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Item No.:
02
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Site:
Medical-AGE Log
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Violation:
The ship did not have and could not produce the acute gastroenteritis surveillance log with all the data elements and in the exact order as specified in the template 13.2.2 of 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. 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.:
41
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Site:
Medical-Crew/Passenger Public Toilets
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Violation:
There were no signs posted in either the crew or passenger public toilets located in the waiting rooms of the medical center to advise users on the need to use paper towels to operate the exit door handle.
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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.:
11
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Site:
Medical-Crew GI Illness Reporting
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Violation:
A crew dishwasher expreienced gastrointestinal illness symptom onset at 5 am and reported to the medical center at 4:30 pm. A crew member in video experienced gastrointestinal illness symptom onset on 26 September at 7 am and reported to the medical center at 8 am on 27 September.
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Recommendation:
Exclude food employees suspected of, diagnosed with, or exposed to any communicable disease caused by Salmonella typhi, Shigella spp., E. coli O157:H7, hepatitis A virus, norovirus, or other communicable diseases that can be transmitted by food, from working in any food or food related areas or operations, including working with exposed food, warewashing, equipment, utensils, table linens, single-service articles and single-use articles. Do not allow the excluded individual to return to the above duties until they are symptom free for a minimum of 48 hours. When food employees meet the case definition for AGE, ensure the following actions are taken: (1) isolate in cabin or designated restricted area until symptom-free for a minimum of 48 hours; (2) follow-up with and receive approval by designated medical personnel before returning crew to work; (3) document date and time of last symptom and clearance to return to work. When nonfood employees meet the case definition for AGE, ensure the following actions are taken: (1) isolate in cabin or designated restricted area until symptom-free for a minimum of 24 hours; (2) follow-up with and receive approval by designated medical personnel before returning crew to work; (3) document the date and time of last symptom and clearance to return to work.
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Item No.:
44
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Site:
Housekeeping-Ice Refills
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Violation:
Housekeeping staff follow a procedure for refilling cabin ice buckets by collecting all the buckets within each stewards section and refilling all at one time in the pantry, then returning the buckets to the individual cabins in their section. There is no established washing in this process and no way of assuring that each ice bucket is returned to the same cabin from where it was removed.
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Recommendation:
Ensure that if individiual passenger cabin ice buckets are removed from several cabins and transported to an ice pantry for refilling, that each is washed, rinsed, and sanitized prior to refilling and returning to the passenger cabins.
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Item No.:
41
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Site:
Housekeeping-Outbreak Prevention and Response Plan (OPRP)
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Violation:
There was no procedure in the written OPRP for notifying embarking passengers following an outbreak voyage.
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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.:
42
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Site:
Children Area-Boys Toilet
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Violation:
The handwash sink hot water temperature reached 114 F.
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Recommendation:
Ensure the maximum water temperature for a handwashing station does not exceed 43C (110F).
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Item No.:
10
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Site:
Recreational Water Facilities-All RWF's
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Violation:
The fleet instruction 5.3.2 containing the fecal accident procedure specified a disinfection concentration of 50 ppm free chlorine applied over a 4 hour contact time for any fecal or vomit accident in any of the recreational water facilities.
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Recommendation:
Ensure a fecal and vomit accident response procedure that meets or exceeds the procedure provided in Annex 13.8 is available for review during inspections. Follow a disinfecting concentration and contact time which meets or exceeds the sample in Annex 13.8.
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Item No.:
10
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Site:
Recreational Water Facilities-All RWF's
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Violation:
None of the recreational water facilities had calculated bather loads and none were equipped with the signs specified in section 6.7.1.1 in the 2011 VSP Operations Manual.
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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. 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.?
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Item No.:
10
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Site:
Recreational Water Facilities-All RWF's
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Violation:
Staff were not monitoring any of the recreational water facilities for combined chlorine residual or clarity.
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Recommendation:
Monitor and adjust the RWF?s flow rates, free and combined halogen levels, pH, total alkalinity, and clarity as recommended by the manufacturer and to maintain optimum public health protection and water chemistry.
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Item No.:
10
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Site:
Recreational Water Facilities-Whirlpool Spa Shock Halogenation
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Violation:
Staff recorded only the concentration and contact time of the shock halogenation in the whirlpool spa records. They did not conduct a manual test to verify the actual halogen concentration at the start and end of the halogenation period.
