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Item No.:
02
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Site:
Medical-Acute Gastroenteritis (AGE) Surveillance Logs
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Violation:
The AGE logs had information that was different from the medical records or from other parts of the logs. For example, (1) the 2-9 October voyage log listed 3 crew reportable cases but the total reportable crew cases part of the log stated 2 cases instead of 3 cases; (2) the 9-16 October voyage log had a passenger with zero diarrheas in the diarrhea column but a note in the underlying illness column stated that the case had 2 watery stools. Medical staff stated that they could not make changes to the log once they entered a value.
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Recommendation:
Ensure the AGE surveillance log entry for each passenger or crew member contain the following information in separate columns: (1) Date of the first medical visit or report to staff of illness; (2) time of the first medical visit or report to staff of illness; (3) case identification number; (4) person's name; (5) person's age; (6) person's sex; (7) designation as passenger or crew member; (8) crew member position or job on the vessel, if applicable; (9) cabin number; (10) meal seating information; (11) date of illness onset; (12) time of illness onset; (13) illness symptoms, including the presence or absence of the following selected signs and symptoms, with a separate column for each of the following: (a) number of episodes of diarrhea in a 24-hour period; (b) number of episodes of vomiting in a 24-hour period; (c) bloody stools; (d) recorded temperature; (e) abdominal cramps; (f) headaches; (g) muscle aches; (14) entry (yes/no) for whether this was a reportable case; (15) entry (yes/no) for antidiarrheal medications sold or dispensed by designated medical staff; (16) presence of underlying medical conditions that may affect interpretation of AGE. Ensure the AGE surveillance log contains the above information in the exact order and is entered in the template in Annex 13.2.2. Ensure that the log data is exported in the exact order as in the example template in Annex 13.2.2 with analyzable formats such as Excel or Access. Ensure that any additional data fields are entered only outside of the form margins when exported to VSP. Ensure that the AGE surveillance logs are accurate and complete.
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Item No.:
11
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Site:
Medical-Crew Acute Gastroenteritis (AGE) Reporting
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Violation:
The review of the AGE logs for the last 5 cruises revealed that a junior stateroom steward had an illness onset on 2 October at 1400 and reported to the medical center on 3 October at 1015. The crew member worked while symptomatic for at least 5.5 hours. A written disciplinary action was on file.
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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.:
02
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Site:
Medical-Immediate Contacts of Symptomatic Crew
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Violation:
There were no notes documenting that the medical staff was at least asking the cases if they had close contacts other than their cabin mates. Staff stated that the new forms they were using as medical records did not provide to enter that information as it used to be with old forms.
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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. An immediate contact means sharing a cabin either full or part time or sharing its bathroom facilities. This includes boyfriends, girlfriends, spouses, or other significant others. If the symptomatic crew member has no cabin mate or other immediate contact, this must be documented.
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Item No.:
08
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Site:
Potable Water-Bunkering Records
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Violation:
There were several instances where the first documented check after the beginning of bunkering occurred from 30 minutes to more than 1 hour to verify that halogen and pH levels were acceptable. This was found several times on 2, 9, 12, 13 October and 6, 7, 12, 20, 21 September.
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Recommendation:
Adjust the free halogen residual level to at least 2.0 mg/L (ppm) within 30 minutes of the start of the bunkering and production processes.
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Item No.:
42
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Site:
Children Area-Restroom with Diaper Changing Station
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Violation:
This restroom was in the center play area and could be used by parents and their 5 years old and under kids under the ship's staff supervision. The toilet was higher than 11 inches from the deck, the handwashing station was higher than 22 inches from the deck, and there were no step stools. Also, the toilet seat opening was more than 8 inches.
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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.:
42
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Site:
Children Area-Under 3 years old
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Violation:
A previously cleaned toy cart and a toy kitchen were soiled with dust between some crevices.
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Recommendation:
Ensure toys used in the child-activity center are maintained in a clean condition.
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Item No.:
13
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Site:
Children Area-Family Cupcake Decorating
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Violation:
Weekly functions occur at La Cucina where youth staff take children and their parents for cupcake decoration. The participants eat their cupcakes after decorating them. There was no assurance that the participants were washing hands accordingly or were not experiencing AGE symptoms while participating in these activities. These activities will require an approved variance from the Vessel Sanitation Program.
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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 person in charge demonstrates this knowledge: (1) By compliance with these guidelines
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Item No.:
16
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Site:
Buffet-Garden Caf Cold Section
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Violation:
The public health advisory for the cold smoked herring was not specific to this food item out for self-service.
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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 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.
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Item No.:
33
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Site:
Galley-Walk-in Refrigerator #01265
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Violation:
Water was noted along the deckhead seam in this room.
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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.:
26
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Site:
Galley-Aft Pantry
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Violation:
The two previously cleaned juice machines had old juice residue along the seam of the food splash area above the nozzles.
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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.:
21
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Site:
Galley-Hot Section
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Violation:
A gap was noted around the chute of the grease pan housing of the grooved top grill.
