with symptoms of infectious illness could be allowed in the child activity center. The staff had access to this information, but it was not posted.
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Recommendation:
Ensure the child activity center has a written exclusion policy on procedures to be followed when a child develops symptoms of an infectious illness while at the center. Ensure the exclusion policy includes a requirement for written clearance from the medical staff before a child with symptoms of infectious illness can be allowed in the child activity center. Post the policy at the entrance of the child activity center.
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Item No.:
43
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Site:
Housekeeping-Shower Head Disinfection
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Violation:
The written procedures for the shower head disinfection included a chlorine concentration of 50 ppm for 10 minutes, or a CT value of 500. This was less than the required CT value of 600.
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Recommendation:
Clean and disinfect shower heads every 6 months. Disinfect with an appropriate halogen-based disinfectant at 10 ppm for 60 minutes, or an equivalent CT value.
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