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Item No.:
02
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Site:
Medical-Acute Gastroenteritis (AGE) Surveillance Log
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Violation:
The paper version AGE log onboard was no exact in comparison to the VSP AGE log provided in section 13.2.2. The log onboard did not describe total passenger or crew ill on the voyage at the top section, and did not include a column for myalgia.
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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.:
02
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Site:
Medical-Gastrointestinal Illness Case Reporting
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Violation:
The Stardocs database does not permit manual determination of GI illness cases and does not use the current VSP Operations Manual 2011 definition of a reportable GI illness case. The system does not allow persons without vomiting to be considered a reportable case if they have less than 3 diarrheal episodes. Additionally, this system makes anyone with 3 or more episodes of diarrhea a reportable case, even if they have underlying medical conditions which might explain those episodes. Additionally, there was an individual passenger who had 10 diarrheal episodes, headache, myalgia, stomach cramps, and fever, as measured by the medical staff, with no underlying medical conditions, yet the database listed them as non-reportable.
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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-Gastrointestinal Illness Case Reporting
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Violation:
The electronic database did not allow gastrointestinal illness symptoms to be recorded as part of the follow-up visits made by persons with initial gastrointestinal illness symptoms. Vital signs only can be added in those follow-up evaluations. One passenger case who originally reported two episodes of diarrhea on 27 February was given antidiarrheal medication and upon follow-up had additional GI illness symptoms. They remained a non-reportable GI illness case and the additional symptoms could not be recorded from the follow-up screen.
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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-Whirlpool Automatic Monitoring
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Violation:
The sample lines for the electronic data loggers for the whirlpools were not directly from the whirlpools or on the return lines before the compensation tanks. (2011 VSP Operations Manual)
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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-Alkalinity Monitoring
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Violation:
There was no test kit to measure total alkalinity. (2011 VSP Operations Manual)
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Recommendation:
Ensure a test kit is available for testing water quality parameters, including free and total halogen levels (chlorine and bromine, where applicable), pH, and total alkalinity. Ensure that test kits are accurate to within 0.2 mg/L (ppm) for halogen and have a testing range of free residual halogen normally maintained in the RWF. Ensure test kits for pH are accurate to within 0.2. Ensure all reagents are not past their expiration dates.
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Item No.:
10
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Site:
Recreational Water Facilities-Antientrapment
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Violation:
The documentation from the manufacturer indicated the drain covers for the swimming pools and whirlpool spas met the antientrapment standards, but there was no way to check the covers to see if they were stamped with the required information. All of the swimming pools and whirlpool spas were full and there were no spare drain covers onboard. The swimming pools had dual gravity drains greater than three feet apart and no alarms were installed. (2011 VSP Operations Manual)
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Recommendation:
Ensure the testing of manufactured drain covers is by a nationally or internationally recognized testing laboratory. Ensure the following information is stamped on each manufactured antientrapment drain cover: (1) certification standard and year; (2) type of drain use (single or multiple); (3) maximum flow rate (in gallons or liters per minute); (4) type of fitting (suction outlet); (5) life expectancy of cover; (6) mounting orientation (wall, floor, or both); (7) manufacturer's name or trademark; and (8) model designation. 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-Safety Signs
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Violation:
The safety signs for the swimming pools and whirlpool spas did not include all of the information as required in 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 #. 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-Whirlpool Shock Halogenation
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Violation:
The free residual halogen concentration was not documented at the start and completion of the shock halogenation for the whirlpools. (2011 VSP Operations Manual)
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Recommendation:
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-Fecal and Vomit Accident Plan
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Violation:
The fecal and vomit accident plan did not indicate the specific recreational water facility where the incident occurred.
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Recommendation:
Ensure a written or electronic record is made of all accidents involving fecal material or vomit. Ensure the record includes the name of the RWF, date and time of the accident, type of accident, response steps taken, and free residual halogen level and contact time reached during disinfection. For a fecal accident, ensure the record also includes whether the fecal material was formed or loose.
