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Item No.:
02
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Site:
Medical-Acute Gastroenteritis (AGE) Surveillance Log
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Violation:
The log only contained the AGE symptoms reported by the passenger or crew member at the time of reporting to the medical center and not all AGE symptoms in a 24-hour period as required. This was noted in the previous inspection.
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Recommendation:
Ensure the AGE surveillance log entry for each passenger or crew member contain the following information in separate columns: (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.
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Item No.:
02
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Site:
Medical-Acute Gastroenteritis (AGE) Surveillance Log
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Violation:
The log only contained reportable cases but no non-reportable cases. The staff explained that they only record in the log cases when they met the definition of a reportable case, otherwise they would have large numbers of cases that would skew their epidemic curves. Also, vomit only cases were not recorded in the log.
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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.
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Item No.:
08
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Site:
Potable Water-Cross-Connection Control Program
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Violation:
The cross-connection log did not list the backflow prevention method or type of device used for 10 cross-connections in the medical center. Also, the log did not list the internal air gaps for the chemical dispensing units at the 3 housekeeping chemical filling lockers. This was corrected during the inspection.
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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:
Recreational Water Facilities-Whirlpool Pump Room #4 and #5
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Violation:
There was no proper air gap on the relief valve to the reduced pressure assembly backflow prevention device (RP) installed for potable water filling. There was a plastic pipe just below the air relief vent which drained into a larger pipe directed to grey water. The first pipe ended inside the larger pipe and there was no way to determine if the RP was malfunctioning.
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Recommendation:
Ensure air gaps are at least twice the diameter of the delivery fixture opening and a minimum of 25 millimeters (1 inch).
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Item No.:
08
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Site:
Potable Water-Garbage Room
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Violation:
One of the two supply water lines in the garbage room had blue/gray/blue stripes indicating distallate or permeate water and also blue stripes indicating potable water. This water line which was connected to the garbage pre-wash hoses, handwashing sink, and eye wash station had two blue potable water stripes in addition to several blue/gray/blue stripes.
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Recommendation:
Stripe or paint potable water lines either in accordance with ISO 14726 (blue/green/blue) or blue only. Stripe or paint distillate and permeate lines directed to the potable water system in accordance with ISO 14726 (blue/gray/blue). Ensure no other lines have the above color designations. Provide potable water to the handwashing sink and eye wash station.
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Item No.:
10
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Site:
Recreational Water Facilities-Shepherd's Hooks
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Violation:
The shepherd's hooks at swimming pools #4 and #5 were not long enough to reach the center of the deepest part of the pool from the side plus two feet.
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Recommendation:
Provide a rescue or shepherd's hook and an approved flotation device at a prominent location (visible from the full perimeter of the pool) at each RWF that has a depth of 1 meter (3 feet) or greater. Mount these devices in a manner that allows for easy access during an emergency. Ensure the pole of the rescue or shepherd's hook is long enough to reach the center of the deepest portion of the pool from the side plus 2 feet. Ensure it is a light, strong, nontelescoping material with rounded, nonsharp ends.
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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 there were 2 food workers and 1 nonfood worker that experienced AGE symptoms and continued to work after those symptoms began. There was an additional food worker that did not work while symptomatic but reported being in the crew mess several times while symptomatic. Specifically, (1) a utility galley worker had an onset of AGE symptoms on 21 March at 11:00 but reported to the medical center at 19:45 that day; he reported going to the crew mess for lunch while symptomatic; (2) a sales assistant had an onset of AGE symptoms on 24 February at 9:00 but reported to the medical center at 16:30 that day; her time card showed that she worked from 16:30 to 23:00, the same time she was in isolation; (3) a waitress had an onset of AGE, symptoms on 23 February at 6:00 but reported to the medical center on 25 February at 11:30; she reported going to the crew mess for lunch, dinner, and snack while symptomatic on 23 February and working all her shifts on 23 and 24 February; (4) an assistant waiter had an onset of AGE symptoms on 15 March at 7:30 but reported to the medical center at 18:00 that day; he reported going to the crew mess for breakfast, lunch, and dinner while symptomatic but did not work. Previous inspection conducted on November 2012 revealed 3 nonfood workers that did not report to the medical center in a timely manner and thus were not restricted from work as soon as having their first AGE symptom.
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Recommendation:
Ensure that employees having AGE symptoms are restricted from work and report to the medical center as soon as having their first AGE symptom.
