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Item No.:
01
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Site:
Medical-Electronic Acute Gastroenteritis (AGE) Reports
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Violation:
The electronic AGE reports were submitted on the sea day prior to arriving in Stirrup Cay, Bahamas when sailing at the end of the voyage into Miami, Florida. Although the reports were made 24-36 hours prior to arrival into the U.S. port, the report was made prior to the foreign port. Often the number of AGE reportable cases for passengers and crew members differed from what was submitted on the electronic reports and what was written on the AGE surveillance logs. Medical staff stated they reported the numbers of people entering the U.S. port at that time. Instead they should have reported the highest number of passengers and crew members during the cruise, since these were the ones in the exposed cohort.
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Recommendation:
Ensure the master, medical staff, or other designated staff of a vessel destined for a U.S. port from a foreign port submits at least one standardized AGE report based on the number of reportable cases in the AGE log to VSP no less than 24 hours-but not more than 36 hours-before the vessel's expected arrival at the U.S. port.
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Item No.:
02
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Site:
Medical-AGE Surveillance Log
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Violation:
Some of the AGE surveillance logs indicated a symptomatic person was a non-reportable AGE case, despite their symptoms meeting the definition of a reportable AGE case. For example, a Bartender had five episodes of diarrhea, had no underlying illness, and was listed as a non-reportable case; and a Third Photographer experienced four episodes of diarrhea, had no underlying illness, and was listed as a non-reportable case.
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Recommendation:
Ensure a reportable case of AGE is a case reported to the master of the vessel, the medical staff, or other designated staff by a passenger or a crew member and meets the case definition based on the following symptoms: (1) Diarrhea (three or more episodes of loose stools in a 24 hour period or what is above normal for the individual. See section 4.1.2.1.3, illness symptoms); or (2) vomiting and one additional symptom including one or more episodes of loose stools in a 24-hour period, or abdominal cramps, or headache, or muscle aches, or fever (temperature of greater than or equal to 38C [100.4F]).
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Item No.:
02
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Site:
Medical-Close Contact Follow-Up
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Violation:
Close contacts of an AGE symptomatic crew member did not receive an initial medical interview and were not followed up for 48 hours.
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Recommendation:
When any crew member (food or nonfood employee) meets the case definition for AGE, take the following actions: (1) restrict exposure to symptomatic crew member(s); (2) undergo a verbal interview with medical or supervisory staff, who will confirm their condition, provide facts and a written fact sheet about hygiene and handwashing, and instruct them to report immediately to medical if they develop illness symptoms; (3) complete a verbal interview daily with medical or supervisory staff until 48 hours after the ill crew members' symptoms began. Ensure that the first verbal interview is conducted within 8 hours from the time the ill crew member initially reported to the medical staff. If the asymptomatic immediate contact or cabin mate is at work, ensure that he or she must is contacted by medical or supervisory staff as soon as possible. Document the date and time of verbal interviews.
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Item No.:
02
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Site:
Medical-AGE Surveillance Log
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Violation:
A bar waiter who was given anti-diarrheal medication was not listed on the AGE surveillance log. According to another medical record, he reported to the medical center on 31 July at 11:00, but his illness onset date and time could not be determined. He was released from medical isolation on 1 August at 16:00.
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Recommendation:
List in the AGE surveillance log (1) the name of the vessel, cruise dates, and cruise number; (2) all reportable cases of AGE; and (3) all passengers and crew members who are dispensed antidiarrheal medication from the master of the vessel, medical staff, or other designated staff.
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Item No.:
06
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Site:
Potable Water-Far-Point Halogen Analyzer and Recorder
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Violation:
The chart recording the free halogen residual on the day of the inspection was mounted to show a time that was 20 minutes ahead of the actual time.
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Recommendation:
Maintain the halogen analyzer-chart recorder properly and operate it in accordance with the manufacturer's instructions.
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Item No.:
08
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Site:
Potable Water-Potable Water Tank Maintenance
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Violation:
The ship had documentation from the paint manufacturer that the potable water tank coating complied with NSF-61 Potable Water Contact standards with accompanying application and curing time instructions. It did not have the independent certification organization's certificate aboard.
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Recommendation:
Ensure the interior coatings on potable water tanks are approved for potable water contact by a certification organization. Follow all manufacturers' recommendations for application, drying, and curing. For the tank coatings used, maintain the following onboard: (1) written documentation of approval from the certification organization (independent of the coating manufacturer).
