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Item No.:
02
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Site:
Medical-AGE Surveillance Log
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Violation:
The AGE surveillance log did not include if antidiarrheal medication was dispensed to non-reportable cases.
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Recommendation:
List in the AGE surveillance log (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.:
02
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Site:
Medical-Acute Gastroenteritis (AGE) Surveillance Log
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Violation:
The AGE surveillance log did not include a case identification number, the information in the log was not in the correct order, and the information was not able to be exported into the format required in the 2011 VSP Operations Manual. Also, the STARDOCs medical surveillance system did not consider underlying medical conditions or what was above normal for the individual in the definition of a reportable case. Finally, the STARDOCS medical surveillance system only allowed for inputting the onset of AGE symptoms. Follow-up information, such as additional symptoms that could make someone a reportable case, could not be entered by staff except manually in the 'comments' section of the database.
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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). 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.
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Item No.:
02
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Site:
Medical-Close Contact Interviews
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Violation:
During the cruise from July 15 to 22, 2012, there was a retail worker with reportable AGE symptoms, but there was no documentation in the STARDOCS medical surveillance system stating this worker did not have any close contacts. Also, during the cruise from July 1 to 8, 2012, there was a waiter with reportable AGE symptoms on July 3, 2012, but there was no documentation in the STARDOCS medical surveillance system stating this worker did not have any close contacts.
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Recommendation:
Document if crew with reportable AGE symptoms have no close contacts.
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Item No.:
06
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Site:
Potable Water-Incubator
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Violation:
The digital thermometer for the incubator in the medical center used for microbiological samples indicated 24C, but the documentation for the media used stated the samples needed to be incubated between 34.5C and 35.5C. According to the staff, the thermometer had not worked since April 2012 and another thermometer was used to manually check the temperature of the incubator throughout the day. A manual check of the incubator was done during the inspection and the thermometer reading was 38C. There were at least five water samples in the incubator at the time of the inspection.
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Recommendation:
If water samples are collected and analyzed by the vessel for the presence of E. coli, analyze the samples using a method accepted in Standard Methods for the Examination of Water and Wastewater. Ensure test kits, incubators, and associated equipment are operated and maintained in accordance with the manufacturers? specifications.
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Item No.:
08
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Site:
Potable Water-Medical Wards 1 and 3
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Violation:
Two reduced pressure assemblies were installed in March 2012 in medical wards 1 and 3, but there was no documentation of the test results after the devices were installed.
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Recommendation:
Inspect and test backflow prevention devices requiring testing with a test kit after installation and at least annually. Maintain the test results showing the pressure differences on both sides of the valves for each device.
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Item No.:
08
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Site:
Food Service General-Chilled Water and Brine Lines
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Violation:
The chilled water lines for the ice machines and the brine lines for the upright refrigerators in the food preparation areas were not uniquely identified.
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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.:
10
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Site:
Recreational Water Facilities-Antientrapment
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Violation:
The drain covers for the gravity drains less than three feet apart in the swimming pools and the single unblockable gravity drain in the solarium pool were not approved for antientrapment and there were no alarms installed for draining of the pools.
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Recommendation:
For RWFs with gravity drainage and a single blockable drain or multiple drains less than 3 feet apart, provide an ASME A112.19.8 compliant antientrapment/antientanglement drain cover and a gravity drainage system. For RWFs with gravity drainage and a single unblockable drain (per ASME A112.19.8), provide either a standard design (not compliant with ASME A112.19.8) drain cover and an alarm, or an ASME A112.19.8 compliant antientrapment/antientanglement drain cover. Ensure the alarm is audible and sounds in both a continuously manned space and at the RWF. Ensure this alarm is for all draining: accidental, routine, and emergency.
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Item No.:
10
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Site:
Recreational Water Facilities-Safety Signs
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Violation:
The whirlpool signs did not include a caution against use by people with low blood pressure. The Solarium pool is considered a spa pool and the safety sign did not include whirlpool safety information. The Flow Rider safety signs did not include the information required for recreational water facilities.
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Recommendation:
Provide safety signs for all RWFs, except for baby-only water facilities. Ensure the signs, at a minimum, include the following words: (1) do not use these facilities if you are experiencing diarrhea, vomiting, or fever; (2) no children in diapers or who are not toilet trained; (3) shower before entering the facility; and (4) bather load #. For children's RWF signs, include the exact wording "TAKE CHILDREN ON FREQUENT BATHROOM BREAKS" or "TAKE CHILDREN ON FREQUENT TOILET BREAKS." In addition to the safety sign requirements in section 6.7.1.1.1, install a sign at each whirlpool spa and spa pool entrance listing precautions and risks associated with the use of these facilities. Include, at a minimum, cautions against use by the following: (1) individuals who are immunocompromised; (2) individuals on medication or who have underlying medical conditions such as cardiovascular disease, diabetes, or high or low blood pressure; and (3) pregnant women, elderly persons, and children. Additionally, caution against exceeding 15 minutes of exposure.