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Item No.:
13
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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 there were 2 food workers that experienced AGE symptoms and continued to work after those symptoms began. There was an additional food worker that did not work while symptomatic but reported being in the crew mess several times while symptomatic.
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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; (2) By being a domestically or foreign certified food protection manager who has shown proficiency of required information through passing a test that is part of an accredited program; or (3) By responding correctly to the inspector's questions as they relate to the specific food operation. Ensure that the areas of knowledge include: (2) Explaining the responsibility of the person in charge to prevent transmission of foodborne disease by a food employee who has a disease or medical condition that may cause foodborne disease; (3) Describing the symptoms associated with diseases that are transmissible through food. Ensure the supervisor or person in charge of food operations on the vessel monitors that: (1) Food operations are not conducted in a room used as living or sleeping quarters; (2) Persons unnecessary to the food operation are not allowed in the food preparation, food storage, or warewashing areas. (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; (4) Food employees are effectively cleaning their hands; (5) Employees are observing foods as they are received to determine that they are from approved sources, delivered at the required temperatures, protected from contamination, unadulterated, and accurately presented; (6) Employees are properly cooking potentially hazardous food, being particularly careful in cooking foods known to cause severe foodborne illness and death, such as eggs and comminuted meats; (7) Employees are using proper methods to rapidly cool potentially hazardous foods that are not held hot or are not for consumption within 4 hours; (8) Consumers who order raw or partially cooked ready-to-eat foods of animal origin are informed that the food is not cooked sufficiently to ensure its safety; (9) Employees are properly sanitizing cleaned multiuse equipment and utensils before they are reused; (10) Consumers are notified that clean tableware is to be used when they return to self-service areas such as salad bars and buffets; (11) Employees are preventing cross-contamination of ready-to-eat food with bare hands by properly using suitable utensils such as deli tissue, spatulas, tongs, single-use gloves, or dispensing equipment; (12) Employees are properly trained in food safety, including food allergy awareness, as it relates to their assigned duties; (13) Food employees are informed of their responsibility to report to the supervisor or person in charge information about their health and activities as they relate to diseases that are transmissible through food. Ensure the supervisor or person in charge of food operations on the vessel monitors that: (13) Food employees are informed of their responsibility to report to the supervisor or person in charge information about their health and activities as they relate to diseases that are transmissible through food.
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Item No.:
19
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Site:
Buffet-Port and Starboard Service Lines
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Violation:
At the pastry, muffin, and fruit three-shelf counter displays, the top shelf hinged door could be extended past 90 degrees leaving the food unprotected. The door was not self-closing.
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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.
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Item No.:
19
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Site:
Buffet-Service Lines
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Violation:
Some containers out for passenger self-service, such as sliced bread and sliced lemons, had the utensil handle in contact with the food item.
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Recommendation:
During pauses in food preparation or dispensing, ensure food preparation and dispensing utensils are stored: (1) In the food with their handles above the top of the food and the container.
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Item No.:
19
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Site:
Galley-Epic Club
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Violation:
On the preparation counter, four containers of salt and pepper were not covered or protected. The area was not in operation during the inspection.
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Recommendation:
Protect food from contamination by storing the food: (1) Covered or otherwise protected; (3) Where it is not exposed to splash, dust, or other contamination.
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Item No.:
20
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Site:
Other-Deck 3 Potwash
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Violation:
There were two red cutting blocks on the clean racks that were heavily scratched and scored, making them difficult to clean.
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Recommendation:
Ensure surfaces such as cutting blocks and boards that are subject to scratching and scoring are resurfaced if they no longer can be effectively cleaned and sanitized, or discarded if they are not capable of being resurfaced.
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Item No.:
20
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Site:
Food Service General-Espresso Machines
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Violation:
There were slotted fasteners at the coffee/water splash zones on the espresso machines located in the following outlets: Cagnes, Shanghai, and O'Sheehan's.
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Recommendation:
Use only low profile, nonslotted, noncorroding, and easy-to-clean fasteners on food-contact surfaces and in splash zones.
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Item No.:
21
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Site:
Galley-Potwash Area
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Violation:
A wire whisk with an open-ended handle was in the soiled area. This open end made it difficult to clean.
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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.:
26
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Site:
Galley-Spiegel Tent
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Violation:
In the upper compartment of the juice machine, the inside of the previously cleaned dispensing ports were soiled with old juice residue. The machine was not in use during the inspection. Three crew members immediately started to clean and sanitize the compartment and dispensing ports.
