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Item No.:
02
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Site:
Medical-Acute Gastroenteritis (AGE) Surveillance Log
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Violation:
The underlying illness column for a reportable case crew member, with a symptom onset on 15 March 2019 at 17:45, was left blank. Additionally, this information was not completed in the electronic medical reporting software. Staff stated training provided requested this field left blank if the crew member did not have an underlying illness. Additionally, the crew member position or job column on the AGE log was completed as '850200.0.' No description of the position or job was documented on the log.
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Recommendation:
Ensure the AGE surveillance log includes a header containing the following information about the voyage: (1) Vessel name; (2) Voyage number; (3) Date from; (4) Date to; (5) Total number of passengers; (6) Reportable total number of passengers ill; (7) Total number of crew; (8) Reportable total number of crew ill. Total number of passengers and total number of crew must be the totals at the beginning of the voyage (i.e., totals on ?date from?). Ensure the AGE surveillance log entry for each passenger or crew member contain the following information in separate columns: (1) Patient ID; (2) Date of the first medical visit or report to staff of illness; (3) time of the first medical visit or report to staff of illness; (4) person's last name; (5) person's first name; (6) person's age; (7) person's sex; (8) designation as passenger or crew member; (9) cabin number; (10) crew member position or job on the vessel, if applicable; (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) bloody stools (yes/no); (c) number of episodes of vomiting in a 24 hour period; (d) fever (yes/no); (e) abdominal cramps (yes/no); (f) headaches (yes/no); (g) myalgia (yes/no); (14) date of last symptom; (15) time of last symptom; (16) entry (yes/no) for whether a specimen was requested; (17) entry (yes/no) for whether a specimen was received; (18) entry (yes/no) for antidiarrheal medications sold or dispensed by designated medical staff; (19) entry (yes/no) for whether this was a reportable case; (20) presence of underlying medical conditions that may affect interpretation of AGE. If none, write ?none,? ?not applicable,? ?N/A,? r similar wording. Comments may also be added to the log in this column after the information about underlying illness. 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:
Galley-Deck 6 Starboard Side Warewash Forward
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Violation:
The two pre-rinse hoses both had backflow prevention devices which had visibly blocked vents. The vents had a brown material inside. Staff responded to fix the issue right away. This area was not in operation.
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Recommendation:
Maintain backflow prevention devices in good repair.
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Item No.:
08
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Site:
Potable Water-Cross-Connection Control Program Log
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Violation:
The vented backflow prevention device attached to the potable water hose bib connection, located in A.C. Room # 05-4-38, was not listed on the ship's cross-connection control program log. The cross-connection control program log did not list any backflow prevention devices attached to the potable water hose bib connections inside any of the ventilation rooms.
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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. Inspect and test backflow prevention devices requiring testing (e.g., reduced pressure backflow prevention devices and pressure vacuum breakers) with a test kit after installation and at least annually. Maintain test results showing the pressure differences on both sides of the valves.
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Item No.:
08
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Site:
Other-Deck 4 Outside of Provision Master's Office
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Violation:
The two potable water lines supplying the handwashing sink, located to the right of the outside door to the office, were not striped or painted either in accordance with ISO 14726 (blue/green/blue) or blue only. Corrections started immediately.
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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. Stripe or paint these lines at 5 meters (15 feet) intervals and on each side of partitions, decks, and bulkheads, except where decor would be marred by such markings, including potable water supply lines in technical lockers. Do not stripe or paint potable water lines after reduced pressure assemblies as potable water. Identify all refrigerant brine lines and nonpotable chilled water lines in all food areas, such as on ice machines, ice cream machines, etc., with either ISO 14726 (blue/white/blue) or by another uniquely identifiable method to prevent cross-connections.
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Item No.:
08
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Site:
Potable Water-Potable Water Tank 6C
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Violation:
When the inspector approached the area, the 50% sample cock for potable water tank # 6C was turned with the bottom perpendicular to the deck. Corrections started immediately.
