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Item No.:
02
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Site:
Medical-Acute Gastroenteritis (AGE) Reportable Case Definition
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Violation:
The AGE reportable case definition for diarrhea episodes did not include what is above normal for an individual.
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Recommendation:
Ensure a reportable case of AGE is a case reported to the master of the vessel, the medical staff, or other designated staff by a passenger or a crew member and meets the case definition based on the following symptoms: (1) Diarrhea (three or more episodes of loose stools in a 24 hour period or what is above normal for the individual. See section 4.1.2.1.3, illness symptoms); 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 of greater than or equal to 38C [100.4F]).
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Item No.:
02
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Site:
Medical-Acute Gastroenteritis (AGE) Log
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Violation:
From the last USPHS inspection until December 7, 2011, the AGE log did not contain a specific case identification number and did not list the required items in the correct order as stated in Annex 13.2.2 in the 2011 VSP Operations Manual. A new AGE log that meets the USPHS requirement was implemented on December 8, 2011.
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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.:
06
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Site:
Potable Water-Microbiologic Monitoring Analysis
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Violation:
The Colilert color comparator used for water microbiological analysis had an expiration date of May 2011.
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Recommendation:
Ensure test kits, incubators, and associated equipment are operated and maintained in accordance with the manufacturers? specifications.
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Item No.:
08
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Site:
Potable Water-Distallate and Permeate Water Lines
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Violation:
The distillate and permeate water lines directed to the potable water system were not painted or striped in accordance with ISO 14726 (blue/gray/blue). (New requirement 2011 VSP Manual)
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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.
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Item No.:
08
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Site:
Potable Water-Adult Pool Machine Room
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Violation:
At the spray mister chlorination station, there was a chlorination supply line that entered the potable water dosing line before the backflow device. The chlorine supply entry point should be after the backflow device to prevent chlorine from entering the potable water supply.
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Recommendation:
Provide a comprehensive cross-connection control program. Protect the following connections to the potable water system against backflow with air gaps or mechanical backflow prevention devices: (1) RWFs; (25) chemical tanks; and (28) any other connection to the potable water system where contamination or backflow can occur.
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Item No.:
10
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Site:
Recreational Water Facilities-Halogen and pH Analyzer Probe Locations
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Violation:
The sample line locations for free halogen residual and pH probes for all recreational water facilities were located after 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-Mickey Pool and Nemo Reef Signage
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Violation:
The signage at these RWF's did not have the exact wording: 'Take children on frequent bathroom breaks' or 'Take children on frequent toilet breaks.' (New requirement 2011 VSP Manual)
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Recommendation:
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-Fecal Vomit Accident Plan
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Violation:
The chlorine residual and contact time for a loose stool accident had a CT value of 9,600, new scientific research recommends a CT value of at least 15,300. (New requirement 2011 VSP Manual)
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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.
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Item No.:
10
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Site:
Recreational Water Facilities-Whirlpool Draining Records
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Violation:
The whirlpool records did not specify the date and time they were drained. (New requirement 2011 VSP Manual)
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Recommendation:
Record the date and time of whirlpool spa and spa pool water changes in the log.
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Item No.:
10
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Site:
Recreational Water Facilities-Secondary Standards
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Violation:
There were no secondary standards for the Palintest kits used to monitor the water chemistry in the RWFs.
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Recommendation:
Where available, ensure appropriate secondary standards are onboard for electronic test kits to verify test kit operation.
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Item No.:
10
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Site:
Recreational Water Facilities-Antientrapment Drains
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Violation:
The gravity drain covers in the swimming pools were shipyard fabricated and greater than two feet apart. The letter that accompanied the drain covers from the shipyard did not indicate all of the requirements listed in section (6.7.1.2.2). (New requirement 2011 VSP Manual)
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Recommendation:
Ensure the design of custom/shipyard constructed (field fabricated) drain covers and suction fittings is fully specified by a registered design professional in accordance with ASME A112.19.8-2007. Ensure the specifications fully address cover/grate loadings, durability, hair, finger and limb entrapment issues, cover/grate secondary layer of protection, related sump design, and features specific to the RWF. Provide a letter from the shipyard for each custom/shipyard constructed (field fabricated) drain cover fitting. At a minimum, ensure the letter specifies the shipyard, name of the vessel, specifications and dimensions of the drain cover, as well as the exact location of the RWF for which it was designed. Ensure the name of and contact information for the registered design professional and signature are on the letter.
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Item No.:
10
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Site:
Recreational Water Facilities-Antientrapment Drains
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Violation:
The shipyard constructed gravity drain covers for the whirlpools did not have documentation from the shipyard indicating that they comply with ASME A112.19.8-2007 standards. (New requirement 2011 VSP Manual)
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Recommendation:
Provide a letter from the shipyard for each custom/shipyard constructed (field fabricated) drain cover fitting. At a minimum, ensure the letter specifies the shipyard, name of the vessel, specifications and dimensions of the drain cover, as well as the exact location of the RWF for which it was designed. Ensure the name of and contact information for the registered design professional and signature are on the letter.
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Item No.:
16
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Site:
Children Area-Time Control Plan
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Violation:
There was no time control plan located in the Oceaneer Club for the food served in that area. A time control log was available in the club with food temperature measurements and times for when food was received at the club and discarded. All food was discarded in less than 4 hours.
