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Item No.:
02
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Site:
Medical-Acute Gastroenteritis (AGE) Log
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Violation:
A passenger with an illness onset on August 3 at 2200 was entered into the AGE log. Several columns of the AGE log were left blank including the passenger meal seating and any symptom information for episodes of diarrhea, vomiting, abdominal cramps, and headache. The reportable case column was also left blank and there was not enough information about this case to determine if it was reportable or not. There were no passengers documented as reportable on the MIDRS confirmation report during the cruise from July 31 - August 7, 2013.
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Recommendation:
Ensure the AGE surveillance log entry for each passenger contain the following information: (10) meal seating information; (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; and (14) entry (yes/no) for whether this was a reportable case.
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Item No.:
02
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Site:
Medical-Acute Gastronenteritis (AGE) Log
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Violation:
The AGE log stated there were six reportable cases, but the total reportable cases in the medical staff documentation indicated there were five reportable cases. It was unknown which of these numbers were correct because there was no documentation confirming the 24-hour MIDRS report was sent.
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Recommendation:
Ensure the AGE surveillance log entry for each passenger or crew member contain the following information in separate columns: (14) entry (yes/no) for whether this was a reportable case. Make the 24-hour and 4-hour reports available for review by VSP during inspections.
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Item No.:
02
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Site:
Medical-Acute Gastroenteritis (AGE) Log
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Violation:
The underlying illness column for the last five cruises included information such as whether passengers and/or crew members are on shore, drank on shore, took shore tours, the location of the shore tour, and also included general comments. This made it very confusing to determine if the information in this column was supposed to be used to indicated whether a case was reportable or not. For example, a passenger had four episodes of diarrhea and no other symptoms, but the underlying illness column stated they were positive for influenza with no other documentation. According to staff, this individual has both AGE and Influenza A, but this could not be determined by the documentation.
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Recommendation:
Ensure the AGE surveillance log entry for each passenger or crew member contain the following information in separate columns: (16) presence of underlying medical conditions that may affect interpretation of AGE.
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Item No.:
02
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Site:
Medical-Acute Gastroenteritis (AGE) Surveillance Log
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Violation:
On August 8, 2013, a crew member had two episodes of diarrhea, abdominal cramps, headache, and muscle cramps, but was not recorded as a reportable case on the AGE log, but upon discussion with staff, this person should have been a reportable case. The pre-programmed AGE log cannot be altered or over-ridden by staff once it is decided whether an individual is a case or not. Even if the underlying illness column states a reason for an individual to not be reportable, this information is not taken into account when the computer program is deciding whether an individual is a case or not.
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Recommendation:
Ensure a reportable case of AGE is a case reported to the master of the vessel, the medical staff, or other designated staff by a passenger or a crew member and meets the case definition based on the following symptoms: (1) Diarrhea (three or more episodes of loose stools in a 24 hour period or what is above normal for the individual. See section 4.1.2.1.3, illness symptoms); or (2) vomiting and one additional symptom including one or more episodes of loose stools in a 24-hour period, or abdominal cramps, or headache, or muscle aches, or fever (temperature of greater than or equal to 38C [100.4F]).
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Item No.:
02
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Site:
Medical-Acute Gastroenteritis (AGE) Surveillance Log
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Violation:
During the cruise from July 31 to August 7, 2013, a crew member with AGE symptoms was counted as a reportable case even though they were already counted as a reportable case on the previous cruise. This individual had an illness onset on July 30 with three episodes of diarrhea. The underlying illness column stated this individual was a carryover case, but this information was not factored into the computer program.
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Recommendation:
Ensure the AGE surveillance log entry for each passenger or crew member contain the following information in separate columns: (16) presence of underlying medical conditions that may affect interpretation of AGE.
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Item No.:
08
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Site:
Potable Water-Backflow Prevention
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Violation:
There was not a proper air gap between the pressure relief vent and the drain for the vent on the reduced pressure assembly on the potable water line to the HI-FOG system.
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Recommendation:
Ensure air gaps are at least twice the diameter of the delivery fixture opening and a minimum of 25 millimeters (1 inch).
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Item No.:
08
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Site:
Potable Water-Port Bunker Station
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Violation:
The six potable water hoses in the hose storage locker did not have readable labels at each connecting end stating 'Potable Water Only'.
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Recommendation:
Label potable water hoses with the words ?POTABLE WATER ONLY? in letters at least 13 millimeters (0.5 inch) high at each connecting end.
