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Item No.:
02
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Site:
Medical-Acute Gastroenteritis Surveillance Log
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Violation:
A review of the acute gastroenteritis (AGE) logs for the last three cruises revealed there were individuals with AGE symptoms that met the reportable case definition, but were considered non-reportable cases. Also, individuals that did not meet the reportable case definition were considered reportable cases by the medical staff, only considering calculations done by the spreadsheet used. There were no comments or notes regarding underlying medical conditions. Specifically, on 3 February a passenger reported to the medical center with 1 episode of vomiting and was considered a reportable case; on 30 January a passenger reported to the medical center with 1 episode of diarrhea and was considered a reportable case; on 27 January a passenger reported to the medical center with 2 episodes of diarrhea and was considered a reportable case; on 8 January a passenger reported to the medical center with 2 episodes of diarrhea and antidiarrheal medication was prescribed and was considered a non-reportable case; on 7 January a crew member reported to the medical center with 2 episodes of diarrhea and antidiarrheal medication was prescribed and was considered a non-reportable case. All of these determinations were done by the spreadsheet and were not questioned by the medical staff.
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Recommendation:
Ensure a reportable case of AGE is a case reported to the master of the vessel, the medical staff, or other designated staff by a passenger or a crew member and meets the case definition based on the following symptoms: (1) Diarrhea (three or more episodes of loose stools in a 24 hour period or what is above normal for the individual. See section 4.1.2.1.3, illness symptoms); or (2) vomiting and one additional symptom including one or more episodes of loose stools in a 24-hour period, or abdominal cramps, or headache, or muscle aches, or fever (temperature of greater than or equal to 38C [100.4F]).
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Item No.:
08
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Site:
Bar-Golden Lion
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Violation:
Inside the multi-flow cabinet, there was no backflow prevention device on the potable water line to the soda gun.
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Recommendation:
Install a continuous pressure backflow prevention device on the potable water line to the soda gun.
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Item No.:
08
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Site:
Potable Water-Cross-Connection Control Program
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Violation:
The list of the nontestable backflow prevention devices listed inspection dates of July and August 2011. Staff showed the inspector an AMOS documentation of inspections of devices by deck dated in January 2013. However, the work descriptions in AMOS only stated that all devices per deck were inspected.
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Recommendation:
Ensure the cross-connection control program includes at a minimum: a complete listing of cross-connections and the backflow prevention method or device for each, so there is a match to the plumbing system component and location. Include air gaps on the listing. Ensure a schedule for inspection frequency is set. Maintain a log documenting the inspection and maintenance in written or electronic form, and ensure it is available for review during inspections.
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Item No.:
08
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Site:
Pantry-8305 and 8404
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Violation:
The nonpotable chilled water lines connected to the back of the ice machines were not uniquely identified. This was corrected during the inspection.
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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-Shock Halogenation
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Violation:
The halogen analyzer-chart recorder charts for the whirlpools and spa pool had stamps with the wording 'Manual Test >10 ppm' with handwritten start and stop times for the shock halogenation, but the actual free residual halogen levels at the start and completion of shock halogenation were not documented. This was noted on all charts since 8 December.
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Recommendation:
Ensure a written or electronic record of the date and time of water dumping and shock halogenation (concentration in ppm at the start and completion and time) is available for review during inspections.
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Item No.:
11
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Site:
Medical-Crew Acute Gastroenteritis (AGE) Reporting
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Violation:
A review of the AGE logs for the last three cruises revealed there was a waiter who experienced AGE symptoms and continued to work after those symptoms began. The waiter had an onset of AGE symptoms on 7 January at 10:00, but reported to the medical center at 17:45 that day.
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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. Ensure food employees who have conditions or symptoms of boils, open sores, infected wounds, diarrhea, jaundice, fever, vomiting, sore throat with fever, or discharges from the nose or mouth report these conditions or symptoms to the vessel's medical staff and are restricted from working with exposed food, warewashing, clean equipment, utensils, and linens, and unwrapped single-service and single-use articles.
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Item No.:
13
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Site:
Galley-Brittania Dishwash (Deck 3)
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Violation:
The alarm on the in-use conveyor dishwash machine was flashing and none of the crew members in the area were reacting to the alarm. The inspector noticed the alarm upon arrival in the area. The wash and final sanitizing rinse temperatures were appropriate, and the final sanitizing spray patterns were effective.
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Recommendation:
Ensure the supervisor or person in charge of food operations on the vessel monitors that: (3) Employees and other persons such as delivery and maintenance persons and pesticide applicators entering the food preparation, food storage, or warewashing areas comply with the guidelines in this manual.
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Item No.:
16
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Site:
Buffet-Egg Stations
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Violation:
The consumer advisory was posted at the entrance to the buffet lines where passengers obtain their plates, and not at the stations where eggs could be cooked to order. Staff moved the advisories to the egg stations.
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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.