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Item No.:
11
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Site:
Medical-Crew Reporting
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Violation:
During the cruise from July 15 to 22, 2012, one assistant waiter had an onset of AGE symptoms on July 17, 2012 at 9:34 a.m. According to their time card, this food worker clocked in at 4:18 p.m. and clocked out at 4:34 p.m. the same day. This individual did not report to medical until 4:45 p.m. on July 17, 2012. During the last inspection, there were two food workers and three nonfood workers that did not report to medical in a timely manner.
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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 Isolation
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Violation:
During the cruise from July 22 to 29, 2012, a stateroom attendant who handles food was a reportable case and had an onset of AGE symptoms on Tuesday July 24, 2012 at 9:37 a.m., but was not classified as a food handler in the STARDOCS medical surveillance system and was not isolated for 48 hours. According to their time card, this person worked on July 25, 2012 from 5:22 p.m. to 10:07 p.m. and on July 26, 2012 from 7:43 a.m. to 12:55 p.m.
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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. Exclude food employees suspected of, diagnosed with, or exposed to any communicable disease caused by Salmonella typhi, Shigella spp., E. coli O157:H7, hepatitis A virus, norovirus, or other communicable diseases that can be transmitted by food, from working in any food or food related areas or operations, including working with exposed food, warewashing, equipment, utensils, table linens, single-service articles and single-use articles. Do not allow the excluded individual to return to the above duties until they are symptom free for a minimum of 48 hours.
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Item No.:
16
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Site:
Other-Hot Dog House
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Violation:
There were hotel pans of cooked hot dogs and sausages inside the undercounter warming oven at the front service area. Staff stated this was a time control unit, but there was no time control label on the warmer and it was not listed on the time control plan. Temperatures of all the meats inside were at or above 135F.
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Recommendation:
Ensure this undercounter cabinet is written on the time control plan and the cabinet is labeled "time control" if the unit will be placed on time control.
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Item No.:
19
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Site:
Buffet-Garden Cafe
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Violation:
There was no serving utensil for the bowl of apples. This was corrected.
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Recommendation:
Provide food-dispensing utensils for each container displayed at a consumer self-service unit such as a buffet or salad bar.
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Item No.:
20
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Site:
Buffet-Deck 15 Solarium/Samba Grill
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Violation:
There were slotted fasteners in the food-splash zone of the water dispenser of the counter-mounted ice/water 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:
Other-Sorrento's
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Violation:
From the service side, the top horizontal sneeze guard to the left of the plate stand was chipped at the front left corner.
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Recommendation:
Repair the sneeze guard.
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Item No.:
22
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Site:
Galley-Windjammer Dishwash
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Violation:
The visual alarm on the in-use conveyor warewash machine was not operational when the final rinse sanitizing temperature was less than 160F.
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Recommendation:
For vessels built to VSP 2005 Construction Guidelines or warewash machines installed/replaced after the VSP 2005 Construction Guidelines, ensure that the warewash machines are equipped with an audible or visual alarm that indicates when the sanitizing temperature or chemical sanitizer level has dropped below the levels stated on the machine data plate.
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Item No.:
22
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Site:
Galley-Windjammer Dishwash
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Violation:
The two sensor curtains inside the clean end of the in-use conveyor warewash machine were soiled. The lower portion of these curtains came in contact with the items in the warewash machine. Staff stated these curtains could not be removed.
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Recommendation:
Ensure warewashing machines, drainboards, and the compartments of sinks, basins, or other receptacles used for washing and rinsing equipment, utensils, or raw foods, or laundering wiping cloths are cleaned: (1) before use; (2) throughout the day at a frequency necessary to prevent recontamination of equipment and utensils and to ensure that the equipment performs its intended function; (3) at least every 24 hours (if used).
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Item No.:
22
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Site:
Other-Tween Deck Corridor
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Violation:
A trolley with soiled plates, glasses, and bowls was stored in this corridor.
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Recommendation:
Store soiled dishware in an appropriate area.
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Item No.:
24
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Site:
Galley-Windjammer Dishwash
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Violation:
The final rinse sanitizing temperature of the in-use conveyor warewash machine was measured at 155F and 156F using the inspector's and crew member's thermometers. Also, two thermometers placed on a long rod and held at the plate surface level measured 152F and 158F and additional thermometers placed through the final rinse measured between 147F and 160F. Only one thermometer during the last temperature check measured 160F.
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Recommendation:
In a mechanical operation, ensure the temperature of the fresh hot water sanitizing rinse as it enters the manifold is not more than 90C (194F) or less than: (1) 74C (165F) for a stationary rack, single-temperature machine; (2) 82C (180F) for all other machines. Ensure the utensil surface temperature is not less than 71C (160F) as measured by an irreversible registering temperature indicator.
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Item No.:
24
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Site:
Buffet-Starboard Thirst Quencher 1
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Violation:
In the undercounter cabinet to the left of the ice machine, a bucket of chlorine sanitizing solution had a concentration measured at less than 50 ppm by the inspector.
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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-Deck 3 Beverage Station
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Violation:
The white piece inside the ice chute on ice dispenser 4411.037P.119 was soiled with a pink substance. The unit was cleaned and sanitized.
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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:
Buffet-Starboard Thirst Quencher 1
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Violation:
The top of the Thirst Quencher sign was soiled with dust.