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Recommendation:
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.:
27
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Site:
Galley-Hot Section Rotisserie Oven
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Violation:
The previously cleaned oven was soiled behind the heating elements as well in the vent on the top of the equipment.
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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.:
21
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Site:
Galley-Azura Hot Section
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Violation:
The sealant around the chutes of the grease pan housings of the grooved and flat top grills was peeling, exposing difficult to clean seams.
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Recommendation:
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.:
27
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Site:
Galley-Azura Hot Section
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Violation:
The seams around the chutes for the grease pan housings of the previously cleaned grooved and flat top grills were soiled.
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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.:
35
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Site:
Galley-Combination Oven #1
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Violation:
Water had pooled on the deck under and in front of the in-use combination oven due to water leaking from the bottom left corner of the equipment. A similar violation was written on the last inspection.
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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.:
26
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Site:
Galley-Aft Pantry
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Violation:
The deflector shield of the cuber in the ice machine had some black debris.
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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.:
19
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Site:
Provisions-Corridor
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Violation:
A pallet of food was stored under a deckhead soiled with dust.
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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.:
33
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Site:
Provisions-Corridor
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Violation:
A deckhead panel was coming off, exposing a very soiled and dusty area.
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Recommendation:
Ensure decks, bulkheads, and deckheads in food preparation, warewashing, pantries, bars, and food and equipment storage areas are constructed and maintained for easy cleaning. 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.:
26
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Site:
Preparation Room-Potato Peeler
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Violation:
The area around the gasket of the front door to the previously cleaned potato peeler was soiled. This was not in use.
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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.:
22
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Site:
Galley-Potwash
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Violation:
A soiled deck stand was stored directly adjacent to the deck-mounted pizza oven.
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Recommendation:
Move soiled items immediately to a proper warewash area and do not store where cooking equipment could be contaminated.
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Item No.:
16
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Site:
Buffet-Crew Mess
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Violation:
The milk in the milk dispenser did not have a 7-day discard label.
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Recommendation:
Ensure refrigerated, ready-to-eat, potentially hazardous food: (1) Prepared on a vessel and held refrigerated for more than 24 hours is clearly marked at the time of preparation to indicate the date or day by which the food must be consumed (7 calendar days or fewer from the day the food is prepared). The day of preparation is counted as day 1. (2) Prepared and packaged by a food-processing plant and held on the vessel after opening for more than 24 hours must be clearly marked at the time the original container is opened to indicate the date by which the food must be consumed (7 calendar days or fewer after the original container is opened). The day of opening is counted as day 1.
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Item No.:
36
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Site:
Buffet-Staff Mess
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Violation:
The light intensity was less than 220 lux at the forward handwashing station behind the staff mess buffet line.
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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 food preparation areas, handwashing facilities, warewashing areas, equipment, and utensil storage, pantries, toilet rooms, and consumer self-service areas.
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Item No.:
37
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Site:
Galley-Cagney's
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Violation:
The deckhead above the bain marie had condensate accumulated on it.
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Recommendation:
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.:
27
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Site:
Galley-Cagney's
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Violation:
Food soil was built up in one of the fittings for the rotisserie sticks of the previously cleaned Elan grill.
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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:
Pantry-Top Siders
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Violation:
Water was standing on the deck in front of the sanitizing compartment of the 3-compartment sink.
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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.:
29
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Site:
Bar-Top Siders
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Violation:
The soap for the handwashing station by the door to the pantry was watered down.
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Recommendation:
Ensure that the handwashing soap is not diluted.
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Item No.:
37
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Site:
Pantry-Sky Bar
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Violation:
Steam and condensation had accumulated on the deckhead from the operation of the undercounter dishwasher.
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Recommendation:
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.:
41
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Site:
Housekeeping-Outbreak Prevention and Response Plan (OPRP)
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Violation:
The OPRP stated that for a public vomit/diarrhea incident in a galley, 200 ppm chlorine for a contact time of 10 minutes would be used. This CT value is not effective against norovirus. In addition, the ORPR stated that in areas contaminated with vomit/feces, a 5000 ppm chlorine concentration would be used, but it did not state the contact time.
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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. More guidance on preventing norovirus infections can be found following this link: http://www.cdc.gov/norovirus/preventing-infection.html
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Item No.:
33
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Site:
Galley-Locker 06-05-079
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Violation:
Standing water was below the storage rack on the deck.
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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.:
21
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Site:
Galley-Cagney's
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Violation:
The port side counter had two deep cracks, which were filled with a material, creating a rough surface difficult to clean. A similar violation was written during the last inspection.
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Recommendation:
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-Combination Oven #1
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Violation:
The in-use combination oven had water leaking from the bottom left corner of the equipment. A similar violation was written on the last inspection.
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Recommendation:
Ensure nonfood contact equipment is maintained in good repair and proper adjustment including: (1) Equipment maintained in a state of repair and condition that meets the materials, design, construction, and operation specifications of these guidelines; (2) Equipment components such as doors, seals, hinges, fasteners, and kick plates are kept intact, tight, and adjusted in accordance with manufacturer's specifications.
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