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Item No.:
02
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Site:
Medical-
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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. (New requirement 2011 VSP Operations Manual)
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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 38°C [100.4°F]). 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.:
05
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Site:
Potable Water-Far Point Halogen Analyzer-Recorder
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Violation:
Halogen analyzer and the chart recorder showed the free chlorine residual to be 3.4 PPM. Successive manual test by the inspector's calibrated test kit and confirmed by the ship's test kit to be 3.0 and 2.9 PPM free chlorine residual which was greater than allowed 0.2 PPM differential. Analyzer was adjusted to proper calibration by the ship's staff.
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Recommendation:
Ensure the free residual halogen measured by the halogen analyzer is within 0.2 mg/L (ppm) of the free residual halogen measured by the manual test.
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Item No.:
08
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Site:
Potable Water-Microbiological Testing
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Violation:
Color comparator for the microbiological testing system had expired in October 2011. New comparator set had been ordered on January 8, 2012, but has still not been delivered to the ship. (New requirement 2011 VSP Operations Manual)
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Recommendation:
5.6.1.1.2 Test kits, incubators, and associated equipment must be operated and maintained in accordance with the manufacturer's specifications.
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Item No.:
10
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Site:
Recreational Water Facilities-Signs
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Violation:
The depth markers for the swimming pools and spa pool were in feet only. The safety signs for all of the RWFs did not meet the requirements of 6.7.1.1. (New requirement 2011 VSP Operations Manual)
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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. 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.? 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.:
17
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Site:
Galley-Cold Section Blast Chiller Logs
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Violation:
The blast chiller logs for 3 March 2012 listed nine food items with the time and temperature when the food items were placed into the blast chiller, but the logs did not indicate the temperature when the food items were removed from the blast chiller. All food items were in the blast chiller for only a short time. The initial food temperatures ranged 40° - 60°F.
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Recommendation:
Ensure logs documenting cooked potentially hazardous food cooling temperatures and times from the starting points designated in 7.3.5.2.1 thru the control points at 2 and 6 hours are maintained onboard the vessel. Ensure logs documenting cooling of potentially hazardous foods prepared from ingredients at ambient temperatures, with the start time to the time when 5°C (41 °F) is reached are also maintained beginning with the day of preparation.
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Item No.:
21
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Site:
Food Service General-Doors
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Violation:
The door gaskets on many of the undercounter refrigerators were worn. This made closing some of the units difficult and allowed warm air to enter the units. This was observed in the lido buffet pantry, the grand buffet, pizzeria, and the main galley pastry/bakery. Staff stated a work order was placed and technicians were assessing each door's condition.
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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.:
22
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Site:
Preparation Room-
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Violation:
The undercounter dishwash machine had been out of order since 17 February. A work order was placed at that time. Staff stated replacement parts were scheduled to be delivered on 17 March.
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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.
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Item No.:
24
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Site:
Galley-Potwash
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Violation:
The temperature of the in-use sanitizing compartment of the three-compartment sink was measured at 168°F as indicated by the temperature gauge and the inspector's and staff's thermometers. The steam line was adjusted, and the temperature was measured at greater than 171°F.
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Recommendation:
In a manual operation, if immersion in hot water is used for sanitizing, ensure: (1) the temperature of the water is maintained at 77°C (171°F) or above.
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Item No.:
27
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Site:
Buffet-Forward Beverage Station
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Violation:
Dried juice residue was noted around the outsides of the protective coverings above the outlets of the juice machine.
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Recommendation:
Ensure nonfood-contact surfaces of equipment are kept free of an accumulation of dust, dirt, food residue, and other debris.
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Item No.:
27
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Site:
Bar-Lobby Bar
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Violation:
The shelves containing alcohol bottles on the back bar counter were soiled with dust.
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Recommendation:
Ensure nonfood-contact surfaces of equipment are kept free of an accumulation of dust, dirt, food residue, and other debris.
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Item No.:
27
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Site:
Pantry-Grand Buffet
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Violation:
The drive gear of the can opener was soiled. Also, when a crew member disassembled the equipment, there was food debris around the gear.
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Recommendation:
Ensure nonfood-contact surfaces of equipment are kept free of an accumulation of dust, dirt, food residue, and other debris.
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Item No.:
33
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Site:
Buffet-Aft Grill
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Violation:
Gaps were found along the decorative bulkhead/stainless steel juncture to the left of the door. This item was corrected.
