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Item No.:
02
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Site:
Medical-Contact Interviews
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Violation:
Medical staff were not consistently conducting verbal interviews with asymptomatic cabin mates or immediate contacts of crew members that met the case definition of Acute Gastroenteritis (AGE). In addition, the date and time of the verbal interviews conducted were not documented.
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Recommendation:
When any crew member (food or nonfood employee) meets the case definition for AGE, take the following actions: (3) complete a verbal interview daily with medical or supervisory staff until 48 hours after the ill crew members? symptoms began. Ensure that the first verbal interview is conducted within 8 hours from the time the ill crew member initially reported to the medical staff. If the asymptomatic immediate contact or cabin mate is at work, ensure that he or she is contacted by medical or supervisory staff as soon as possible. Document the date and time of verbal interviews.
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Item No.:
02
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Site:
Medical-Acute Gastroenteritis (AGE) Surveillance Log
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Violation:
The AGE surveillance log did not have the case identification number for each passenger or crew member. Also, the required items in the AGE surveillance log were not in the order specified in the 2011 VSP Operations Manual.
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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.
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Item No.:
06
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Site:
Potable Water-Microbiological Samples
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Violation:
Two of the four monthly potable water samples were taken from ice machines in September 2011.
Also, there was no comparator to verify the test results of the potable water samples. The instructions for the test kit requires a comparator be used with all potable water samples.
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Recommendation:
Collect and analyze a minimum of four potable water samples per month for the presence of E. coli. Collect samples from the forward, aft, upper, and lower decks of the vessel. Change the sample sites each month so that all of the potable water distribution system is effectively monitored. Ensure microbiological samples are not taken from ice machines or potable water storage tanks.
Analyze samples using a method accepted in Standard Methods for the Examination of Water and Wastewater. Operate and maintain test kits, incubators, and associated equipment in accordance with the manufacturers? specifications.
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Item No.:
08
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Site:
Potable Water-Cross-Connection Log
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Violation:
The cross-connection log listed drains as the backflow prevention method instead of air gaps for the mineralizers.
The cross-connection log did not indicate an inspection date for several of the air gaps and a few of the backflow prevention devices listed on the log.
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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.
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Item No.:
08
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Site:
Medical-Backflow Prevention
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Violation:
There were no backflow prevention devices approved for health hazards installed on the potable water lines in two ward rooms where dialysis equipment was used. According to staff, dialysis equipment was used for more than 12 hours in some cases.
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Recommendation:
Install backflow prevention devices that are approved for health hazards associated with dialysis equipment.
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Item No.:
08
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Site:
Potable Water-Evaporators
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Violation:
The distillate lines directed to the potable water system from all three evaporators were not striped or painted in accordance with ISO 14726 (blue/gray/blue).
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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.
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Item No.:
08
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Site:
Potable Water-Tanks 3C and 3P
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Violation:
Potable water tanks 3C and 3P were disinfected, but the free residual halogen test result was not documented.
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Recommendation:
Flush the disinfected parts of the system with potable water or otherwise dechlorinate until the free residual halogen is less than or equal to 5.00 mg/L (ppm). Document the free halogen test result.
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Item No.:
10
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Site:
Recreational Water Facilities-Filter Housing Cleaning
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Violation:
There was no documentation for the cleaning, rinsing, and disinfecting of the filter housings of each of the RWFs before new filter media was used.
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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.
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Item No.:
10
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Site:
Recreational Water Facilities-Turnover Rates
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Violation:
It was unclear from the documentation if the turnover rate for the mid-ship pool met the requirement of every 6 hours.
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Recommendation:
Design recirculation systems and equipment, including chemical control equipment, UV disinfection systems, filter, and pumps to maintain adequate water chemistry control while operating at the following minimum turnover rates: (1) swimming pool (VSP 2005 Construction Guidelines or earlier): 6 hours; (2) swimming pool (VSP 2011 Construction Guidelines or later): 4 hours.
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Item No.:
10
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Site:
Recreational Water Facilities-Whirlpool Antientrapment
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Violation:
The therapy pumps in the whirlpools had multiple suction fittings that were less than 3 feet apart and ASME compliant covers, but did not have safety vacuum release systems (SVRS) or automatic pump shut-off systems.
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Recommendation:
For RWFs with suction fittings and a single blockable drain or multiple drains (less than 3 feet apart), provide an ASME A112.19.8 compliant antientrapment/antientanglement drain cover and a safety vacuum release system or automatic pump shut-off system.
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Item No.:
10
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Site:
Recreational Water Facilities-Sample Lines
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Violation:
The sample lines for the analyzer probes on each of the RWFs to measure free residual halogen and pH were not directly from the RWF or on the return line from each RWF and before the compensation tank.
