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Item No.:
02
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Site:
Medical-Nonreportable Gastointestinal Illness (GI) cases
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Violation:
On the March 3-21st voyage, a passenger and crew member (beauty therapist) experienced 2 episodes of loose bowels, and were categorized as nonreportable GI cases. In the medical notes, there was no documentation stating if this was above normal or normal for the individual. The beauty therapist was precautionary isolated.
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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.:
11
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Site:
Medical-Crew Member Gastrointestinal Illness (GI) Late Reporting
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Violation:
During the March 3rd-21st outbreak voyage, crew members reported late to the medical after experiencing GI symptoms and were not isolated while experiencing GI symptoms. A waiter experienced GI symptoms on 3/7 at 1500, and reported to medical at 1830; this crew member ate in the crew mess at 1530. An assistant 2nd cook experienced GI symptoms on 3/10 at 1015 (1st bowel of loose stool) and 1310 (2nd bowel of loose stool), and reported to medical at 1310; this food handler crew member worked from 1100-1300. A cruise staff experienced GI symptoms on 3/10 at 1000 (2 loose bowls) and did not report to medical until 1813; this crew member was consulted and reported he went to his cabin since he felt ill at work (between 1000-1200), but there was no way to verify this crew member stayed in his cabin while experiencing GI symptoms. On a prior voyage, an assistant boutique experienced GI symptoms on 1/28 at 0830 and reported to medical at 1730; documentation showed this crew member ate in staff mess at 0845 and worked while ill. Staff did not give any disciplinary action for crew members who reported late after experiencing GI symptoms.
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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.:
19
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Site:
Galley-Freezer #2
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Violation:
A pan of lime gelato, with a piece of plastic wrap frozen to the surface, was stored under a speaker in this freezer. Condensate had frozen to the speaker and was observed inside the pan of gelato on the surface of the plastic wrap.
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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.:
19
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Site:
Provisions-Corridor
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Violation:
During active provisioning, the soiled plastic curtain for the door adjacent to the wine storage area was stored on top of on a pallet of water.
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Recommendation:
Protect food from contamination by storing the food: (3) Where it is not exposed to splash, dust, or other contamination.
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Item No.:
19
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Site:
Provisions-Frozen Fish
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Violation:
Significant frozen condensate was observed on a box of tilapia and on two boxes of lobster tails. The lobster boxes were frozen together.
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Recommendation:
Protect food from contamination by storing the food: (2) In a clean, dry location.
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Item No.:
19
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Site:
Provisions-Beverage
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Violation:
The feet of a deck stand were resting on cases of beer.
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Recommendation:
Protect food from contamination that may result from a physical, chemical, biological origin.
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Item No.:
19
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Site:
Provisions-Corridor
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Violation:
A food worker was observed transporting a hotel pan full of freshly cooked French fries uncovered to the officers mess.
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Recommendation:
Protect food from contamination that may result from a physical, chemical, biological origin.
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Item No.:
20
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Site:
Galley-Combination Oven
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Violation:
The point where the caster joined the drip pan for this unit was not connected properly causing water to leak, drip and pool on the deck.
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Recommendation:
Food contact equipment must be maintained in good repair and proper adjustment: (1) Equipment must be maintained in a state of repair and condition that meets the materials, design, construction, and operating specifications of these guidelines; and (2) Cutting or piercing parts of can openers must be kept sharp to minimize the creation of metal fragments that can contaminate food when the container is opened.
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Item No.:
24
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Site:
Buffet-Laterrazza
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Violation:
The sanitizer in the shallow clear wiping tray, beside the coffee dispenser for the open buffet line, had a concentration less than 50 ppm.
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Recommendation:
Ensure sanitizing solutions are used with the following concentrations: (1) A chlorine solution with a concentration between 50 mg/L (ppm) and 200 mg/L (ppm).
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Item No.:
26
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Site:
Galley-Laterrazza
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Violation:
A previously cleaned 10 inch serving plate and a small silver desert bowl stored in the clean dishwash area were soiled with food debris.
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Recommendation:
Ensure food only contacts surfaces of equipment and utensils that are cleaned and sanitized. Ensure food contact surfaces of equipment and utensils are clean to sight and touch.
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Item No.:
26
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Site:
Galley-Laterrazza
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Violation:
The fifth shelf of the knife locker across from the potwash containing previously cleaned knives was locked and contained food debris on the knives and inside shelf.