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Item No.:
16
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Site:
Buffet-Center Service Line
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Violation:
A dispensing container of strawberry smoothie was on time control, but was not labeled with the discard time. This food outlet was open for more than four hours. The set-up and discard times were written on the logs maintained in the area. The staff labeled the food with the discard time according to the log.
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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 (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.
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Item No.:
16
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Site:
Galley-Service Pantry (Deck 9)
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Violation:
Numerous containers of cut melons in time control reach-in refrigerators #1, 2, 3, and 4 were not labeled with the discard times. The logs indicated these food items were placed on time control around 06:15. Staff stated one service line closes at 10:00 and the other service line closes at 11:00. These reach-in refrigerators maintained proper temperatures, so there could be confusion of the correct discard times if more containers were to be placed in these refrigerators later in the morning. Staff labeled the food items with the discard times according to the log.
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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 (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.
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Item No.:
16
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Site:
Galley-Verandah Restaurant (Deck 2)
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Violation:
The menus contained animal-derived foods that could be cooked to order and there was a consumer advisory statement at the bottom of the menu. However staff stated that veal and beef filet could be cooked to order, but there was no asterisk beside these food items to indicate the consumer advisory applied to them.
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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 disclosure is made by one of the two following methods: (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:
Pantry-Captain's Pantry
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Violation:
The milk in the refrigeration compartment of the coffee machine was labeled as being on time control. The unit was labeled as time control, but there was no time control plan.
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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:
Buffet-
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Violation:
Original food containers out for passenger self service, such as peanut butter, jelly, marmalade, etc. had the lids removed. These containers were not under a sneeze shield or otherwise protected.
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Recommendation:
Protect food on display from contamination by the use of packaging; counter, service line, or salad bar food guards; display cases; self-closing hinged lids; or other effective means. Install side protection for sneeze guards if the distance between exposed food and where consumers are expected to stand is less than 1 meter (40 inches).
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Item No.:
19
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Site:
Galley-Brittania Dishwash (Deck 3)
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Violation:
Due to the set-up of the area, soiled room service trolleys were transported alongside the clean storage tables to their designated soiled storage area across from the dishwash soiled landing. Also, staff stated that waiters carry trays of food past this soiled storage area to the dining room through the same doors that soiled dishes are brought from the dining room.
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Recommendation:
Move the clean storage table to the clean area near the dishwash machine. Reconfigure the soiled storage area so food items are not transported through this area.
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Item No.:
20
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Site:
Pantry-Captain's Pantry
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Violation:
The food splash zone of the coffee machine had two slotted fasteners. This was corrected during the inspection.
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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.:
22
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Site:
Other-Locker 8301
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Violation:
Several soiled glasses and a soiled knife were in a soiled bin stored above a housekeeping trolley.
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Recommendation:
Ensure drainboards, utensils, racks, or tables large enough to accommodate all soiled and cleaned items that may accumulate during hours of operation are provided for necessary utensil holding before cleaning and after sanitizing.
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Item No.:
28
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Site:
Pantry-8404
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Violation:
The soap dispenser to the right of the handwashing sink was above the edge of a food preparation table with plastic containers labeled 'Fruit Only'. The inspector noticed that during the handwashing process, while extending the wet hand to reach to the soap dispenser, water dripped over a clean plastic container right below the soap dispenser. The container was relocated, but that side of the table could still get wet during handwashing procedures.
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Recommendation:
Ensure soap dispensers are not located over clean utensil storage, food storage, or food preparation surfaces.
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Item No.:
28
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Site:
Galley-Brittania Dishwash (Deck 3)
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Violation:
A soiled room service trolley was in contact with the clean storage table. Other trolleys full of soiled items were stored less than one meter from the clean storage table.
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Recommendation:
Store cleaned equipment and utensils, laundered linens, and single-service and single-use articles: (2) in a location where they are not exposed to splash, dust, or other contamination.
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Item No.:
34
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Site:
Galley-Brittania (Deck 3)
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Violation:
Water was leaking from the deckhead hatch onto the deck in front of bain marie #145. No food was impacted.
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Recommendation:
Ensure the plumbing system in a food area is maintained in good repair.
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Item No.:
36
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Site:
Room Service-
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Violation:
The light intensity was less than 220 lux on the preparation counter outside cold room #34.
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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.:
42
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Site:
Children Area-
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Violation:
The diaper changing area had a sign advising handwashing after diaper changing, but was not specific to the need of handwashing after each diaper change.
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Recommendation:
Post signs in the diaper changing area advising handwashing after each diaper change.
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Item No.:
44
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Site:
Medical-Acute Gastroenteritis Surveillance Log
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Violation:
A review of the AGE logs for the last three cruises revealed there were individuals with AGE symptoms that met the reportable case definition, but were considered non-reportable cases. Also, individuals that did not meet the reportable case definition were considered reportable cases by the medical staff, only considering calculations done by the spreadsheet used. There were no comments or notes regarding underlying medical conditions. All of the determinations were done by the spreadsheet and were not questioned by the medical staff.
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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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