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Item No.:
11
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Site:
Medical-Crew Gastrointestinal Illness Reporting
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Violation:
An assistant waiter developed GI illness symptoms at 7 am on 19 March and reported to the medical center at 4:55 pm the same day. On 18 February a casino dealer developed GI illness symptoms at 10 am and reported to the medical center at 6:04 pm the same day. On 13 February a bar server developed GI illness symptoms at 11 am and reported to the medical center at 6:17 pm the same day.
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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.
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Item No.:
16
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Site:
Galley-Time Control Plan
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Violation:
The posted hot and cold time control plans for buffet operations did not list the set up times for buffets. The control plan was not evaluated since the buffet operations were closed as the inspection team was working in the area. In discussions with the management and staff, the plan could be simplied to conform to the current operations and improve the time management system, for example in those operations that extend for more than four hours and others that actually close within four hours. They also stated that the time control plans need to be updated throughout the food operations. (New requirement 2011 VSP Operations Manual)
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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.:
16
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Site:
Buffet-Consumer Advisory Statement
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Violation:
The individual service stations were undercooked eggs, smoked salmon, and grilled to order hamburgers are prepared and served do not have specific advisories for these food products.
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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.:
16
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Site:
Dining Room-Murano's Restaurant / QSINE Restaurant
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Violation:
The consumer advisory has been printed on the new menu, but foods that may be ordered undercooked such as steaks, lamb and smoked salmon had not been designated with an asterisk. The tablet computers used for the QSINE Restaurant were not available to review the consumer advisory for the sushi sticks served. (New requirement 2011 VSP Operations Manual)
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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.:
19
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Site:
Buffet-Buffet Lines
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Violation:
A broken glass light shield was noted above a cold item buffet. The housing had a large amount of the shattered glass in it. The shattered glass particles were directly above where the open containers of food had been on display for the passengers. The ship cleaned the glass shards from the housing and replaced the missing panel during the inspection. During the outbrief, the ship management reported during the original incident when the glass shield shattered, the operation of this buffet was suspended, affected food was removed and the buffet counter was thoroughly cleaned.
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Recommendation:
Protect food from contamination that may result from a physical origin.
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Item No.:
19
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Site:
Other-Cafe al Bacio
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|
Violation:
An open pitcher of water was stored on the handwash sink. The pitcher was moved to the serving counter.
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Recommendation:
Protect food from contamination by storing the food: (1) Covered or otherwise protected; (3) Where it is not exposed to splash, dust, or other contamination.
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Item No.:
20
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Site:
Preparation Room-Poultry Preparation Room
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|
Violation:
The two previously cleaned cutting boards on the clean rack were heavily scored from deep knife marks and required re-surfacing to be easy to clean.
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Recommendation:
Ensure surfaces such as cutting 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.:
22
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Site:
Galley-Pot Wash
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Violation:
A prewash sink was being used for soaking the enormous number of heavily soiled pots, pans and preparation utensils on the soiled landing and on the several deck stands in the area. The soak water was completely saturated with food debris. Three out of four utensils removed from automatic potwash by the crew members were returned to the prewash station for further cleaning.
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Recommendation:
Ensure drainboards, utensils, racks, or tables large enough to accommodate all soiled and cleaned items that may accumulate during hours of operation are provided for necessary utensil holding before cleaning and after sanitizing. Ensure the wash, rinse, and sanitize solutions are maintained clean. Ensure the washing procedures selected are based on the type and purpose of the equipment or utensil and on the type of soil to be removed.
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Item No.:
22
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Site:
Galley-Dishwashing
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Violation:
Main warewash machine was not working during the inspection. Crew reported that morning check showed that the final rinse pressure was not adequate because of malfunctioning final rinse pump. Dishwashing operation was severly overloaded with soiled dishes because of the malfunction. The rack conveyor glasswashing machine was being used for washing all lido soiled dishes and serving utensils.
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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.
Recommend creating a Preventitive Maintenance Plan for each warewashing machine based on manufacturer's recommendations and fleet and ship experience and that includes schedule, needed parts and instructions for the maintenance procedures.
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Item No.:
26
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Site:
Galley-Dishwashing
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Violation:
Cleaned ware storage racks had: more than four large black plastic serving trays with food debris; one blue glass with lipstick on the rim; white serving utensils with food soil; and smaller black serving trays with food soil on them.