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Recommendation:
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.
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Item No.:
10
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Site:
Recreational Water Facilities-Shepherd's Hooks
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Violation:
The shepherd's hooks were not long enough to reach the center of the deepest part of the swimming pools 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-Hydropool Safety Signage
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Violation:
The sign for the hydropool did not include: do not use these facilities if experiencing diarrhea, vomiting, or fever, no children in diapers who are not toilet trained, or a caution against elderly persons and children.
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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 #. 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.:
16
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Site:
Food Service General-Time Control Plans
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Violation:
Time control plans were posted throughout the food outlets and included specific refrigeration and hot holding units used for time control, but the units were not physically labeled.
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Recommendation:
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): (2) List refrigeration and hot holding units (compartments and cabinets) on time control (the physical units must also be labeled as such).
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Item No.:
16
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Site:
Buffet-Asian Station
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Violation:
There was no consumer advisory at the buffet station where poached eggs were out for self service.
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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 disclosure is made by the 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.
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Item No.:
21
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Site:
Bar-Lido
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Violation:
There was an open electrical penetration which led to a void space in the front bar undercounter technical compartment.
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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-Explorations Cafe
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Violation:
The power cable to the mounted coffee machine at the front counter was coiled beneath the machine on the counter, making cleaning difficult.
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Recommendation:
Shorten or secure the power cable above the counter to allow for cleaning.
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Item No.:
21
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Site:
Galley-Deck 2 Silverware Wrapping Station
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Violation:
The edges of the table used for wrapping silverware had exposed bare wood. The wood was rough and chipped.
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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.:
26
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Site:
Galley-
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Violation:
Dried food residue was observed on the food contact area of the press plate of the previously cleaned deli slicer.
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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.:
33
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Site:
Food Service General-Bulkhead Flanges
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Violation:
There were more than five flanges on water line penetrations at the bulkhead for handwashing stations located throughout preparation rooms and in the lido, crew, and deck 2 main galleys. The flanges were either missing or not sealed to the bulkhead, creating a seam to a void space.
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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.:
34
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Site:
Galley-Bistro Warewashing
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Violation:
When in use, the handwashing sink next to the chemical locker leaked water onto the deck.
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Recommendation:
Ensure the plumbing system in the food area is maintained in good repair.
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Item No.:
36
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Site:
Food Service General-Lighting
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Violation:
The light intensity was less than 110 lux behind and around many pieces of deck-mounted and counter-mounted equipment throughout the food areas. This was also observed behind the ice machine in housekeeping deck pantry P.1.2.01.
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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-Bistro Warewashing
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Violation:
Condensation was collecting at the top of the hood and dripping onto the deck at the soiled end of the in-use flight-type warewash machine. The air intake for the hood was increased.
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Recommendation:
Ensure ventilation hood systems and devices are sufficient in number and capacity to prevent grease or condensation from collecting on bulkheads and deckheads.
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Item No.:
39
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Site:
Dining Room-Pinnacle Grill
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Violation:
A live small fly was observed flying near the entrance to the galley.
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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.:
39
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Site:
Galley-Hamburger Bar
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Violation:
A live large fly was observed flying above the main preparation table in the galley. The galley was not in operation at the time of the inspection.
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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.:
42
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Site:
Children Area-Diaper Changing Station
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Violation:
There was no airtight, soiled-diaper receptacle in the diaper changing station.
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Recommendation:
Include in each diaper changing station: (3) An airtight, soiled-diaper receptacle.
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Item No.:
42
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Site:
Children Area-Exclusion Policy
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Violation:
There was no written policy posted at the entrance of the child activity center on procedures followed when a child develops symptoms of an infectious illness while at the center.
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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.:
42
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Site:
Children Area-Toilet Room
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Violation:
When using the step stool, the children's handwashing sink was measured at 25 inches above the stool and the children's toilet was measured at 13 inches above the stool.
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Recommendation:
If toilet rooms are located in a child-activity center, provide a child-size toilet(s) or child-accessible toilet(s) (child-size seat and step stool) and handwashing facilities. Ensure child-size toilets (to include the toilet seat) have a maximum height of 280 millimeters (11 inches) and a toilet seat opening no greater than 203 millimeters (8 inches). Ensure handwashing sinks have a maximum height of 560 millimeters (22 inches) above the deck or a step stool.
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Item No.:
43
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Site:
Ventilation-HVAC Cleaning
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Violation:
Technical water was used to clean the HVAC distribution system.
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Recommendation:
Use only potable water for cleaning HVAC distribution systems.
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