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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 was not in the format and exact order specified in Annex 13 of the 2011 VSP Operations Manual. In addition, the electronic database used for collecting AGE case information used the previous VSP definition for an AGE illness case and did not consider diarrhea in excess of what was normal for the individual. Therefore, a patient with underlying medical conditions could be reported as an AGE case.
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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]). Ensure the AGE surveillance log entry for each passenger or crew member contain the following information in separate columns: (1) Date of the first medical visit or report to staff of illness; (2) time of the first medical visit or report to staff of illness; (3) case identification number; (4) person's name; (5) person's age; (6) person's sex; (7) designation as passenger or crew member; (8) crew member position or job on the vessel, if applicable; (9) cabin number; (10) meal seating information; (11) date of illness onset; (12) time of illness onset; (13) illness symptoms, including the presence or absence of the following selected signs and symptoms, with a separate column for each of the following: (a) number of episodes of diarrhea in a 24-hour period; (b) number of episodes of vomiting in a 24-hour period; (c) bloody stools; (d) recorded temperature; (e) abdominal cramps; (f) headaches; (g) muscle aches; (14) entry (yes/no) for whether this was a reportable case; (15) entry (yes/no) for antidiarrheal medications sold or dispensed by designated medical staff; (16) presence of underlying medical conditions that may affect interpretation of AGE. Ensure the AGE surveillance log contains the above information in the exact order and is entered in the template in Annex 13.2.2. Ensure that the log data is exported in the exact order as in the example template in Annex 13.2.2 with analyzable formats such as Excel or Access. Ensure that any additional data fields are entered only outside of the form margins when exported to VSP.
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Item No.:
08
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Site:
Potable Water-Engine Room
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Violation:
The striping on the produced water line between the mineralizers and the halogen injection point was blue, not blue/gray/blue. This was corrected.
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Recommendation:
Stripe or paint distillate and permeate lines directed to the potable water system in accordance with ISO 14726 (blue/gray/blue). Ensure no other lines have the above color designations. Stripe or paint these lines at 5 meters (15 feet) intervals and on each side of partitions, decks, and bulkheads, except where decor would be marred by such markings, including potable water supply lines in technical lockers.
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Item No.:
08
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Site:
Buffet-Crew Mess
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Violation:
The nonpotable chilled water lines connected to the back of the ice cream machine had tags attached to them, but the tags were unreadable. The staff explained that the tags were to identify the brine lines, but the ink was blurred.
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Recommendation:
Uniquely identify all refrigerant brine lines in all galleys, pantries, and cold rooms to prevent cross-connections.
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Item No.:
10
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Site:
Recreational Water Facilities-Deck 8 Forward Pool Machinery Room
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Violation:
The sample lines for the children's pool and spa pool were located on the return lines to the RWFs, after the compensation tank and filtration.
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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-Antientrapment Protection
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Violation:
There was no documentation that the drain covers on the swimming pools or children's pool were certified for antientrapment and there were no alarms for draining. These RWFs had gravity drainage and dual drains greater than three feet apart.
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Recommendation:
For RWFs with gravity drainage and multiple drains (2 or more drains greater than 3 feet apart), provide either a standard design (not compliant with ASME A112.19.8) drain cover and an alarm, or an ASME A112.19.8 compliant antientrapment/antientanglement drain cover. Ensure the alarm is audible and sounds in both a continuously manned space and at the RWF. Ensure this alarm is for all draining: accidental, routine, and emergency.
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Item No.:
10
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Site:
Recreational Water Facilities-Depth Markers
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Violation:
The depth markers for the swimming pools and spa pool were in feet only.
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Recommendation:
Prominently display the depth of each RWF that is deeper than 1 meter (3 feet) so that it can be seen from the deck and in the pool. Label depth markers in both feet and meters. Additionally, install depth markers for every 1 meter (3 feet) change in depth.
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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 all of the RWFs did not meet the requirements of the 2011 VSP Operations Manual.
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Recommendation:
Provide safety signs for all RWFs, except for baby-only water facilities. Ensure the signs, at a minimum, include the following words: (1) do not use these facilities if you are experiencing diarrhea, vomiting, or fever; (2) no children in diapers or who are not toilet trained; (3) shower before entering the facility; and (4) bather load #. For children's RWF signs, include the exact wording "TAKE CHILDREN ON FREQUENT BATHROOM BREAKS" or "TAKE CHILDREN ON FREQUENT TOILET BREAKS." In addition to the safety sign requirements in section 6.7.1.1.1, install a sign at each whirlpool spa and spa pool entrance listing precautions and risks associated with the use of these facilities. Include, at a minimum, cautions against use by the following: (1) individuals who are immunocompromised; (2) individuals on medication or who have underlying medical conditions such as cardiovascular disease, diabetes, or high or low blood pressure; and (3) pregnant women, elderly persons, and children. Additionally, caution against exceeding 15 minutes of exposure.
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Item No.:
10
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Site:
Recreational Water Facilities-Monitoring
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Violation:
Alkalinity, clarity, and combined chlorine were not monitored. According to the staff, a new test kit would be ordered.
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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-Hair and Lint Strainer Housings
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Violation:
The documentation did not include disinfection of the housings.
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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.
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Item No.:
11
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Site:
Medical-Food Worker Reporting
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Violation:
On 25 January 2012, a team headwaiter had an onset of acute gastroenteritis symptoms at 1000 but did not report to the medical center until 1717. A review of the work schedule and medical records indicated that this waiter worked while symptomatic. There was also documentation that the ship's staff followed up on this case immediately and the waiter was given a warning.
