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Item No.:
02
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Site:
Medical-Close Contacts
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Violation:
On September 16 a food worker had an onset of AGE symptoms, but no information was documented regarding their close contacts. Also, on September 11 a nonfood worker had an onset of AGE symptoms, but no information was documented regarding their close contacts. According to the staff, these individuals did not have any close contacts.
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Recommendation:
Maintain the following records on board for 12 months and make them available for review by VSP during inspections: (7) documentation of the date and time of verbal interviews with asymptomatic cabin mates and immediate contacts of symptomatic crew.
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Item No.:
02
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Site:
Medical-Acute Gastroenteritis (AGE) Log
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Violation:
On September 5 a passenger had an illness onset of 10 episodes of diarrhea, but was recorded as nonreportable on the AGE log. This individual was isolated for 24 hours.
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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) Log
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Violation:
According to the AGE log, on September 5 a food worker had an illness onset of vomiting and abdominal cramps at 9:00 a.m., but did not report to medical until 5:24 p.m. According to the medical notes section in the eSeaCare computer system, this individual had nausea on September 5 and was treated at the medical center for sea sickness, but no time was recorded. In another area of eSeacare, it was documented that this individual came to the medical center at 9:00 a.m. and was treated for nausea. The computer system also stated this individual went to work, vomited around noon, went to sleep and then reported to medical at 4:00 p.m. The notes in the eSeaCare system also stated this individual was a sea sickness case. Nothing was recorded in the underlying illness column of the AGE log. The AGE log stated this person was a case and they were isolated for 48 hours. According to their work record, this person worked on September 5 from 7:46 a.m. until 11:21 a.m.
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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: (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) Log
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Violation:
A food worker had an illness onset of one loose stool and abdominal cramps on September 9 at 0600 and was recorded as nonreportable on the AGE log. On September 10, this individual had additional symptoms, but was not changed to a reportable case on the AGE log and the specific symptoms the individual was having were not recorded in the medical notes. According to staff, this person was having the same symptoms as the previous day on September 10 and they were not able to change this individual from nonreportable to reportable in the eSeaCare computer system. The last symptoms for this individual occurred on September 10 at 8:47 a.m., but they were released from isolation on September 11 at 10:03 a.m. According to their work record, this individual worked from 5:19 p.m. until 11:03 p.m. on September 11 and from 7:32 a.m. until 10:38 a.m. on September 12.
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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.:
08
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Site:
Galley-Deck 4 - Beverage Station - Starboard / Forwward
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Violation:
A carbonator backflow preventer had water leaking from air relief hole indicating a possible failure.
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Recommendation:
Maintain backflow prevention devices in good repair.
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Item No.:
08
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Site:
Galley-Deck 11 - Windjammer - Beverage Station
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Violation:
The water supply line to the beverage dispensing system had a leaking backflow preventer which indicates a possible failure.
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Recommendation:
Maintain backflow prevention devices in good repair.
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Item No.:
08
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Site:
Potable Water-Striping
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Violation:
The middle drain line for the mineralizers was striped blue for potable water.
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Recommendation:
Remove the potable water striping on the middle mineralizer drain line. Stripe or paint potable water lines either in accordance with ISO 14726 (blue/green/blue) or blue only. Ensure no other lines have the color designation.
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Item No.:
08
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Site:
Pantry-Chilled Water Lines
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Violation:
The chilled water lines were not uniquely identified on the deck-mounted ice machines in the following pantries: deck 9 midship, deck 10 aft, and deck 10 mid-ship.
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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.:
11
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Site:
Medical-Crew Isolation
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Violation:
A food worker had an illness onset of one loose stool and abdominal cramps on September 9 at 0600 and was recorded as nonreportable on the AGE log. On September 10, this individual had additional symptoms, but was not changed to a reportable case on the AGE log. The last symptoms for this individual occurred on September 10 at 8:47 a.m., but they were released from isolation on September 11 at 10:03 a.m. According to their work record, this individual worked from 5:19 p.m. until 11:03 p.m. on September 11 and from 7:32 a.m. until 10:38 a.m. on September 12.
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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.
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Item No.:
11
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Site:
Medical-Crew Reporting
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Violation:
On September 11, a nonfood worker had an illness onset of abdominal cramps, headache, and vomiting at 12:30 a.m., but did not report to the medical center until 11:18 a.m. According to their work record, this individual did not work while sick.
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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.
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Item No.:
16
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Site:
Galley-Deck 11 - Windjammer
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Violation:
A walk-in cooler where beverages were stored was on extended defrost. The food including a very large quantity of individual and bulk dairy products in the walk-in was warming up to temperatures ranging from 42-47F as represented from the >6 food temperature measurements which were taken. Discussions with staff indicated that this cooler had problems in maintaining the product temperature for an extended period of time. All food was immediately discarded and the cooler was taken out of service.
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Recommendation:
Maintain potentially hazardous foods at 5C (41F) or less.