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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-Preparation Area
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Violation:
Two cleaned tilting skillets were found with dried black and white food particles on the inside of both of the skillets.
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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:
Buffet-Buffet Lines
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Violation:
The lights in the food splash zones above the food displayed on the island buffet lines had old dried food soil on them.
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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:
Buffet-Buffet Lines
|
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Violation:
Cleaned plates stored for passenger service on the buffet lines were found with a large grease spot and dried egg yolk on them.
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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-Mast Grill
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Violation:
The cleaned hot dog rolling cooker had old food soil at the ends of the rollers particularly under the 'O' rings.
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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-Murano's Restaurant / QSINE Restaurant
|
|
Violation:
A cleaned deep fat fryer had grease residue on the heating elements.
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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-Dishwashing - Deck 4 - Starboard
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|
Violation:
Food debris was found on cleaned plates, and soup bowl in the clean utensil storage rack.
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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-Appetizer Preparation - Deck 4
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|
Violation:
A cleaned food slicer had food soil on the lower exit area near the blade. A cleaned food chopper had soiled blades.
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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.:
28
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Site:
Buffet-Buffet Lines
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|
Violation:
Bowls were found in the passenger service line that had not been air dried. Water droplets flowed from the nested-bowls as they were picked up.
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Recommendation:
After cleaning and sanitizing, ensure equipment and utensils are air dried or adequately drained before contact with food.
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Item No.:
29
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Site:
Bar-Mast Bar
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|
Violation:
The water temperature at the handwash sink was 136F as measured by the inspector's thermometer. The user could not adjust the water temperature. This was corrected.
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Recommendation:
Ensure handwashing sinks are equipped to provide water at a temperature of at least 38C (100F) through a mixing valve or combination faucet. For handwash sinks with electronic sensors, and other types of handwash sinks where the user cannot make temperature adjustments, ensure the temperature provided to the user after the mixing valve does not exceed 49C (120F).
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Item No.:
33
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Site:
Galley-Murano's Restaurant / QSINE Restaurant
|
|
Violation:
Garbage dumb waiter was found with old food soil on the deck.
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|
Recommendation:
Ensure decks in food preparation areas are cleaned as often as necessary.
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Item No.:
36
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Site:
Buffet-Buffet Lines
|
|
Violation:
Light bulb in the opening above the shattered light shield noted above did not have a shatter resistant coating.
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|
Recommendation:
Ensure light bulbs are shielded, coated, or otherwise shatter-resistant in areas where there is exposed food.
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Item No.:
38
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|
Site:
Galley-Potwash - Deck 3
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|
Violation:
A mop was stored in a mop bucket at the soiled end of the potwash area.
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|
Recommendation:
After use, ensure mops are placed in a position that allows them to air-dry without soiling walls, equipment, or supplies.
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Item No.:
41
|
|
Site:
Housekeeping-Crew and Passenger Public Toilets
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|
Violation:
There was no sign in the public toilet in the medical facility waiting room advising persons to use paper towels to open the door upon exit. Additionally this same sign was missing in the engine room corridor men's and women's crew public toilets. In these toilet rooms there was no sign advising users to wash hands posted at the handwash sink.
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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. Provide the passenger and crew public toilets with a handwashing station that includes: (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 OPP plan specified contact times for the Oxivir Five 16 cleaner/disinfectant used on most surfaces throughout the ship in the elevated response level 2, but no concentration was listed when it was described to be used. Additionally, the area fogging product, Vital Oxide, is described with contact time but no concentration was provided for this.
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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: (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).
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Item No.:
41
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|
Site:
Housekeeping-Outbreak Prevention and Response Plan (OPRP)
|
|
Violation:
There were a series of letters for guests to notify them of the elevated GI illness condition onboard under response level 2, either during the voyage or for guests boarding following a level 2 voyage. All the letters begin with reference to illnesses like colds, influenza, and stomach flu, which confuses the true issue of gastrointestinal illness, which is mentioned third. Beyond that both the stateroom letter following the level 2 cruise and the pillow letter provided during a level 2 GI illness cruise don't mention the elevated gastrointestinal illness problem experienced. These letters provide advice on prevention of GI illness only.
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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.
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