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Item No.:
09
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Site:
Recreational Water Facilities-Halogen Residual
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Violation:
The free chlorine residual was initially measured at 9.34 PPM and 7.32 PPM by the inspector in an open swimming pool # PA 1. The ship's test kit showed the level at the same time to be >10 PPM. The engine control room's reading of this residual was 3.42 PPM, concurrently. A recheck of the pool on the other side showed the halogen to be 5.0 PPM. The pool was closed for retesting to ensure the level was stabilized. Staff thought the momentary excursion may be related to the recirculation system including the chlorine monitoring and injection to be in the engine room approximately 15 decks below. The records of the four-hour manual test taken at pool side did not show these high values during the many months reviewed.
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Recommendation:
Maintain a free residual halogen in recirculated RWFs in the following ranges: (1) swimming pools, between 1.0 and 5.0 mg/L (ppm).
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Item No.:
10
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Site:
Recreational Water Facilities-Halogen Monitoring System
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Violation:
The spa halogen level chart recording was 0.4 PPM higher than the analyzer reading for spa C in the mechanical room.
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Recommendation:
Maintain halogenation and pH control systems in good repair and operate them in accordance with the manufacturer's recommendations.
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Item No.:
10
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Site:
Recreational Water Facilities-Safety Equipment
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Violation:
The shepherd's hook for swimming pool #PA 2 was found in an adjacent empty decorative fountain and not on its visible mounting bracket. It was returned to the bracket before the inspection team left the area.
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Recommendation:
Provide a rescue or shepherd's hook and an approved flotation device at a prominent location (visible from the full perimeter of the pool) at each RWF that has a depth of 1 meter (3 feet) or greater. Mount these devices in a manner that allows for easy access during an emergency.
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Item No.:
11
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Site:
Medical-Crew Member Reporting and Isolation
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Violation:
On 5 August, a Bartender had an onset of acute gastroenteritis (AGE) symptoms at 12:00, but he did not report to the medical center until 17:50. The crew member experienced five episodes of diarrhea and he was listed as a non-reportable case although he had no underlying illnesses. He was placed in medical isolation for only 24 hours. According to his time card, he worked from 12:00-14:00 on 5 August.
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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. When nonfood 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 24 hours; (2) follow-up with and receive approval by designated medical personnel before returning crew to work; (3) document the date and time of last symptom and clearance to return to work.
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Item No.:
13
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Site:
Medical-Crew Member Reporting and Isolation
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Violation:
On 5 August, a Bartender had an onset of acute gastroenteritis (AGE) symptoms at 12:00, but he did not report to the medical center until 17:50. The crew member experienced five episodes of diarrhea and he was listed as a non-reportable case although he had no underlying illnesses. He was placed in medical isolation for only 24 hours. According to his time card, he worked from 12:00-14:00 on 5 August. It was discussed that crew members were not receiving adequate training for AGE, to include signs/symptoms and when to report to the medical center.
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Recommendation:
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. Recommend creating a training specific to AGE that informs crew members when to report, how to report, and consequences for late reporting.
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Item No.:
16
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Site:
Buffet-Calumet Buffet- Consumer Advisory
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Violation:
The marinated herring on the self-service buffet was cold smoked and served raw. A general consumer advisory was posted at the entrance of the buffet line but no advisory specifically for the marinated herring was posted at the display station.
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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:
Galley-Discard Time Labeling
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Violation:
A total of 4 trays and hotel pans of potentially hazardous foods (cut melons) stored in the pass through refrigerators were not labeled with a discard time. The pass through refrigerators were labeled as time control units and listed on the time control plan and the operation was open for longer than 4 hours.
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Recommendation:
If time only-rather than time in conjunction with temperature-is used as the public health control for a working supply of potentially hazardous food before cooking, or for ready-to-eat potentially hazardous food that is displayed or held for service for immediate consumption, ensure the food (1) Has an initial temperature of 5C (41F) or less or 57C (135F) or greater before placement on time control. (2) Is not be placed on temperature control again. (3) Is marked or otherwise identified to indicate the time 4 hours past the point in time when the food is removed from temperature control (if the time between service set-up and closing is greater than 4 hours. and (4) Is discarded within 4 hours of placement on time control.
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Item No.:
16
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Site:
Galley-Galaxy Restaurant
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Violation:
The undercounter hot cabinet 165211B was listed on the posted time control plan as a time control unit but was not labeled on the physical unit. This was corrected.
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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:
Galley-Deck 6 Pastry
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Violation:
The undercounter refrigerator 067546A was listed on the posted time control plan as a time control unit but was not labeled on the physical unit.
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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.:
19
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Site:
Galley-Deck 5 - Bakery
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Violation:
Two trolleys of bakery items were stored near the proofing ovens with the top items not protected. This was immediately corrected.
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Recommendation:
Protect food from contamination by storing the food: (1) Covered or otherwise protected; (2) In a clean, dry location; (3) Where it is not exposed to splash, dust, or other contamination; and (4) At least 15 centimeters (6 inches) above the deck.