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Item No.:
08
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Site:
Potable Water-Starboard Bunker Station
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Violation:
The reduced pressure assembly for the international shore connection had a tag indicating 'disconnected' on it and the fire protection line above the device had caution tape around it and a plastic bag full of tools. According to the staff, the device was working properly and the tag, tape, and bag were removed.
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Recommendation:
Provide a comprehensive cross-connection control program. Protect the following connections to the potable water system against backflow with air gaps or mechanical backflow prevention devices: (20) international fire and fire sprinkler water connections (install a reduced pressure assembly).
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Item No.:
08
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Site:
Potable Water-Water Testing Room
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Violation:
The backflow prevention device on the shower hose was not on the cross-connection control log.
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Recommendation:
Ensure the cross-connection control program includes at a minimum: a complete listing of cross-connections and the backflow prevention method or device for each, so there is a match to the plumbing system component and location.
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Item No.:
08
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Site:
Potable Water-Mineralizers
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Violation:
There was no air gap between the combined drain line and the drain.
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Recommendation:
Ensure air gaps are at least twice the diameter of the delivery fixture opening and a minimum of 25 millimeters (1 inch).
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Item No.:
08
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Site:
Bar-Deck 6 - International Cafe
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Violation:
The air relief vent on the left carbonator backflow preventer in cabinet #065202-T651 was closed with a screw-type plug that was sealed in place with joint tape. The backflow preventer on water supply line to the carbonator system was also continually leaking from the air relief vent indicating a possible failure. Staff immediately replaced these devices.
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Recommendation:
Maintain backflow prevention devices in good repair.
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Item No.:
10
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Site:
Recreational Water Facilities-Sand and Cartridge Filters
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Violation:
The sand was replaced for Spas D and E on March 3 and 23, 2013 respectively, but there were no records indicating the filter housing was cleaned, rinsed, and disinfected. Also, documentation indicated the cartridge filter had been changed several times for the Lotus pool, but there was no documentation indicating the housing was cleaned, rinsed, and disinfected.
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Recommendation:
Clean, rinse, and disinfect the filter housing before the new filter media is placed in it. 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.:
10
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Site:
Recreational Water Facilities-Sand Filters
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Violation:
According to staff, monthly inspections and samples were done and collected for all of the spas and pools that had sand filters, but there was no documentation. Staff had a box of the samples collected for August 2013, but no record of the results. According to staff, samples are kept for one month and then discarded.
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Recommendation:
Examine granular filter media for channels, mounds, or holes. Inspect a core sample of the filter media for excessive organic material accumulation using a recommended sedimentation method. For whirlpool spas and spa pools, ensure inspections and sedimentation tests are done monthly. For all other RWFs, ensure inspections and sedimentation tests are conducted quarterly. Change granular filter media for whirlpool spas and spa pools based on the inspection and sedimentation test results or every 12 months, whichever is more frequent. For all other RWFs, change granular filter media based on the inspection and sedimentation results or per the manufacturer?s recommendations, whichever is more frequent. Record the results of both the filter inspection and sedimentation test.
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Item No.:
10
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Site:
Recreational Water Facilities-Hair and Lint Strainers
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Violation:
There was no documentation indicating the hair and lint strainers or their housings were cleaned, rinsed, and disinfected on a weekly basis for any of the RWFs.
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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-Crew Reporting
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Violation:
On August 10 a food worker had an illness onset of two episodes of diarrhea, two episodes of vomiting, and abdominal cramps at 2200 and did not report to medical until August 11 at 1730. According to their work record, this individual worked on August 10 from 1800-2400 and on August 11 from 1100 to 1600. Also, on August 10 a food worker had an illness onset of two episodes of diarrhea, two episodes of vomiting, and abdominal cramps at 2200 and did not report to medical until August 11 at 1730. According to their work record, this individual worked on August 10 from 1800-2400 and on August 11 from 1100 to 1600.
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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; (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. Ensure food employees who have conditions or symptoms of diarrhea 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.:
11
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Site:
Medical-Crew Reporting
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Violation:
On August 8, 2013 a food worker had an illness onset of two episodes of diarrhea and abdominal cramps at 0700 and was a reportable case. According to their work record, this individual worked on August 8 from 0730 until 1130, but did not report to medical until 1300 the same day. This was noted on the previous inspection.
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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; (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. Ensure food employees who have conditions or symptoms of diarrhea 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.:
13
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Site:
Medical-
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Violation:
There were two food workers that worked while sick and did not report to medical immediately. For example, on August 8, 2013 a food worker had an illness onset of two episodes of diarrhea and abdominal cramps at 0700 and was a reportable case. According to their work record, this individual worked on August 8 from 0730 until 1130, but did not report to medical until 1300 the same day.