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Recommendation:
Increase the free residual halogen to at least 10.0 mg/L (ppm) and circulate for at least 1 hour every 24 hours. Test the free residual halogen both at the start and completion of shock halogenation. Superhalogenate the water in the entire RWF system to 10 ppm to include the whirlpool spa/spa pool tub, compensation tank, filter housing, and all associated piping before starting the 1-hour timing. Ensure a written or electronic record of the date and time of water dumping and shock halogenation (concentration in ppm at the start and completion and time) is available for review during inspections.
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Item No.:
10
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Site:
Recreational Water Facilities-All RWF's
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Violation:
There was no automatated free halogen and pH testing or recording equipment installed for each recreational water facility either direct to the RWF or on the return line between the RWF and the compensation tank.
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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. In the event of equipment failure, measure free residual halogen and pH by a manual test kit at the RWF or return line at least hourly for whirlpool spas, spa pools, children?s pools, and wading pools and every 4 hours for all other RWFs. Record manual readings on a chart or log, retain for at least 12 months, and ensure that they are available for review during inspections. Complete repairs on malfunctioning halogen analyzer-chart recorders within 30 days of equipment failure. Provide an audible alarm in a continuously occupied watch station to indicate low and high free halogen and pH readings in each RWF. For whirlpool spas and spa pools, ensure the analyzer probes for dosing and recording systems are capable of measuring and recording levels up to 10 mg/L (10 ppm).
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Item No.:
10
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Site:
Recreational Water Facilities-All RWF's
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Violation:
All recreational water facility hair and lint strainers and the housings for same were cleaned monthly according to staff. Additionally, the turnover rates of each RWF could not be validated against the chart at 6.2.1.1 of the VSP Operations Manual 2011, as the staff have not calculated these.
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Recommendation:
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. For RWFs with skim gutters, ensure that the fill level of the RWF is to the level of the skim gutters. 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; (3) children's pool: 0.5 hours; (4) wading pool: 1 hour; (5) whirlpool spa: 0.5 hours; (6) spa pool: 2 hours; (7) interactive RWF or activity pool less than 610 millimeters (24 inches) deep: 1 hour; (8) interactive RWF or activity pool greater than 610 millimeters (24 inches) deep: 2 hours; and (9) baby-only water facility: 0.5 hours. Ensure an RWF slide that is combined with a pool has a turnover rate that matches the rate for the pool.
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Item No.:
10
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Site:
Recreational Water Facilities-Lotus Spa Pool
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Violation:
The shepherd's hook was 3-4 feet short of the distance specified in 6.7.1.2.1, as taken from the side of the pool.
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Recommendation:
Provide a rescue or shepherd?s hook and an approved flotation device at a prominent location (visible from the full perimeter of the pool) at each RWF that has a depth of 1 meter (3 feet) or greater. Mount these devices in a manner that allows for easy access during an emergency. 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. Ensure the approved flotation device includes an attached rope that is at least 2/3 of the maximum pool width.
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Item No.:
16
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Site:
Buffet-Horizon Court
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Violation:
There was no consumer advisory posted at the cold platter station where cold smoked salmon and mackerel were offered 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 raw shell egg preparations are not used in uncooked products as described in section 7.3.3.2.3. Ensure that disclosure is made by one of the two following methods: (1) On a sign describing the animal-derived foods (e.g., ?oysters on the half-shell,? ?hamburgers,? ?steaks,? or ?eggs?); AND that they can be cooked to order and may be served raw or undercooked; AND a statement indicating that consuming raw or undercooked meats, seafood, shellfish, eggs, milk, poultry may increase your risk for foodborne illness, especially if you have certain medical conditions. Ensure the advisory is posted at the specific station where the food is served raw, undercooked, or cooked to order OR (2) On a menu using an asterisk at the animal-derived foods requiring disclosure and a footnote with a statement indicating that consuming raw or undercooked meats, seafood, shellfish, eggs, milk, or poultry may increase your risk for foodborne illness, especially if you have certain medical conditions.
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Item No.:
26
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Site:
Buffet-Horizon Port Side Beverage Station
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Violation:
An accumulation of sticky brown coffee residue was observed in the regular coffee dispensing nozzle when the inside was scraped with a drinking straw. It appeared to be an excess amount and that it had accumulated over several service periods. Other dispensing nozzles at the other beverage stations throughout the Horizon buffet did not yield any coffee residue.