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Recommendation:
Ensure potable water tanks have labeled sample cocks that are turned down. Identify the sample cocks with the appropriate tank number.
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Item No.:
10
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Site:
Recreational Water Facilities-Hydropool Depth Marker
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Violation:
The depth markers for the hydropool recreational water facility were not prominently displayed so they were visible from the deck and inside the tub. The depth of this recreational water facility was only labeled inside the tub along the forward end. These depth markers were not visible to individuals located outside of the forward end of the facility. The depth of the facility was one meter.
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Recommendation:
Prominently display the depth of each RWF that is deeper than 1 meter (3 feet) so that it can be seen from the deck and in the pool. Label depth markers in both feet and meters. Additionally, install depth markers for every 1 meter (3 feet) change in depth.
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Item No.:
10
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Site:
Recreational Water Facilities-Whirlpool Spa # 9 Safety Sign - Bather Load
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Violation:
The safety sign for whirlpool spa #9 incorrectly identified the bather loads as eight individuals. The flow meter for whirlpool spa #9 identified a flow rate of 6.75 m3/h, which corresponds to a bather load of 5.92 individuals.
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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.? Maintain documentation on the maximum bather load for each RWF. Ensure the maximum bather load is based on the following factor: one person per five gallons (19 liters) per minute of recirculation flow. Ensure the rates of the from the meters is used to calculate bather loads.
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Item No.:
10
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Site:
Recreational Water Facilities-Fecal/Vomit Accident Plan
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Violation:
The current fecal/vomit accident identifies to maintain a temperature above 77F (25C) during disinfection; however, the two most recent fecal/vomit accident records did not identify to maintain this temperature. The two vomitus instances dated 12 March 2019 and 23 February 2019 utilized Rev. 04 - 04/28/2017 of the fecal/vomit accident record. This revision did not identify the proper temperature during disinfection. Staff stated there was a discrepancy in the records.
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Recommendation:
Ensure a fecal and vomit accident response procedure that meets or exceeds the procedure provided in Annex 13.9 is available for review during inspections.
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Item No.:
16
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Site:
Galley-Deck 7 Orchid Garden Asian Restaurant
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Violation:
The sushi menu did not have an asterisk beside the sashimi. Sashimi is served raw and should carry a consumer advisory.
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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 made by one of the two following methods: (1) 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 or 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 OR (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.:
19
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Site:
Other-Deck 4 Engineer's Office
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Violation:
Five cardboard boxes containing 1 liter (33.8 fluid ounces) plastic bottles of drinking water were stored directly on the deck, adjacent to the bulkhead. The deck underneath these five cardboard boxes was not soiled. Corrections started immediately.
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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; (4) At least 150 millimeters (6 inches) above the deck; (5) At least 127 millimeters (5 inches) for food in packages and working containers on pallets, skids, and racks; and (6) At least 150 millimeters (6 inches) above the deck on shelving racks.
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Item No.:
22
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Site:
Galley-Deck 12 Garden Cafe Hot Galley
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Violation:
A bucket of sanitizing solution stored in this area was cloudy. Staff removed it to be refilled with fresh solution.
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Recommendation:
Ensure the wash, rinse, and sanitize solutions are maintained clean.
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Item No.:
27
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Site:
Galley-Deck 7 Teppanyaki
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Violation:
The wooden ledge of the deckhead between the hoods (4) at both teppanyaki grills was soiled with grease beyond a day's accumulation. The inspector could wipe away the grease with her hand. The light intensity in this area was dim and staff stated that the lighting could not be adjusted for cleaning. Staff responded to clean the area.
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Recommendation:
Ensure nonfood-contact surfaces of equipment are kept free of an accumulation of dust, dirt, food residue, and other debris.
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Item No.:
27
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Site:
Galley-Deck 12 Garden Cafe Clean Dish Storage
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Violation:
There were two, clear, plastic, previously-cleaned carafes which had a sticky residue on the outside nonfood-contact surface. The sticky substance appeared to be the adhesive from the time control sticker. Staff removed the carafes right away to be recleaned.