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Recommendation:
Ensure food only contacts surfaces of equipment and utensils that are cleaned and sanitized. 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-Main
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Violation:
The three 4 meter long large stainless steel dry stores cabinets at the entrance on the starboard side across from the clean dishwash area had an accumulation of dust and grease on the top greater than one day's accumulation.
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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:
Galley-Main
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Violation:
One silver and one grey flatware holder for dishwashing had a sticky label residue on the outside. These were located in the clean area of the dishwash starboard side across from the ice machine noted previously.
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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.:
29
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Site:
Galley-Laterrazza
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Violation:
Access to the handwash station across from the dirty dish drop-off area was blocked by two 55 gallon trash cans and a stainless steel table.
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Recommendation:
Ensure handwashing facilities are used for no other purpose and are accessible at all times.
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Item No.:
33
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Site:
Galley-Laterrazza
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Violation:
A clear plastic light fixture adjacent to the in use hot grill and the egg preparation counter had an accumulation of dirt, grease, and oil greater than one day's accumulation.
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Recommendation:
Ensure decks, bulkheads, deckheads, and attached equipment in food preparation, warewashing, pantries, and storage areas are cleaned as often as necessary.
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Item No.:
33
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Site:
Other-Pool Grill
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Violation:
The front bar, under the serving area, contained food debris under the counter. Food debris such as crumbs, a French fry, and pizza dough were observed in this closed previously cleaned area.
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Recommendation:
Ensure decks, bulkheads, deckheads, and attached equipment in food preparation, warewashing, pantries, and storage areas are cleaned as often as necessary.
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Item No.:
33
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Site:
Galley-Main
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Violation:
Three 2 cm holes were observed approximately 4 cm off the deck on the bulkhead behind the ice machine at the entrance on the starboard side across from the clean dishwash area that lead to the void space behind the bulkhead. These holes were adjacent to the ice machine drain and appeared to be wet.
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Recommendation:
Ensure decks, bulkheads, and deckheads in food preparation, warewashing, pantries, and storage areas are maintained in good repair.
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Item No.:
33
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Site:
Galley-Port Beverage Station
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Violation:
A significant amount of water was dripping from an enclosed technical area from an undetermined source onto the deck under a technical area under the coffee station. This was previously reported to engineering.
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Recommendation:
Ensure decks, bulkheads, deckheads, and attached equipment in food preparation, warewashing, pantries, and storage areas are cleaned as often as necessary.
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Item No.:
33
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Site:
Galley-Deck
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Violation:
The deck under the dough sheeter and the bulkhead deck juncture along the back of the grill area contained food debris greater than a day's accumulation.
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Recommendation:
Ensure decks, bulkheads, deckheads, and attached equipment in food preparation, warewashing, pantries, and storage areas are cleaned as often as necessary.
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Item No.:
35
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Site:
Galley-Combination Oven
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Violation:
A significant amount of soiled water from the combination oven was pooling on the deck.
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Recommendation:
Ensure black and gray water is discharged to the vessel's wastewater disposal system and does not pool on the deck.
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Item No.:
36
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Site:
Galley-Garde Manger
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Violation:
The light intensity at both of the handwash sinks in this area during food preparation was less than 220 lux.
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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 handwashing facilities.
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Item No.:
39
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Site:
Bar-Panorama
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Violation:
Three ants were observed under the front bar under the technical space adjacent to the drain in the deck.
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Recommendation:
Effectively control the presence of insects to minimize their presence in the food storage, preparation, and service areas and warewashing and utensil storage areas aboard a vessel.
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Item No.:
44
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Site:
Medical-Crew Member Gastrointestinal Illness (GI) Late Reporting
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Violation:
Upon review of the crew members' medical records, it was found that crew members were reporting to medical for other reasons that GI symptoms. A consultation reason was documented, such as a fever or abdominal cramps, and in the medical notes loose bowel movements were additionally reported and recorded after medical staff interviewed them. When crew members experienced a loose stool, they did not consult medical immediately and would wait 3-8 hours before reporting to medical. It is unknown if crew members that experienced GI stayed in their cabins between the GI onset and time they reported to medical. From this review and discussion with staff, it was determined the GI training for crew members was not sufficient. Crew members should not wait until a second loose bowel movement to report to medical and should report after the first GI symptom. Also, disciplinary action for GI late reporting was not conducted or documented.
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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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