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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 meet the new requirements. For example, there was no column for patient ID, only one column for name, and two columns to indicate passenger and crew. There were also several extra columns, including isolation cabin, dinner table, elaspsed time from onset, date out and time out. Finally, several of the columns were not in the exact order of the template in Annex 13.2.2.
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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.:
10
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Site:
Recreational Water Facilities-Turnover Rates and Bather Loads
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Violation:
There was no documentation for the turnover rates for the whirlpools. There was no documentation for the bather loads for each RWF.
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Recommendation:
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: (5) whirlpool spa: 0.5 hours. 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-Antientrapment
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Violation:
There were no antientrapment drain covers or alarms on the main and aft pools. The pools had multiple drains more than 3 feet apart. According to the staff, antientrapment drain covers had been ordered. The three midship whirlpools had multiple suction fittings less than three feet apart. The fittings had antientrapment drain covers, but there were no suction vacuum release systems or automatic pump shut-off systems installed.
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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. 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-Safety Signs
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Violation:
The safety signs for the two swimming pools, five whirlpools and hydropool did not include the bather load number. The safety sign for the hydropool did not include a caution against use by individuals on medication or who have underlying medical conditions such as cardiovascular disease, diabetes, or high or low blood pressure. Finally, the safety signs for the whirlpools stated that children under the age of 14 required adult supervision.
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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. Consider including a caution that children under the age of 16 require adult supervision.
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Item No.:
10
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Site:
Recreational Water Facilities-Automated Monitoring
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Violation:
The whirlpools did not have chart recorders or electronic data loggers installed on sample lines from the RWFs or on the return lines from the RWFs before the compensation tanks.
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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.
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Item No.:
11
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Site:
Medical-Crew Member Acute Gastroenteritis (AGE) Reporting
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Violation:
On 16 November at 09:00, a kitchen assistant reported to the medical clinic with AGE symptoms. The symptoms began on 15 November at 06:00. On 17 November at 14:15, a casino dealer reported to medical with AGE symptoms. The symptoms began on 14 November at 16:00. Both crew members worked after having AGE symptoms. Disciplinary action was immediately taken by the ship's staff. In addition, the areas where each crew member worked were sanitized and passengers and crew members were monitored to see if they developed AGE symptoms from these areas.
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Recommendation:
Ensure crew members are instructed to report to the medical clinic immediately following AGE symptoms. 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.:
16
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Site:
Food Service General-Consumer Advisories
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Violation:
There was no consumer advisory at the Lido buffet service line where eggs could be ordered undercooked. In addition, the menus for the Pinnacle Grill and the Tamarind Restaurant had consumer advisories indicating that consuming raw or undercooked animal-derived foods may increase the risk for foodborne illness, especially to consumers with certain medical conditions. However, the animal-derived products in the menu that could be ordered undercooked were not identified with an asterisk.
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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 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.:
16
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Site:
Galley-
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Violation:
A large hotel pan of cut tomatoes had temperatures that ranged from 55F to 58F. The tomatoes had a discard date of 8 December 2011. The tomatoes were discarded.
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Recommendation:
Except during preparation, cooking, or cooling, or when time is used as the public health control, maintain potentially hazardous foods at 57C (135F) or above, except that roasts may be held at a temperature of 54C (130F); or 5C (41F) or less.
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Item No.:
16
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Site:
Pantry-Pinnacle Bar
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Violation:
An opened whipped cream can in the upright refrigerator did not have a 7-day discard label.
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Recommendation:
Ensure refrigerated, ready-to-eat, potentially hazardous food prepared and packaged by a food-processing plant and held on the vessel after opening for more than 24 hours is clearly marked at the time the original container is opened to indicate the date by which the food must be consumed (7 calendar days or fewer after the original container is opened). The day of opening is counted as day 1.
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Item No.:
20
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Site:
Food Service General-Tip-Sensitive Temperature-Measuing Devices (TMDs)
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Violation:
None of the staff in the cooking areas were equipped with tip-sensitive TMDs.
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Recommendation:
Ensure food temperature-measuring devices are provided and readily accessible for use in ensuring attainment and maintenance of food temperatures. Use tip-sensitive temperature-measuring devices, such as a thermocouple or thermistor, for measuring thin food products.
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Item No.:
21
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Site:
Galley-Deck 3
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Violation:
Three plate storage carts were scratched and scored at the plate contact surfaces.
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Recommendation:
Ensure nonfood-contact surfaces of equipment that are exposed to splash, spillage, or other food soiling or that require frequent cleaning are constructed of a corrosion-resistant, nonabsorbent, and smooth material.
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Item No.:
21
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Site:
Pantry-Multiflow Systems
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Violation:
The bottom panels of the CCool 9 multiflow systems were heavily corroded, making cleaning difficult. This was observed in multiflow systems in the pantries for the Ocean, Crow's Nest, and Pool bars.
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Recommendation:
Design and construct nonfood-contact surfaces of equipment and utensils to be durable and to retain their characteristic qualities under normal use conditions.
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Item No.:
21
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Site:
Buffet-Petty Officers Mess
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Violation:
The power cable to the bulk milk dispenser was draped on the counter.
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Recommendation:
Shorten or support the power cables above the counter to allow for cleaning.
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Item No.:
22
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Site:
Galley-Pinnacle Grill Dishwash
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Violation:
During active use of the flight-type conveyor dishwash machine, the gauge for the auxiliary rinse temperature indicated 164F. The data plate affixed to the machine indicated a minimum required auxiliary rinse temperature of 180F.
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Recommendation:
Ensure a warewashing machine and its auxiliary components are operated in accordance with the machine?s data plate and other manufacturer?s instructions. Ensure a warewashing machine?s conveyor speed or automatic cycle times is maintained accurately timed in accordance with manufacturer?s specifications.
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Item No.:
26
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Site:
Galley-Deck 3 Beverage Station - Bulk Milk Dispenser
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Violation:
The bulk milk dispensing tube chutes were soiled with a thick white material. The dispenser was previously cleaned and not in use at the time of the inspection.
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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:
Galley-Garde Manger
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Violation:
The mixer shaft was soiled with brown debris. The mixer was previously cleaned and not in use at the time of the inspection. This was corrected.
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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:
Provisions-Decks
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Violation:
The decks under the pallets in dry store rooms #16, #19, and #20 were soiled with accumulated dust.
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Recommendation:
Ensure decks, bulkheads, deckheads, and attached equipment in food preparation, warewashing, pantries, and storage areas are cleaned as often as necessary.
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Item No.:
38
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Site:
Other-Concierge Lounge
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Violation:
A broom and dust pan were stored against the deck stand of the general storage locker.
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Recommendation:
Ensure maintenance tools such as mops, brooms, and similar items are stored in a designated locker so they do not contaminate food, food-contact surfaces of utensils, and equipment, linens, and single-service and single-use articles.
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Item No.:
41
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Site:
Medical-Public Toilet Room
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Violation:
There was no sign in the toilet room advising users to use a tissue or paper towel to open the door. The door was not hands free, and this toilet was available to passengers and crew in the medical facility. This was corrected.
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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:
The OPRP did not include contact times for the disinfectants. According to the staff, this information was included in the training material, but not in the written plan. In addition, the OPRP did not include procedures for returning the vessel to normal operating conditions after an outbreak. According to the staff, the procedures were decided on a case by case basis in coordination with the corporate office and medical department.
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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: disinfectant products or systems used, including the surfaces or items the disinfectants will be applied to, concentrations, and required contact times; and procedures for returning the vessel to normal operating conditions after an outbreak.
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