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Recommendation:
Ensure nonfood-contact surfaces of equipment are kept free of an accumulation of dust, dirt, food residue, and other debris.
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Item No.:
27
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Site:
Galley-Deck 12 Garden Cafe Hot Galley
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Violation:
There were three combination ovens which had a significant buildup of grease and food debris on the undersides. The buildup was well beyond a day's worth accumulation. Staff responded right away to clean the ovens.
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Recommendation:
Ensure nonfood-contact surfaces of equipment are kept free of an accumulation of dust, dirt, food residue, and other debris.
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Item No.:
27
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Site:
Galley-Deck 6 Hot Galley
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Violation:
The two combination ovens in this area had a buildup of grease in excess of a day's accumulation on the undersides of them. Staff responded to clean.
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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.:
30
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Site:
Galley-Deck 12 Garden Cafe Glasswash Machine
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Violation:
There were empty packets of sugar discarded in the handwash sink garbage receptacle at the soiled end of the flight-type dishwash machine. Staff removed the receptacle to be cleaned.
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Recommendation:
Ensure receptacles and waste-handling containers for refuse and recyclables and for use with materials containing food residue are insect and rodent resistant and have tight-fitting lids.
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Item No.:
30
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Site:
Galley-Deck 7 Orchid Garden Asian Restaurant
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Violation:
The water temperature at the handwash station located just inside of the galley from the dining area, reached 130F when the handle was turned all the way to the cold side. Staff responded to make adjustments to the valves on the pipes below the sink.
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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:
Galley-Deck 12 Garden Cafe Glasswash Machine
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Violation:
There was a continuous leak coming from a pipe beneath the glasswash machine in this area. The water was pooling on the deck and not sufficiently draining to the scupper.
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Recommendation:
Ensure decks, bulkheads, deckheads, and attached equipment in food preparation, warewashing, pantries, and storage areas are cleaned as often as necessary.
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Item No.:
33
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Site:
Other-Deck 4 Locker 04-5-64
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Violation:
The deck of the food storage locker was soiled with dust and debris greater than a day's worth of accumulation. Cardboard boxes containing cans of carbonated drinks and plastic bottles of water were stored on a pallet over this accumulation. Corrections started immediately.
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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.:
34
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Site:
Galley-Deck 12 Garden Cafe Glasswash Machine
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Violation:
There was a continuous leak coming from a pipe beneath the glasswash machine in this area. The water was pooling on the deck and not sufficiently draining to the scupper.
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Recommendation:
Ensure a plumbing system in a food area is maintained in good repair.
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Item No.:
36
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Site:
Galley-Deck 12 Garden Cafe Glasswash Machine
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Violation:
The wooden ledge of the deckhead between the hoods (4) at both teppanyaki grills was soiled with grease beyond a day's accumulation. The inspector could wipe away the grease with her hand. The light intensity in this area was dim and staff stated that the lighting could not be adjusted for cleaning. Staff responded to clean the area.
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Recommendation:
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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 ship's OPRP, provided by the corporate office, identified the contact time for the accelerated hydrogen peroxide disinfectant during code green conditions was five minutes. This same plan identified the contact time for the accelerated hydrogen peroxide disinfectant during code red conditions was a minimum of three to five minutes. The use directions on the outside of a 1:64 dilution of this disinfectant identified to 'allow to remain wet for 5 minutes - for non-food contact sanitizing, allow to remain wet for 3 minutes.' Staff stated the contact time during code red was reduced due to utilizing a higher concentration of disinfection. The OPRP did not identify using a higher concentration of disinfectant during code red conditions.
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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.
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Item No.:
43
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Site:
Ventilation-AC Unit # 4-04-01.1
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Violation:
The edges of the removable droplet eliminator were covered in a layer of white debris. The inspector rubbed an alcohol wipe over this surface, and the wipe became soiled with white residue. Staff stated this unit was last serviced on 4 March 2019.
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Recommendation:
Keep air handling units clean.
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