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Item No.:
20
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Site:
Galley-Deck 6
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Violation:
There were loose cloth fibers protruding from the edges of the in-use woven dough sheeter belt located near the hot section. A similar violation was noted in the previous inspection report.
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Recommendation:
Ensure the dough sheeter belt is maintained in good repair.
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Item No.:
20
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Site:
Galley-Eataly Steakhouse- Show Galley
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Violation:
The red deli slicer had several slotted fasteners on the food contact surface and in food splash zones.
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Recommendation:
Use only low profile, nonslotted, noncorroding, and easy-to-clean fasteners on food-contact surfaces and in splash zones. Prohibit the use of exposed slotted screws, Phillips head screws, or pop rivets in these areas.
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Item No.:
20
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Site:
Buffet-Midship Portside Beverage Station
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Violation:
Two slotted fasteners were in the top right and left corners of the ice cuber inside the ice machine.
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Recommendation:
Use only low profile, nonslotted, noncorroding, and easy-to-clean fasteners on food-contact surfaces and in splash zones. Prohibit the use of exposed slotted screws, Phillips head screws, or pop rivets in these areas.
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Item No.:
21
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Site:
Dining Room-Le Muse Storage Locker 1976
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Violation:
The shelving units used to storage several types of beverages was made with galvanized metal. The galvanized metal had several hard to reach and clean spaces and also showed signs of rust.
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Recommendation:
Ensure nonfood-contact surfaces of equipment that are exposed to splash, spillage, or other food soiling or that require frequent cleaning are constructed of a corrosion-resistant, nonabsorbent, and smooth material. Ensure nonfood-contact surfaces are free of unnecessary ledges, projections, and crevices, and designed and constructed to allow easy cleaning and to facilitate maintenance.
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Item No.:
21
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Site:
Galley-Eataly Steakhouse- Show Galley
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Violation:
The technical compartments under the flat and grooved grills had a wood paneling exterior installed on the stainless steel panels. The backside of the paneling had exposed wood that was difficult to clean.
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Recommendation:
Ensure nonfood-contact surfaces of equipment that are exposed to splash, spillage, or other food soiling or that require frequent cleaning are constructed of a corrosion-resistant, nonabsorbent, and smooth material.
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Item No.:
22
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Site:
Galley-Cucina Pizzeria- Coffee Station
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Violation:
Empty and half-empty coffee dispensers were stored on the same counter as the coffee machines and with clean coffee dispensers. Staff stated these coffee dispensers were used in the lido and returned to this counter as a holding area before they are taken to warewashing for cleaning and sanitizing. The storage arrangement made it difficult to determine which coffee dispensers were soiled and which were clean.
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Recommendation:
Ensure all used coffee dispensers are taken immediately to warewashing.
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Item No.:
26
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Site:
Buffet-Crew Mess
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Violation:
At the beverage station, inside the left juice machine the dispensing ports were soiled with old food debris. This machine was posted 'not in use' since the morning of the inspection. Inside the right juice machine the dispensing ports were soiled. At 11:45, staff stated this machine was last used for breakfast that day.
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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 5 - Between Garde Manger and Butcher
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Violation:
A previously cleaned pasta machine had some food residue inside the two square chambers.
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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.:
28
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Site:
Galley-Deck 5 - Room Service
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Violation:
Many previously cleaned coffee carafes were stored wet inside the undercounter cabinet across from the office.
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Recommendation:
Store clean equipment and utensils in a self-draining position that allows air drying, and covered or inverted.
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Item No.:
28
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Site:
Galley-Aft Warewashing
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Violation:
Clean equipment was stored on the deck in linen locker 1339.
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Recommendation:
Store cleaned equipment and utensils, laundered linens, and single-service and single-use articles: (1) in a clean, dry location; (2) in a location where they are not exposed to splash, dust, or other contamination; (3) at least 150 millimeters (6 inches) above the deck.
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Item No.:
28
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Site:
Buffet-Lido Portside Locker 2234
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Violation:
Several boxes of food equipment were stored on the deck.
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Recommendation:
Store cleaned equipment and utensils, laundered linens, and single-service and single-use articles: (1) in a clean, dry location; (2) in a location where they are not exposed to splash, dust, or other contamination; (3) at least 150 millimeters (6 inches) above the deck.
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Item No.:
28
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Site:
Galley-Potwash
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Violation:
Several soiled pots and pans were stored with clean equipment on the clean storage rack adjacent to the mechanical pot wash machine. All items were removed and sent to be rewashed.
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Recommendation:
Do not store soiled equipment on the clean storage rack.