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Item No.:
19
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Site:
Galley-Deck 4 - Soup / Vegetable Station
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Violation:
A quart of heavy cream was found stored in the recessed space of the evaporator fins in a walk-in cooler.
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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, dust, or other contamination.
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Item No.:
21
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Site:
Galley-Deck 4 - Hot Preparation Station
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Violation:
The back technical area access panel on combination oven (Deck 4-2) was missing leaving the insulation and difficult to clean piping and wiring exposed.
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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.
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Item No.:
21
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Site:
Provisions-Deck 3 - Dry Stores
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Violation:
Over 10 pallets of food were found in the provision passage ways on bare wooden pallets.
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Recommendation:
Ensure nonfood-contact surfaces of equipment that are exposed to splash, spillage, or other food soiling are constructed of a nonabsorbent, and smooth material.
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Item No.:
22
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Site:
Galley-Deck 4 - Soup / Vegetable Station
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Violation:
The three bucket cleaning system sanitizer solution had a grease film on the top of the solution.
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Recommendation:
Ensure the sanitize solutions are maintained clean.
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Item No.:
26
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Site:
Galley-Deck 4 - Pot Wash
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Violation:
A small amount of dried food soil was noted in two pots in the clean storage area. Another pot had a smear of moist chocolate in the interior of pot in the clean storage area.
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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.:
27
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Site:
Galley-Deck 11 - Windjammer - Beverage Station
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Violation:
The beverage syrup storage cabinet had spilled syrup on the bottom shelf of the cabinet.
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Recommendation:
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Item No.:
27
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Site:
Galley-Deck 4 - Beverage Station - Starboard / Forwward
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Violation:
Old food debris was noted in the under-counter carbonator cabinet.
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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:
Provisions-Deck 3 - Dry Stores
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Violation:
The passage way does not met the construction standards for food.
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Recommendation:
Ensure decks, bulkheads, and deckheads in food storage areas are constructed and maintained for easy cleaning. Cove all bulkhead/deck junctures including food storage rooms.
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Item No.:
33
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Site:
Dining Room-Deck 4 - Main Dining Room
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Violation:
Carpet was on the deck surrounding the cold buffet table. The carpet was clean.
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Recommendation:
Ensure decks, bulkheads, and deckheads in food areas are constructed and maintained for easy cleaning. Do not use carpet in these areas.
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Item No.:
34
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Site:
Provisions-Deck 3 - Dry Stores
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Violation:
A leak was noted from a deckhead seam in the back right corner of the store room. A light fixture across this seam had water standing in the light cover. The drip was falling on the walk way and no food was impacted. A maintenance team determined the leak was from a potable water line and repaired the leak while the team was aboard.
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Recommendation:
Ensure a plumbing system in a food area is maintained in good repair.
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Item No.:
36
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Site:
Galley-Deck 4 - Hot Preparation Station
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Violation:
The light behind the line of combination ovens (Deck 4-1, 4-2, and 4-3) 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.
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Item No.:
36
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Site:
Dining Room-Deck 4 - Main Dining Room
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Violation:
A temporary cold breakfast buffet operation was set up in the middle of the dining room on movable tables. The light was less than 220 lux in this area.
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Recommendation:
Ensure the light intensity is at least 220 lux (20 foot candles) on food preparation surfaces, and at a distance of 75 centimeters (30 inches) above the deck in consumer self-service areas.
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Item No.:
42
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Site:
Children Area-Nursery
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Violation:
There was no air-tight waste receptacle at the diaper changing station.
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Recommendation:
Include in each diaper changing station: (1) A changing table that is nonabsorbent, nontoxic, smooth, durable, easily cleanable, and designed for diaper changing; (2) A supply of disposable diapers, gloves, wipes, table cleanser, and disinfectant; (3) An airtight, soiled-diaper receptacle; and (4) An adjacent handwashing station.
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Item No.:
42
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Site:
Children Area-Toilet Rooms
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Violation:
The toilet was more than 11 inches from the deck and the handwashing sink was more than 22 inches from the deck in both the unisex toilet room and the handicap accessible toilet room for 3-11 year olds.
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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.:
44
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Site:
Medical-AGE Log
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Violation:
Medical staff were not clear on when to count an individual as a reportable AGE case, especially if they have had sea sickness. Also, medical staff did not include a passenger as an AGE case even though they had 10 episodes of diarrhea. In addition, the information in the AGE log did not always match the medical notes and it was very difficult to determine if an individual was an AGE case or not based on the information provided to the inspector. In one instance, the information in the AGE log contradicted the information in the medical notes.
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Recommendation:
Ensure the supervisor or person in charge of medical operations related to AGE on the vessel demonstrates to VSP?during inspections and on request?knowledge of medical operations related to AGE, is able to demonstrate this knowledge by compliance with Section 4 of the VSP 2011 Operations Manual or by responding correctly to the inspector?s questions as they relate to the specific operation, and properly trains employees to comply with Section 4 of the VSP 2011 Operations Manual as it relates to their assigned duties.
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