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Recommendation:
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. Ensure food employees who have conditions or symptoms of boils, open sores, infected wounds, diarrhea, jaundice, fever, vomiting, sore throat with fever, or discharges from the nose or mouth report these conditions or symptoms to the vessel's medical staff and are restricted from working with exposed food, warewashing, clean equipment, utensils, and linens, and unwrapped single-service and single-use articles.
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Item No.:
16
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Site:
Dining Room-Sun King Steakhouse
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Violation:
The menu had the consumer advisory indicating that consuming raw or undercooked animal-derived foods may increase the risk for foodborne illness. The broiled rosemary infused chicken had an asterisk indicating that this product could be cooked to order and served raw or undercooked. However, the staff explained that the chicken could not be cooked to order and the asterisk next to that item was a mistake.
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Recommendation:
Ensure the asterisks to indicate animal-derived foods that require a consumer advisory are only at animal-derived foods that can be served raw or undercooked.
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Item No.:
20
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Site:
Food Service General-Espresso Machines
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Violation:
The Scharf espresso machines had an opening to internal parts in the food-splash zones on the underside of the coffee making area, making them difficult to clean. The staff explained that they were waiting for the delivery of a new panel to be installed at these food-splash zones. The staff furthered explained that this panel was being installed fleet-wide on all espresso machines of this kind.
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Recommendation:
Materials used in the construction of multiuse utensils and food-contact surfaces of equipment must be: (1) durable, corrosion resistant, and nonabsorbent; (2) sufficient in weight and thickness to withstand repeated warewashing; (3) finished to have a smooth, easily cleanable surface; and (4) resistant to pitting, chipping, crazing, scratching, scoring, distortion and decomposition.
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Item No.:
20
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Site:
Galley-
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Violation:
The ice machine in front of the chef's office had a continuous leak of water to the deck from inside the upper ice compartment. The deck around the ice machine was wet with pooled water. The staff serviced the machine during the inspection.
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Recommendation:
Food contact equipment must be maintained in good repair and proper adjustment: (1) Equipment must be maintained in a state of repair and condition that meets the materials, design, construction, and operating specifications of these guidelines.
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Item No.:
22
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Site:
Galley-Potwash
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Violation:
During the active use of the flight-type potwash machine, the spray nozzles of the upper final sanitizing rinse spray arm were not spraying in an effective manner. This was corrected during the inspection.
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Recommendation:
Maintain warewashing equipment in good repair and proper adjustment, including: (1) warewashing equipment is maintained in a state of repair and condition that meets the standards of the materials, design, and construction of these guidelines; (2) water pressure and water temperature-measuring devices are maintained in good repair and accurate within the intended range of use.
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Item No.:
33
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Site:
Galley-Food Lifts
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Violation:
The door tracks of both food transportation lifts were soiled with an accumulation of debris.
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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.:
33
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Site:
Buffet-Officer's Mess Locker FSD 0055
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Violation:
The deck of the locker at the entrance of the officer's mess was soiled with dust. Some equipment parts were stored directly on the deck under the deck stands, making cleaning difficult. There was also an excessive amount of utensils stored inside the locker that made it difficult to maneuver in the space and clean and check for pests. This was corrected.
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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. Do not store items directly on the deck. Ensure equipment is stored in an orderly fashion, providing enough space to clean inside the locker and check for pests.
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Item No.:
33
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Site:
Bar-Steakhouse
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Violation:
The bulkhead and deckhead had decorative gold trimming with numerous grooves and crevices. The chandeliers also had difficult to clean features.
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Recommendation:
Ensure bulkheads and deckheads have smooth, hard finishes and light colored surfaces. Exception: bars may have decorative surfaces provided that they are easily cleanable.
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Item No.:
33
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Site:
Galley-Steakhouse Grill Front Counter
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Violation:
The deckhead above the food preparation area had decorative gold trim with numerous grooves and crevices.
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Recommendation:
Ensure bulkheads and deckheads have smooth, hard finishes and light colored surfaces. Exception: bars may have decorative surfaces provided that they are easily cleanable.
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Item No.:
36
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Site:
Pantry-Light Intensity
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Violation:
The light intensity around and behind the ice machines was less than 110 lux.
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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.:
41
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Site:
Housekeeping-Passenger Public Toilet Rooms
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Violation:
There were no signs at the handwashing stations advising users to wash hands.
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Recommendation:
Provide the passenger and crew public toilets with a handwashing station that includes: (1) Hot and cold running water; (2) Soap; (3) A method to dry hands; (4) A sign advising users to wash hands.
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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 meet the requirements of the 2011 VSP Operations Manual. In addition, the plan stated that Tor HB would be used for sanitizing, but the vessel was using HB Quat.
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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. Ensure the correct disinfectant is included in the OPRP.
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Item No.:
41
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Site:
Medical-Staff Toilet Room
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Violation:
In the toilet room labeled for staff use only, it appeared that a deck-mounted urinal had been converted to a handwashing sink. There was a water faucet, soap holder, and sign advising users to wash their hands after using the toilet, and the toilet room was stocked with toilet tissue, paper towels, and other items. According to the staff, this toilet room was not used.
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Recommendation:
Install a proper handwashing sink or remove the toilet room from service.
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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 at the handwashing sink advising handwashing. There was also no sign advising users to use a paper towel or tissue to open the door.
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Recommendation:
Provide the passenger and crew public toilets with a handwashing station that includes: (4) A sign advising users to wash hands. 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.:
42
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Site:
Children Area-Toilet Room
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Violation:
The height of the child-size toilet was greater 11 inches from the deck. The height of the handwashing sink was greater than 22 inches from the deck. No step stools were provided.
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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-Heating, Ventilation, and Air Conditioning (HVAC) Units
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Violation:
Technical water was used to clean the HVAC units.
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Recommendation:
Use only potable water for cleaning HVAC distribution systems.
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