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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.:
26
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Site:
Galley-Garden Cafe Ice Machine
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Violation:
In front of the ice cuber panel, the back side of the white plastic splash shield was soiled with a film of black material. There was also soil along the top and bottom left corner of the cuber panel. Staff stated all ice machines were cleaned and sanitized monthly. This ice machine was last cleaned and sanitized on 1 February 2013.
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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.:
29
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Site:
Galley-Dishwash Area
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Violation:
At the clean end of the dishwash and glasswash machines, the minimum water temperature at the handwashing sink was 126F. Staff could adjust the water temperature, but this was the coldest water temperature available. The area was in use during the operation.
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Recommendation:
Ensure handwashing sinks are equipped to provide water at a temperature of at least 38C (100F) through a mixing valve or combination faucet. 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-Taste / Special Order
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Violation:
The minimum water temperature at the handwash station was 127F. Staff could adjust the water temperature, but this was the coldest water temperature available. The area was in use during the operation.
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Recommendation:
Ensure handwashing sinks are equipped to provide water at a temperature of at least 38C (100F) through a mixing valve or combination faucet. 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.:
33
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Site:
Preparation Room-
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Violation:
At the entrance of the room, the bulkhead-mounted wire glove box holder above the handwashing sink was peeling and corroded, making it difficult to clean.
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Recommendation:
Replace the wire glove box holder with another holder made of noncorroding and easily cleanable materials.
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Item No.:
34
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Site:
Galley-Cold Pantry
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Violation:
Between upright refrigerators #7 and #10, there was a leak below the handwashing sink. The plumbers determined a pipe was loose. The leak was corrected.
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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:
Buffet-Port and Starboard Beverage Stations
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Violation:
At both beverage stations, the light intensity was less than 110 lux between the coffee machines, between the bulk milk dispenser and the bulkhead, and between the juice machine and the bulkhead.
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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.:
36
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Site:
Dining Room-Taste
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Violation:
The light intensity could not be raised to 220 lux at all areas of the waiter stations.
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Recommendation:
In bars and dining room waiter stations, provide 220 lux (20 foot candles) light intensity during cleaning operations.
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Item No.:
36
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Site:
Galley-Room Service
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Violation:
The light intensity was less than 220 lux in front of the juice machines and less than 110 lux between the juice machines.
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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. 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.:
43
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Site:
Ventilation-Fan Room 484
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Violation:
There was an accumulation of mold growth and sediment build-up inside the condensate compartment of air handling unit AW4041 and AW4011. Also, there was a white insulation material on the backside of the access panel to these compartments which had an accumulation of mold build-up. This insulation was not easily cleanable.
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Recommendation:
Keep air handling units clean. Inspect evaporative condensers at least annually and clean as necessary to remove scale and sediment. Clean cooling coils and condensate pans as necessary to remove dirt and organic material. Remove the white insulation material.
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Item No.:
44
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Site:
Medical-Acute Gastroenteritis (AGE) Surveillance Log
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Violation:
The medical staff only included in the AGE log reportable cases but no non-reportable cases. The staff explained that they only record in the log cases when they met the definition of a reportable case, otherwise they would have large numbers of cases that would skew their epidemic curves. Also, vomit only cases were not recorded in the log.
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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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Item No.:
44
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Site:
Potable Water-Garbage Room
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Violation:
One of the two supply water lines in the garbage room had blue/gray/blue stripes indicating distallate or permeate water and also blue stripes indicating potable water. This water line which was connected to the garbage pre-wash hoses, handwashing sink, and eye wash station had two blue potable water stripes in addition to several blue/gray/blue stripes. During the inspection, the crew members did not know if this water line had potable or nonpotable water. Two manual water tests were conducted by the inspector at the pre-wash hose and the handwashing sink which yielded chlorine residuals less than 0.2 ppm. A manual water test was also conducted at the crew handwashing sink at the toilet room located across from the garbage room and found the chlorine level to be above 1 ppm.
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Recommendation:
Ensure the supervisor or person in charge of potable water operations on the vessel demonstrates to VSP-during inspections and on request-knowledge of potable water operations, is able to demonstrate this knowledge by compliance with Section 5 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 5 of the VSP 2011 Operations Manual as it relates to their assigned duties.
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