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Recommendation:
Ensure food only contacts surfaces of equipment and utensils that are cleaned and sanitized. Ensure food contact surfaces of equipment and utensils are clean to sight and touch.
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Item No.:
27
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Site:
Buffet-Port Side Beverage Station
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Violation:
The the walls and sides of the undercounter technical compartment (CS2-PRT) were soiled with dried coffee residue. The coffee residue was also dried on the insulation material and Vitality equipment in the same 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.:
16
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Site:
Dining Room-Sabatini's and Crown Grill
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Violation:
The menus for theses outlets did not have asterisks at the animal-derived foods that could be served raw or undercooked and a footnote stating: 'consuming raw or undercooked meats, seafood, shellfish, eggs, milk, or poultry may increase your risk for foodborne illness, especially if you have certain medical conditions'.
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Recommendation:
If an animal food such as beef, eggs, fish, lamb, milk, pork, poultry, or shellfish that is raw, undercooked, or not otherwise processed to eliminate pathogens is offered in a ready-to-eat form or as a raw ingredient in another ready-to-eat food, ensure the consumer is informed by way of disclosure using menu advisories, placards, or other easily visible written means of the significantly increased risk to certain especially vulnerable consumers eating such foods in raw or undercooked form. Locate the advisory at the outlets where these types of food are served. Ensure that raw shell egg preparations are not used in uncooked products as described in section 7.3.3.2.3. Ensure that disclosure is made by one of the two following methods: (1) On a sign describing the animal-derived foods (e.g., ?oysters on the half-shell,? ?hamburgers,? ?steaks,? or ?eggs?); AND that they can be cooked to order and may be served raw or undercooked; AND a statement indicating that consuming raw or undercooked meats, seafood, shellfish, eggs, milk, poultry may increase your risk for foodborne illness, especially if you have certain medical conditions. Ensure the advisory is posted at the specific station where the food is served raw, undercooked, or cooked to order OR (2) On a menu using an asterisk at the animal-derived foods requiring disclosure and a footnote with a statement indicating that consuming raw or undercooked meats, seafood, shellfish, eggs, milk, or poultry may increase your risk for foodborne illness, especially if you have certain medical conditions.
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Item No.:
21
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Site:
Galley-Sabatini's
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Violation:
Several cords from the coffee machines were laying on the counter at the coffee station.
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Recommendation:
Shorten power cords or elevate them so they hang above the counter to facilitate cleaning.
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Item No.:
20
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Site:
Galley-Sabatini's
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Violation:
A badly scored white cutting board was observed at the soiled side of the dishwash station.
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Recommendation:
Ensure surfaces such as cutting blocks and boards that are subject to scratching and scoring are resurfaced if they no longer can be effectively cleaned and sanitized, or discarded if they are not capable of being resurfaced.
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Item No.:
21
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Site:
Galley-Hot Galley Aft - DK 6
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Violation:
The grooved grill was leaking grease from the below technical compartment and was slowly leaking onto the deck. The grease was coming out of a seam on the technical compartment on the front side below the grill area.
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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-Crown Grill - Dishwash
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Violation:
A previously cleaned and sanitized food strainer was had an accumulation of dark sediment on the surface of the straining end.
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Recommendation:
Ensure food only contacts surfaces of equipment and utensils that are cleaned and sanitized. Ensure food contact surfaces of equipment and utensils are clean to sight and touch.
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Item No.:
16
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Site:
Buffet-Time Control Plan - Crew Mess
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Violation:
The posted public health time control plan for this outlet did not have set up and discard times for dinner service.
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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): (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.:
37
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Site:
Galley-Potwash - DK 5
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Violation:
Excess condensation was observed dripping on the crew member who was operating the stationary potwash. It appeared that the condensate was collecting at the deckhead and dripping from the juncture where the light fixture joined the deckhead.
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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.:
39
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Site:
Buffet-Officer Mess
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Violation:
A live fruit fly was observed flying inside the cold counter display container.
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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.:
19
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Site:
Buffet-Officer Mess
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Violation:
Self service utensils were not available for the cut asparagus.
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Recommendation:
Provide food-dispensing utensils for each container displayed at a consumer self-service unit such as a buffet or salad bar.
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