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Recommendation:
Because of the risks for foodborne illness inherent to the food operation, ensure the supervisor or person in charge of food operations on the vessel demonstrates to VSP - during inspections and on request - knowledge of foodborne disease prevention, application of the Hazard Analysis Critical Point principles, and the food-safety guidelines in this manual. Ensure that the areas of knowledge include: (2) Explaining the responsibility of the person in charge to prevent transmission of foodborne disease by a food employee who has a disease or medical condition that may cause foodborne disease. Ensure the supervisor or person in charge of food operations on the vessel monitors that: (13) Food employees are informed of their responsibility to report to the supervisor or person in charge information about their health and activities as they relate to diseases that are transmissible through food.
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Item No.:
16
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Site:
Galley-Deck 6 - Hot Galley
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Violation:
The current time control plan specified the set up and discard time for the food items being held under the plan to be 1700 - 2230, respectively. The plan did not describe how the food time in the danger zone would be controlled, i.e. labeled batches, since the service period was more than four hours. A new time control plan for this area is under development.
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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.:
17
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Site:
Galley-Deck 14 - Horizon Court - Beverage Pantry
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Violation:
A new bulk milk carton had been placed in the bulk milk dispenser #T631 without the dispensing tube being trimmed to 1-inch. This was corrected immediately by trimming the tube at a 45 angle to less than 1-inch.
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Recommendation:
Cut bulk milk dispensing tubes 45 degrees on the diagonal, leaving no more than 25 mm (1 inch) protruding from the chilled dispensing head.
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Item No.:
19
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Site:
Provisions-Deck 4 - Cold Rooms
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Violation:
The leak described above in walk-in cooler #4209 exposed the top layer of a pallet of honey dew melons in open cartons to potential contamination. The staff immediately moved the pallets and washed the affected melons.
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Recommendation:
Protect food from contamination by storing the food: (2) In a clean, dry location; and (3) Where it is not exposed to splash or other contamination.
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Item No.:
26
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Site:
Galley-Deck 5 - Cold Pantry
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Violation:
A small amount of dried food soil was found on the recessed area of the backplate of a food slicer.
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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-Deck 14 - Horizon Court - Pastry Counter
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Violation:
Five bowls were found in the clean stack of tableware being dispensed to passengers that had dried food residue on the front or back of the bowl. The soiled bowls were removed immediately for re-washing.
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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-Deck 4 - Cold Rooms
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Violation:
The forward fruit and vegetable walk-in cooler had mildew on the evaporator unit fins closest to the door. A heavy buildup of ice was noted on the top section of the other units' evaporator fins and also on units #4211, #4209, #4212 and #4201.
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Recommendation:
Ensure attached equipment in food storage areas are cleaned as often as necessary.
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Item No.:
33
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Site:
Provisions-Deck 4 - Cold Rooms
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Violation:
A water leak from an unknown source was noted along about 8 feet of the mid cooler deckhead seam in walk-in cooler #4209.
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Recommendation:
Ensure deckheads in food storage areas are maintained in good repair.
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Item No.:
37
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Site:
Galley-Deck 6 - Dishwashing
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Violation:
Heavy condensate was dripping from the bulkhead and deckhead from the soiled landing area to the mid-section of the dishwasher. A section of the canopy had been cut out to allow the control panel door to be open and steam was escaping, condensing and dripping from the deckhead in this area to the deck where personnel were walking from the dirty to the clean areas. Moist air was also escaping at the dirty entrance to the machine. The mid-machine exhaust also had a positive pressure at an opening that allowed moist air to escape the exhaust system.
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Recommendation:
Ensure ventilation hood systems and devices are sufficient capacity to prevent condensation from collecting on bulkheads and deckheads. Ensure ventilation hood systems and devices operate effectively to prevent condensate from collecting on the bulkheads and deckheads and remove contaminants generated by equipment located under them.
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Item No.:
41
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Site:
Housekeeping-Outbreak Prevention and Response Plan (OPRP)
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Violation:
During red level sanitation when at least 2% of passengers or crew had AGE, the OPRP stated that public areas should be cleaned both continuously and then only frequently in the same section. The language was confusing and even the staff could not determine how often these areas should be cleaned.
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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: (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.
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Item No.:
41
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Site:
Housekeeping-Outbreak Prevention and Response Plan (OPRP)
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Violation:
There were no procedures to notify crew of an outbreak while onboard or how to notify passengers of a cruise that had a previous outbreak on the last voyage. Also, there were no procedures stating how to protect passengers from exposure to chemicals and disinfectants used onboard.
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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; and (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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