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Item No.:
01
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Site:
Medical-Acute Gastroenteritis (AGE) Reporting
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Violation:
The 5 March 24-hour AGE report was incorrect, and reported 3 reportable passengers and 1 reportable crew; upon review of the records, only 2 passengers were reportable. The 25 February 24-hour AGE report was not submitted within 24-36 hours arrival to U.S. port, and a 4-hour report was submitted. The 19 February 24-hour AGE report was incorrect, and reported 3 reportable passengers and 3 reportable crew; the AGE log for this voyage showed 2 reportable passengers and 2 reportable crew. The 11 February and 5 February 24-hour AGE reports were incorrect as patients were incorrectly categorized as reportable or nonreportable cases.
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Recommendation:
Ensure the master, medical staff, or other designated staff of a vessel destined for a U.S. port from a foreign port submits at least one standardized AGE report based on the number of reportable cases in the AGE log to VSP no less than 24 hours?but not more than 36 hours?before the vessel?s expected arrival at the U.S. port. Ensure the AGE reports are accurate and correct.
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Item No.:
02
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Site:
Medical-Acute Gastroenteritis (AGE) Surveillance Log
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Violation:
The paper medical logs and the AGE surveillance log had inconsistent information for the time crew members reported to medical. The information for the AGE log was populated from the electronic medical record. A similar violation was noted on the last inspection.
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Recommendation:
Ensure the AGE logs are accurate and correct.
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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 logs for the past 5 voyages were incomplete. For example, the underlying illness column was blank for 8 patients. Fever temperature information was also not recorded for a crew member and a passenger when the fever column was 'Yes.'
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Recommendation:
Ensure the AGE surveillance log entry for each passenger or crew member contain the following information in separate columns: (d) recorded temperature; (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.:
10
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Site:
Housekeeping-
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Violation:
For at least 6 of the private whirlpool tubs in the suites, the entries weren't signed off as completed for the weekly disinfection.
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Recommendation:
Clean and disinfect individual hydrotherapy pools, including associated recirculation systems, between customers. Ensure disinfection is accomplished with an appropriate halogen-based disinfectant at 10 ppm for 60 minutes, or an equivalent CT value.
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Item No.:
11
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Site:
Medical-Crew late AGE reporting
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Violation:
A food handler had an AGE onset at 1300 on 2/21 and reported to medical at 1730. This crew member ate in the crew mess at 1400 and 1600, then reported to work from 1630 to 1700 and supervisor told crew member to report to medical. No disciplinary action was documented since crew member signed off on 2/25. A crew member, who worked in casino, had an AGE onset at 1130 on 1/30 and reported to medical at 0938 on 2/17. Disciplinary action was documented. This crew member reported being lactose intolerant and he reported that he experienced an increased frequency of loose stools (3-5 daily), which was above normal for individual, before reporting to medical to total 36 diarrheas. A food handler reported to the medical center promptly after experiencing vomiting and additional symptoms on 2/2, but was not classified as reportable, and was released from isolation less than 24 hours after last symptoms.
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Recommendation:
When food employees meet the case definition for AGE, ensure the following actions are taken: (1) isolate in cabin or designated restricted area until symptom-free for a minimum of 48 hours; (2) follow-up with and receive approval by designated medical personnel before returning crew to work; (3) document date and time of last symptom and clearance to return to work. When nonfood employees meet the case definition for AGE, ensure the following actions are taken: (1) isolate in cabin or designated restricted area until symptom-free for a minimum of 24 hours; (2) follow-up with and receive approval by designated medical personnel before returning crew to work; (3) document the date and time of last symptom and clearance to return to work.
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Item No.:
17
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Site:
Galley-Deck 5 - Pastry
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Violation:
The cooling log for 4 March was not completed for three items that were cream-based. Mango cheese cake, strawberry custard, and key lime tart had start temperatures of 63.4°F, 60.7°F, and 60.3°F respectively. No further temperatures were recorded to indicate the products were cooled to 41°F (5°C) or below.
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Recommendation:
Ensure logs documenting cooling of potentially hazardous foods prepared from ingredients at ambient temperatures, with the start time to the time when 5°C (41 °F) is reached are also maintained for a period of 30 days, beginning with the day of preparation. Ensure the cooling temperatures of potentially hazardous foods prepared from ingredients at ambient temperatures are documented. Potentially hazardous foods shall be cooled from 21°C (70°F) to 5°C (41°F) or less within 4 hours.
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Item No.:
19
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Site:
Buffet-Crew Mess
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Violation:
Some plates out for crew self-service were stored on the buffet line upright and not protected from contamination.
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Recommendation:
During service, ensure the food contact portion of each self-service food dispensing utensil is covered or located beneath shielding. Ensure that dishware, glassware, and utensils out for service are inverted or covered.
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Item No.:
19
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Site:
Room Service-Deck 11
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Violation:
Some plates were stored upright at the beverage station, and not protected from contamination.