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Recommendation:
Ensure bulkheads in food preparation areas are maintained in good repair.
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Item No.:
33
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Site:
Buffet-Aft Grill
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Violation:
To the left of the entrance door, the decorative bulkhead/stainless steel juncture was damaged near the deck. This was corrected.
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Recommendation:
Ensure bulkheads in food preparation areas are maintained in good repair.
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Item No.:
33
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Site:
Buffet-Aft Grill
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Violation:
Both side of the fire shutter door channels near the deckhead were soiled with grease. Also, the decorative bulkhead and fire shutter door on both side of the grooved grill were soiled with grease. These areas were immediately cleaned.
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Recommendation:
Ensure decks and bulkheads in food preparation areas are cleaned as often as necessary.
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Item No.:
33
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Site:
Buffet-Aft Grill
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Violation:
The top of the stainless steel kick plate on the door from the grill into the pantry was loose, creating gaps. This was corrected. Also, the dark brown diamond design on the door was loose on both side corners. These gaps lead to a void space in the bulkhead which could create vermin harborage problems for this food area.
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Recommendation:
Ensure bulkheads in food preparation areas are maintained in good repair.
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Item No.:
34
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Site:
Galley-Center Galley - Hot Section
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Violation:
The potable water filling spout between the left and middle soup stations was leaking. Staff attempted to turn off the water, but the spout continued to leak.
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Recommendation:
Ensure the plumbing system in a food area is maintained in good repair.
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Item No.:
36
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Site:
Food Service General-Lighting
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Violation:
The light intensity was below 110 lux behind and around many pieces of deck- and counter-mounted equipment. This was observed in areas such as at the ice machines, and behind the oven in the lido center galley and in the main galley pastry/bakery. It also included the deck pantries. (2011 VSP Operations Manual)
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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.:
36
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Site:
Bar-Casino Bar
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Violation:
The light intensity was below 110 lux at the handwash station. The area was in use at the time of the inspection. (2011 VSP Operations Manual)
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Recommendation:
Ensure the light intensity is at least 110 lux (10 foot candles) at handwashing stations in bars.
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Item No.:
37
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Site:
Galley-Warewash / Potwash Area
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Violation:
Water was dripping from the middle fastener of the deckhead-mounted light fixture near the soiled side of the in-use flight-type warewash machine. No equipment or utensils were impacted.
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Recommendation:
Ensure exhaust ventilation hood systems in food preparation and warewashing areas--including components such as hoods, fans, guards, and ducting--are designed to prevent grease or condensation from draining or dripping onto food, equipment, and utensils.
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Item No.:
41
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Site:
Housekeeping-Outbreak Pevention and Response Plan
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Violation:
The Outbreak Prevention and Response Plan: 1. Did not include a procedure for returning the ship to normal operations after the occurrence of an outbreak; 2. Included disinfectants that had been previously used, but not the current disinfectant with its recommended concentration; and 3. Did not include the sample letter that specifically informed current passengers and crew or future passengers and crew that about an outbreak on current or immediately preceding cruise. (New requirement 2011 VSP Operations Manual)
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Recommendation:
Ensure each vessel has a written OPRP that details standard procedures and policies to specifically address AGE onboard. Include the following in the written OPRP: (1) Duties and responsibilities of each department and their staff for all the passenger and crew public areas; (2) Steps in outbreak management and control and the trigger for required action at each step. Ensure the triggers address a graduated approach to outbreak management in response to increasing case counts; (3) Disinfectant products or systems used, including the surfaces or items the disinfectants will be applied to, concentrations, and required contact times. Ensure the disinfectant products or systems are effective against human norovirus or an acceptable surrogate (e.g., caliciviruses); (4) Procedures for informing passengers and crew members of the outbreak. Ensure this section also includes procedures for notification of passengers embarking the vessel following an outbreak voyage or segment of a voyage; (5) Procedures for returning the vessel to normal operating conditions after an outbreak; (6) Procedures to protect the passengers and crew from exposure to disinfectants, if not already included in the vessel?s safety management system. Ensure this protection includes: (a) Material safety data sheets (MSDSs); (b) Personal protective equipment for crew; (c) Health and safety procedures to minimize respiratory and dermal exposures to both passengers and crew.
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