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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-Windjammer Dishwash
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Violation:
Numerous plates and bowls were coming out of the warewash machine leaning against one another. This prohibited proper washing and sanitizing of the food-contact surfaces of these items.
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Recommendation:
Ensure items are placed in the warewash machine in a manner so they can be properly washed and sanitized.
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Item No.:
28
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Site:
Other-Tween Deck Corridor
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Violation:
In this corridor, four dishwash racks of clean glasses were stored on a table and eight dishwash racks of clean glasses were stored on a trolley covered by a tablecloth. These glasses were stored under HI fog and grey water lines. In addition, the trolley was directly adjacent to a table with soiled bowls, plates, glasses and linen. According to the staff, the racks of clean glasses were supposed to be stored in the bar equipment storage locker one deck below and had probably been in the corridor since the previous evening.
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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.
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Item No.:
29
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Site:
Bar-Boardwalk
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Violation:
Two liquor bottle pour spouts were stored at the back of the handwash station. These were removed.
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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.:
29
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Site:
Preparation Room-Fish
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Violation:
The water temperature at the handwash station next to the door was 124F. The user could not adjust the temperature.
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Recommendation:
For handwash sinks with electronic sensors, and other types of handwash sinks where the user cannot make temperature adjustments, ensure the temperature provided to the user after the mixing valve does not exceed 49C (120F).
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Item No.:
29
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Site:
Galley-Deck 4 Bakery
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Violation:
The water temperature at the handwash station next to the stack ovens was 134F. The user could not adjust the temperature. The temperature was lowered.
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Recommendation:
For handwash sinks with electronic sensors, and other types of handwash sinks where the user cannot make temperature adjustments, ensure the temperature provided to the user after the mixing valve does not exceed 49C (120F).
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Item No.:
29
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Site:
Galley-Sorrento's
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Violation:
The water temperature of the handwash station at the entrance inside the galley was measured at 131F. The user could not adjust the temperature. The temperature was adjusted during the inspection.
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Recommendation:
For handwash sinks with electronic sensors, and other types of handwash sinks where the user cannot make temperature adjustments, ensure the temperature provided to the user after the mixing valve does not exceed 49C (120F).
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Item No.:
29
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Site:
Other-Deck 6 Diamond Lounge
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Violation:
Staff stated their only option was to use the handwash sink for rinsing drink preparation utensils and equipment. There was no utility sink installed.
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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.:
36
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Site:
Food Service General-Lighting
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Violation:
The light intensity was less than 110 lux behind and around a few pieces of deck- and counter-mounted equipment. This was observed at the aft starboard Windjammer Thirst Quencher 2 between the ice machine and the left bulkhead, and in the Solarium Galley behind the juice machines.
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Recommendation:
Ensure the light intensity is at least 110 lux (10 foot candles) behind and around mounted equipment, including counter-mounted equipment.
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Item No.:
38
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Site:
Galley-Deck 4 Bakery
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Violation:
A broom was stored in the technical locker next to the rotating oven. The broom was removed.
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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.:
39
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Site:
Other-Deck 11 Concierge Lounge
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Violation:
One live fruit fly was observed on the faucet of the preparation sink.
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Recommendation:
Effectively control the presence of insects, rodents, and other pests 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.:
40
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Site:
Integrated Pest Management-Rat Guards
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Violation:
The rat guards on the mooring lines were not installed properly to restrict the access of rodents. During the last inspection, some of the mooring lines on the forward starboard side of the ship were missing rat guards.
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Recommendation:
Protect entry points where pests may enter the food areas.
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Item No.:
41
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Site:
Housekeeping-Passenger Public Restroom Handwashing Signs
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Violation:
In the male and female public restrooms on deck 8 aft, including the handicapped stall in the women's restroom, the women's handicapped restroom on deck 6 aft, and the men's deck 8 forward restroom, there were no signs at the handwashing stations or on the adjacent bulkheads advising users to wash their hands. Several of these signs were added at the correct locations during the inspection. During the last inspection, several public restrooms were found to not have signs advising users to wash their hands at the handwashing stations.
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Recommendation:
Provide the passenger and crew public toilets with a handwashing station that includes: (4) A sign advising users to wash hands.
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Item No.:
44
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Site:
Medical-Knowledge
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Violation:
The medical staff in charge did not know the criteria for isolating food workers and nonfood workers. During the cruise from July 22 to 29, 2012, a stateroom attendant who handles food had an onset of AGE symptoms on Tuesday July 24, 2012 at 9:37 a.m., but was classified as a nonfood worker in the STARDOCS medical surveillance system by the medical staff and was isolated for 24 hours. Also, the medical staff did not understand when the AGE symptom onset should be entered and what symptoms should be entered under the illness onset area of STARDOCS. On July 2, 2012, a food worker was documented in STARDOCS as having 3 episodes of diarrhea and 6 episodes of vomiting at 10:00 a.m. and reported to medical at 5:18 p.m., but according to their medical chart, this worker reported to medical at 10:40 a.m. with severe stomach cramps but no other symptoms and reported to medical at 5:18 p.m.
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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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