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Recommendation:
During service, ensure the food contact portion of each self-service food dispensing utensil is covered or located beneath shielding. Ensure that dishware, glassware, and utensils out for service are inverted or covered.
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Item No.:
19
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Site:
Galley-Deck 6 - Coral Dining Room Wine Cellar
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Violation:
An open, half-used, and unlabeled bottle of clear liquid was stored in the walk-in refrigerator.
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Recommendation:
Ensure containers holding food or food ingredients that are removed from their original packages for use on the vessel, such as cooking oils, flour, herbs, potato flakes, salt, spices, and sugar are identified with the common name of the food. Protect food from contamination by storing the food: (1) Covered or otherwise protected.
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Item No.:
19
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Site:
Provisions-Eggs Defrost (Room 4720)
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Violation:
A container of liquid eggs was partially open. The container was immediately discarded.
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Recommendation:
Protect food from contamination by storing the food: (1) Covered or otherwise protected.
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Item No.:
19
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Site:
Bar-Blackbeards Bar
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Violation:
The front counter ice bin was open when no crew members were actively obtaining ice.
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Recommendation:
Protect food from contamination by storing the food: (1) Covered or otherwise protected.
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Item No.:
19
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Site:
Bar-Tradewinds Bar
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Violation:
The front counter ice bin was open when no crew members were actively obtaining ice.
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Recommendation:
Protect food from contamination by storing the food: (1) Covered or otherwise protected.
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Item No.:
20
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Site:
Buffet-Horizon Court - Gazebo
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Violation:
It was unclear if the crew member responsible for cooking raw shelled eggs was equipped with a tip-sensitive thermometer and alcohol wipes. He did not have a thermometer with him, but was handed one by another crew member. He also stated that he took temperatures of the fully cooked eggs at least once a day. No eggs were being prepared during the inspection.
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Recommendation:
Ensure food temperature-measuring devices are provided and readily accessible for use in ensuring attainment and maintenance of food temperatures. Use tip-sensitive temperature-measuring devices, such as a thermocouple or thermistor, for measuring thin food products.
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Item No.:
25
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Site:
Galley-Deck 6 - Forward Hot Line
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Violation:
A wet wiping cloth was stored in an empty sanitizing solution bucket.
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Recommendation:
Restrict wiping cloths to the following: (4) Wet wiping cloths used with a freshly made sanitizing solution.
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Item No.:
28
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Site:
Other-Corridor Outside Pizzeria/Trident Grill
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Violation:
Four clean hotel pans were stored stacked upright on a trolley near the elevators. Crew members were actively moving luggage in this area.
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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.:
33
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Site:
Buffet-Horizon Court - Gazebo
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Violation:
The gazebo door had a hole on the inside where the lock was missing.
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Recommendation:
Repair the door or replace the lock. Ensure decks, bulkheads, and deckheads in food preparation, warewashing, pantries, and storage areas are maintained in good repair.
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Item No.:
37
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Site:
Galley-Deck 6 - Potwash
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Violation:
Excess steam was escaping outside the hood overhang around the potwash machine. Steam was going into the clean storage area and in the soiled area where the crew member was working. No condensation was observed on clean items.
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Recommendation:
Ensure all food rooms have sufficient ventilation to keep them free of excessive steam.
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Item No.:
37
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Site:
Galley-Dishwash
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Violation:
Excess steam was escaping outside the hood overhang around the dishwash machine. Steam was going into the clean storage area. Condensation was on the bulkheads at the clean end of the machine. Also, condensation was inside the light fixture above the clean end of the machine and dripping onto the machine. No clean items were impacted during the inspection.
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Recommendation:
Ensure all food preparation, warewashing, and toilet rooms have sufficient ventilation to keep them free of excessive heat, steam, condensation, vapors, obnoxious odors, smoke, and fumes. Ensure ventilation hood systems and devices operate effectively to prevent grease and condensate from collecting on the bulkheads and deckheads and remove contaminants generated by equipment located under them.
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Item No.:
39
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Site:
Galley-Deck 6 - Coral Dining Room Wine Cellar
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Violation:
Two flies were outside the wine cellar.
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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.:
44
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Site:
Medical-Acute Gastroenteritis (AGE) Definition
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Violation:
Medical staff were not applying the AGE case definition correctly. 1) A passenger on 2/25-3/5 voyage had an underlying illness of sepsis, which caused diarrhea, and should of been categorized as a non-reportable case. 2) A crew member on 2/25-3/5 voyage had 1 diarrhea episode, which was normal for crew member, and should have been categorized as a non-reportable case. 3) A passenger on 2/5-11 voyage had 6 vomits with no additional symptoms and should have been categorized as a non-reportable case. 4) A crew food handler on 1/28-2/5 voyage had 1 vomit with abdominal cramps, headache, and nausea and should have been categorized as a reportable case.
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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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