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Recommendation:
If time only?rather than time in conjunction with temperature?is used as the public health control for a working supply of potentially hazardous food before cooking, or for ready-to-eat potentially hazardous food that is displayed or held for service for immediate consumption, ensure the food (1) Has an initial temperature of 5C (41F) or less or 57C (135F) or greater before placement on time control. (2) Is not be placed on temperature control again. (3) Is marked or otherwise identified to indicate the time 4 hours past the point in time when the food is removed from temperature control (if the time between service set-up and closing is greater than 4 hours. and (4) Is discarded within 4 hours of placement on time control.
Maintain a written time control plan(s) that ensures compliance with these guidelines on the vessel and make it available for review during inspections. Post a time control plan at each outlet where time control is used. Ensure plan(s): (1) Includes set-up and discard times for each outlet. (2) List refrigeration and hot holding units (compartments and cabinets) on time control (the physical units must also be labeled as such). (3) Describe or show the flow of potentially hazardous food from when last in temperature control to placement in time control and discard.
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Item No.:
16
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Site:
Bar-Cove Cafe and Currents Time Control Plans
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Violation:
The time control plans at the Cove Cafe and Currents did not list the set-up and discard times. Temperature logs were at the outlets and included the set-up and discard times. All food was discarded in less than 4 hours.
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Recommendation:
If time only?rather than time in conjunction with temperature?is used as the public health control for a working supply of potentially hazardous food before cooking, or for ready-to-eat potentially hazardous food that is displayed or held for service for immediate consumption, ensure the food (1) Has an initial temperature of 5C (41F) or less or 57C (135F) or greater before placement on time control. (2) Is not be placed on temperature control again. (3) Is marked or otherwise identified to indicate the time 4 hours past the point in time when the food is removed from temperature control (if the time between service set-up and closing is greater than 4 hours. and (4) Is discarded within 4 hours of placement on time control.
Maintain a written time control plan(s) that ensures compliance with these guidelines on the vessel and make it available for review during inspections. Post a time control plan at each outlet where time control is used. Ensure plan(s): (1) Includes set-up and discard times for each outlet. (2) List refrigeration and hot holding units (compartments and cabinets) on time control (the physical units must also be labeled as such). (3) Describe or show the flow of potentially hazardous food from when last in temperature control to placement in time control and discard.
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Item No.:
20
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Site:
Preparation Room-Bakery
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Violation:
The deck-mounted mixer had 2 slotted screws in the food splash zone.
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Recommendation:
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:
Preparation Room-Buffet
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Violation:
There was one slotted screw in the deck-mounted mixer in the food splash zone.
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Recommendation:
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.:
21
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Site:
Preparation Room-Bakery
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Violation:
The lock mechanism for the walk-in refrigerator door D-33-1-009 had been out of operation and missing since December 8, 2011. There were two holes in the door and the missing latches created an opening within the door leading to a void space. This missing lock was not impacting the temperature of the unit or the food within it.
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Recommendation:
Ensure nonfood contact equipment is maintained in good repair and proper adjustment including: (1) Equipment maintained in a state of repair and condition that meets the materials, design, construction, and operation specifications of these guidelines; (2) Equipment components such as doors, seals, hinges, fasteners, and kick plates are kept intact, tight, and adjusted in accordance with manufacturer's specifications.
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Item No.:
26
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Site:
Bar-Currents Bar
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Violation:
The inside of the previously cleaned Michelob beer tap line was soiled with a residue.
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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.:
26
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Site:
Bar-Bon Voyage
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Violation:
The inside of the three beer tap lines were soiled with a residue. The beer taps had not been used yet today and had not been cleaned in almost two weeks.
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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.:
40
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Site:
Integrated Pest Management-Active Surveillance
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Violation:
The active surveillance logs written by the IPM contractor did not include the follow-up inspection results. The sighting logs conducted by staff did not include the time of the inspection and did not always indicate what type of pests were found. In some cases a pests was noted as 'bites' in the log and even though a spray was used, the actual pest was not identified in the log.
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Recommendation:
Ensure the IPM Plan sets a schedule for periodic active monitoring inspections, including some at night or during periods of no or minimal activity. When pests are noted during an inspection, ensure the log includes action taken and follow-up inspection results.
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Item No.:
41
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Site:
Other-Spa
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Violation:
There were no tissues or towels available to exit the men's or women's changing rooms and there was no sign available advising users of the toilet facilities to use hand towel, paper towel, or tissue to open the door. The exits were not hands free.
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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 (OPRP)
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Violation:
There were no procedures for informing passengers and crew of an outbreak in the OPRP. Also, there were no specific procedures to protect the passengers from dermal and respiratory exposures to disinfectants in the OPRP.
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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; (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-Oceaneer Lab Toilet Rooms
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Violation:
The girls and boys toilet rooms are used by children 3-12 years old but the handwashing sink was 24 inches above the deck and the toilet was 15 inches above the deck. Step stools were not available in these areas.
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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.:
42
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Site:
Children Area-Oceaneer Lab Diaper Changing Station
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Violation:
There was no disinfectant located in the diaper changing station.
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Recommendation:
Include in each diaper changing station: (2) A supply of disinfectant.
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Item No.:
42
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Site:
Children Area-Oceaneer Club Toilet Rooms
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Violation:
The two outer sinks in the boys and girls club toilet rooms were 24 inches from the deck and the toilets were 15 inches above the deck. Step stools were not available in these areas.
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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.:
42
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Site:
Children Area-Oceaneer Club Diaper Changing Station
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Violation:
There was no disinfectant at the diaper changing table.
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Recommendation:
Include in each diaper changing station: (2) A supply of disinfectant.
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