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Item No.:
28
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Site:
Galley-Potwash
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Violation:
An employee hung his apron on the clean storage rack adjacent to the mechanical pot wash where it was in contact with clean hotel pan. The hotel pan was sent to be rewashed.
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Recommendation:
Ensure employees do not hang their aprons in manner that will contaminate clean equipment.
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Item No.:
34
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Site:
Galley-Deck 5 - Pastry
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Violation:
Across from the dough sheeter, the utility sink faucet was continuously leaking.
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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:
Buffet-Lido Midship Portside Beverage Station
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Violation:
The light bulb above the ice chute and water dispenser inside the ice and water machine was not covered or shatter resistant. The ship had a total of six of this type of ice machine.
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Recommendation:
Ensure light bulbs are shielded, coated, or otherwise shatter-resistant in areas where there is exposed food, clean equipment, utensils, and linens, or unwrapped single-service and single-use articles.
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Item No.:
37
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Site:
Galley-Starboard Warewashing
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Violation:
Excessive condensation was accumulating on the deckhead and hood above the in-use mechanical dishwash machine. No water was observed dripping on the clean equipment exiting the dishwash machine. Condensation was also accumulating on the air supply vents on the deckhead between the dishwash machine and glasswash machine and was observed dripping onto the deck below.
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Recommendation:
Ensure ventilation hood systems and devices are sufficient in number and capacity to prevent grease or condensation from collecting on bulkheads and deckheads.
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Item No.:
37
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Site:
Galley-Deck 6 Hot Galley
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Violation:
The bain maries were producing an excessive amount of steam that was accumulating on the deckhead above the bain maries and around the air supply vents on the deckhead in front of the bain maries. No condensation was observed dripping on food in the bain maries but water was dripping from the air supply vents on the deck below.
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Recommendation:
Ensure ventilation hood systems and devices are sufficient in number and capacity to prevent grease or condensation from collecting on bulkheads and deckheads. Ensure ventilation hood systems and devices operate effectively to prevent grease and condensate from collecting on the bulkheads and deckheads and remove contaminants generated by equipment located under them.
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Item No.:
37
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Site:
Galley-Deck 5 - Soup Station
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Violation:
The soup kettles were in use with their lids open. Condensation was beginning to form on the deckhead above the far right soup kettle. No condensation was observed dripping onto exposed food. Also, near the far right soup kettle, excess condensation was on the air conditioning vent. Condensation was observed dripping onto the deck and on the preparation counter. No food or clean items were on the preparation counter.
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Recommendation:
Ensure ventilation hood systems and devices are sufficient in number and capacity to prevent grease or condensation from collecting on bulkheads and deckheads. Ensure ventilation hood systems and devices operate effectively to prevent grease and condensate from collecting on the bulkheads and deckheads and remove contaminants generated by equipment located under them.
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Item No.:
38
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Site:
Galley-Potwash Area
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Violation:
Approximately two meters from the clean landing of the in-use potwash machine, brooms and mops were hung on the bulkhead and cleaning chemicals were stored on the lower shelf. These items were not stored in a designated cleaning locker.
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Recommendation:
Ensure maintenance tools such as mops, brooms, and similar items are stored in a designated locker so they do not contaminate food, food-contact surfaces of utensils, and equipment, linens, and single-service and single-use articles.
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Item No.:
40
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Site:
Integrated Pest Management-Mooring Lines
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Violation:
As the inspection team was boarding the ship, it was observed that only one of the mooring lines had a rat guard on the line. At least two forward lines and one aft line did not have the rat guard mounted. The staff explained that the normal ship's procedure is to add the rat guards later which would not be an effective timing for control.
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Recommendation:
Ensure the vessel has an IPM plan to implement effective control strategies for pests aboard the vessel.
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Item No.:
41
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Site:
Housekeeping-Outbreak Prevention and Response Plan
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Violation:
The ship's Outbreak Prevention and Response Plan (OPRP) did not include the example notice to future passengers of an elevation on the previous cruise. The plan did have a clear plan for triggers to increase the response, but not in how to return to normal operations.
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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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Item No.:
44
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Site:
Medical-
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Violation:
Medical staff were not routinely applying the requirements of the VSP Operations Manual section 4.0. For example: (1) according to medical staff all reportable AGE crew members were released from medical isolation after 24 hours if they were not experiencing additional symptoms regardless if the crew member was a food worker or not; (2) the initial, 24- and 48-hour interviews of an AGE symptomatic crew members close contacts was not conducted or documented; and (3) medical staff were using the 2005 VSP Operations Manual definition for AGE, stating a case was someone who experienced vomiting and diarrhea, and were not taking into consideration diarrhea that was above normal for the individual.
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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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